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Ozempic: 7 things you should know

Written by Carmen Fookes, BPharm on June 19, 2020.

1. How it works

  • Ozempic is a brand (trade) name for semaglutide.
  • Semaglutide mimics the actions of GLP-1, a naturally occurring hormone that helps to regulate blood glucose levels. By binding to and activating the GLP-1 receptor, it stimulates insulin secretion and lowers glucagon secretion when blood glucose levels are high. It also causes a slowing down in how fast the stomach empties.
  • Ozempic belongs to the class of medicines called GLP-1 receptor agonists.

2. Upsides

  • Ozempic may be used in the treatment of type 2 diabetes alongside diet modification and increased exercise.
  • Ozempic may also be given to reduce the risk of future cardiovascular events, such as a heart attack or stroke, in people with type 2 diabetes who also have heart disease.
  • Ozempic is effective at reducing blood glucose levels and it also reduces body weight.
  • Ozempic is given once a week, on the same day each week (for example, every Monday).
  • The dosage of Ozempic does not need to be adjusted in people with kidney or liver disease.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Common side effects of Ozempic include hypoglycemia (low blood sugar levels), nausea, vomiting, diarrhea, abdominal pain, and constipation.
  • Ozempic needs to be given by injection under the skin (subcutaneous). However, self-administration is easy to learn for most people.
  • Ozempic does not take the place of insulin and is not effective in people with type 1 diabetes or for the treatment of diabetic ketoacidosis.
  • Animal studies have reported thyroid C-cell tumors in rats given semaglutide. It is not known if semaglutide increases the risk in humans of these tumors.
  • Ozempic should not be used in people with a history of thyroid cancer or those with Multiple Endocrine Neoplasia syndrome type 2.
  • Ozempic may increase the risk of pancreatitis. If this occurs, Ozempic should be discontinued and not restarted. There have also been reports of kidney damage, which may require hemodialysis, in people treated with GLP-1 receptor agonists (RA), such as Ozempic. Anaphylaxis and angioedema have also been reported with GLP-1 RAs and the initial administration of Ozempic should preferably be done in a medical facility.
  • Ozempic has not been adequately studied in pregnant women and should not be used unless the perceived benefits outweigh the risks of uncontrolled diabetes, which include preeclampsia, spontaneous abortions, and preterm delivery.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

  • Ozempic lowers blood sugar levels by mimicking the effects of GLP-1, a naturally occurring hormone that stimulates insulin secretion and lowers glucagon secretion from the liver. It is self-administered by subcutaneous injection once a week and may be used for the treatment of type 2 diabetes. Common side effects include low blood sugar levels, nausea, vomiting, and diarrhea.

5. Tips

  • Ask your doctor or nurse to show you how to self-administer Ozempic before you first do it yourself. Ozempic should be injected just under the skin into the abdomen, thigh, or upper arm. Change injection sites each week so that you are not injecting into the same bit of skin every week. Always inspect the injection and do not use Ozempic if it contains particles or discoloration is seen.
  • If you also need to self-administer insulin, administer the insulin at a different site to the Ozempic, at least 15cm apart. Never mix insulin with Ozempic and never share your injection with another person. Taking Ozempic with insulin (as well as other medications such as sulfonylureas that also lower blood sugar levels) increases your risk of hypoglycemia (low blood sugar levels) so monitor yourself for symptoms of low blood sugar which include sweating, shaking, dizziness, a fast heartbeat, and mood changes.
  • If you need to change the day you administer Ozempic, you can, as long as you allow at least 48 hours between two doses (for example, you can change from a Monday administration to a Wednesday administration).
  • If you miss a dose of Ozempic, administer it as soon as possible, but within 5 days of the missed dose. If more than five days have passed, skip the missed dose and just administer the next dose on the regularly scheduled day.
  • Report any symptoms of a possible thyroid tumor (such as a lump in the neck, shortness of breath, difficulty swallowing, or persistent hoarseness) to your doctor immediately.
  • If you develop persistent, severe, abdominal pain, which may radiate to the back or be accompanied by vomiting, ring your doctor immediately as Ozempic can increase your risk of developing pancreatitis.
  • Ozempic may temporarily worsen diabetic retinopathy, an eye condition. Tell your doctor if you notice any change in your vision. If you are a woman, use adequate contraception to ensure you do not become pregnant while taking Ozempic. For a planned pregnancy, it is recommended Ozempic is discontinued at least two months before conception. Tell your doctor if you inadvertently become pregnant while taking Ozempic.

6. Response and effectiveness

  • Treatment with Ozempic 1mg subcutaneously reduced blood glucose levels by 22% when fasting, 36% two hours after eating a meal, and by 22% over 24 hours.
  • Insulin secretion typically occurs in two phases following a meal, and Ozempic increased both first and second phase insulin secretion.
  • Ozempic also reduced glucagon release by the liver by 8% (fasting), 14-15% after a meal, and by 12% over 24 hours.
  • After Ozempic administration the insulin secretion rate in people with type 2 diabetes was similar to that of healthy people.

7. Interactions

Medicines that interact with Ozempic may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with Ozempic. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Ozempic include:

  • acetazolamide
  • anticonvulsants such as phenytoin
  • antidepressants such as tricyclic antidepressants (such as amitriptyline, nortriptyline) or monoamine oxidase inhibitors (MAOI) (eg, selegiline, isocarboxazid, and phenelzine)
  • antipsychotics, such as aripiprazole
  • beta-blockers, such as atenolol, labetalol, and metoprolol, may enhance the hypoglycemic effects
  • bexarotene
  • ciprofloxacin
  • corticosteroids, such as prednisone or cortisone
  • diuretics, such as bumetanide, HCTZ, and bendroflumethiazide
  • HIV medications, such as amprenavir, atazanavir, and fosamprenavir
  • hormones, such as ethinylestradiol and hydroxyprogesterone
  • insulin (may increase risk of hypoglycemia)
  • isoniazid
  • other medications that affect blood sugar levels or are used for diabetes, such as glimepiride, or metformin.

Ozempic may also enhance the toxic effects of alcohol, causing flushing.

Note that this list is not all-inclusive and includes only common medications that may interact with Ozempic. You should refer to the prescribing information for Ozempic for a complete list of interactions. Also, because Ozempic causes a delay in gastric emptying, it may impact the absorption of any medication taken orally. However, in clinical trials, this did not appear to change the effects of other medications.

References

Ozempic. Novo Nordisk. Updated 01/2020 https://www.drugs.com/pro/ozempic.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Ozempic only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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