Ozempic with other medicines and health conditions

What Ozempic is for, and who it is not for

Ozempic is a GLP-1 receptor agonist, not a steroid and not insulin ^[1]. It is approved for adults with type 2 diabetes to improve blood sugar, to lower the risk of major cardiovascular events in those with heart disease, and to lower the risk of kidney decline, kidney failure and cardiovascular death in those with chronic kidney disease ^[1]. Type 1 diabetes is not a labeled use. Its safety in children has not been established ^[1].

People without diabetes sometimes get Ozempic off-label for weight loss or for conditions such as PCOS. Neither is a labeled use ^[1]. Wegovy, the semaglutide brand approved for weight management, also carries labeled uses for heart risk in people with obesity and, for the injection, a form of fatty liver disease with fibrosis (MASH) ^[2]. See the Ozempic vs Wegovy comparison.

Diabetes medicines: metformin, insulin and sulfonylureas

The Ozempic label does not list metformin as an interaction. The interaction it does flag is with insulin and sulfonylureas, which raise the chance of low blood sugar; the prescriber may lower their doses ^[1]. In trials, documented symptomatic lows occurred in 29.8% of people on Ozempic 1 mg with basal insulin vs 15.2% on placebo with insulin, and in 24.4% on 1 mg with a sulfonylurea ^[1]. If you use insulin, give Ozempic as a separate injection and never mix them ^[1].

Pills, birth control and thyroid medicine

Ozempic delays stomach emptying, so it may change how oral medicines are absorbed. In the label's studies, semaglutide did not change absorption of the tested oral drugs to a clinically relevant degree, but the label still advises caution ^[1]. Ask your pharmacist about medicines where small changes matter. For levothyroxine, the Wegovy label reports that oral semaglutide tablets raised levothyroxine exposure by 33% ^[2]; that finding is for the tablet, not Ozempic injection, but it is a reason to have thyroid levels checked when starting.

The Ozempic label's drug studies included an oral contraceptive (ethinyl estradiol with levonorgestrel), and no clinically relevant interaction was seen ^[1]. Ozempic's label does not carry the backup birth control instruction found on the Mounjaro label, which advises a non-oral or barrier method for 4 weeks after starting and after each dose increase ^[3]. Ask your prescriber if you have questions about your birth control.

Phentermine, ibuprofen and antibiotics are not named in the Ozempic label, and the label does not study Ozempic together with phentermine. Ask your prescriber before combining weight or diabetes medicines. Ozempic has caused kidney injury when vomiting or diarrhea led to dehydration ^[1], so ask a pharmacist about pain relievers if you have kidney disease or are sick. Fluids, food and vitamin timing are on what to eat on Ozempic.

Thyroid, heart, kidney and liver conditions

• Thyroid. Do not use Ozempic with a personal or family history of medullary thyroid carcinoma or MEN 2 ^[1]. Tell your prescriber about any thyroid nodule or other thyroid condition.
• Heart. In SUSTAIN 6, major cardiovascular events occurred in 6.6% on Ozempic vs 8.9% on placebo (hazard ratio 0.74) ^[1]. Average heart rate rose by 2 to 3 beats per minute ^[1]. The sections we reviewed do not report blood pressure results; ask your clinician.
• Kidneys. Ozempic is approved to lower kidney risks in type 2 diabetes with chronic kidney disease (FLOW hazard ratio 0.76) ^[1], but dehydration from vomiting or diarrhea has caused acute kidney injury ^[1].
• Liver. Ozempic is not labeled for fatty liver disease. Wegovy injection has an accelerated approval for MASH with moderate to advanced fibrosis ^[2].
• Eyes. People with diabetic retinopathy had more eye complications in SUSTAIN 6 (8.2% vs 5.2%) ^[1].
• Stomach. Not recommended in severe gastroparesis ^[1].
• Pancreas and gallbladder. Pancreatitis and gallstones have been reported ^[1].

Pregnancy, fertility and breastfeeding

The label says to use Ozempic during pregnancy only if the potential benefit justifies the potential risk to the fetus, based on animal findings ^[1]. Because of its long washout, stop at least 2 months before a planned pregnancy ^[1]. There are no human data on whether semaglutide enters breast milk; in rats it did, at levels 3 to 12 times lower than in blood ^[1]. The label does not describe effects on fertility in people. If you are trying to conceive or breastfeeding, plan your diabetes treatment with your prescriber.

Surgery and procedures

Pulmonary aspiration, where food or liquid enters the lungs, has been reported during general anesthesia or deep sedation in people on GLP-1 medicines ^[1]. Before a procedure, including a colonoscopy, make sure the surgeon and anesthesia team know you use Ozempic. There is no label rule for how many days to hold it or when to restart, so your procedure team and prescriber set those. See stopping Ozempic for restarting and how to use Ozempic for dose-day rules.

More: Ozempic side effects, switching GLP-1s, and Ozempic cost.