Ozempic side effects, and what the label actually says

The most common Ozempic side effects

From Ozempic's US prescribing information: two placebo-controlled trials in adults with type 2 diabetes, one with Ozempic alone and one alongside basal insulin, with 521 people on Ozempic for an average of 32.9 weeks.¹

Source: Ozempic prescribing information, Table 1 and section 6.1.¹ In a separate 40-week trial of the 2 mg and 1 mg doses, stomach and bowel side effects were reported by 34% and 30.8%, and no new safety signals were identified.¹ Rates from different trials can't be directly compared.

Semaglutide side effects at weight-management doses

Ozempic is approved in the US for type 2 diabetes. The same medicine, semaglutide, is sold as Wegovy for weight management, and in Wegovy's 2.4 mg trials side effects were reported more often.^1,3 Placebo rates are in brackets.

The two columns come from different trials in different people, so they show why semaglutide's figures vary rather than ranking the two products.^1,3 More in Wegovy side effects and Ozempic vs Wegovy.

When Ozempic side effects start, and when they ease

The label describes a pattern rather than a timetable, and everyone is different.

1. Starting out
   The dose starts low

   Ozempic's label begins with a low dose and steps it up gradually, and says why: to reduce the risk of stomach side effects. Your prescriber sets the steps.¹

2. While the dose is stepped up
   Most reports come now

   "The majority of reports of nausea, vomiting, and/or diarrhea occurred during dose escalation," the label says.¹

3. The weeks and months after
   They usually settle

   In STEP 1, a 68-week trial of semaglutide 2.4 mg, nausea and diarrhea were "typically transient and mild-to-moderate in severity and subsided with time."⁴

4. If they don't settle
   Talk to your prescriber

   In the label's trials, 3.1% on 0.5 mg and 3.8% on 1 mg stopped Ozempic because of stomach side effects, against 0.4% on placebo.¹ If side effects are hard to live with, tell your prescriber; decisions about your dose are theirs to make with you.

Common side effects, and what can help

General, non-drug measures. They don't replace your care team's advice, and none of them involves changing your medicine.

• Nausea. A queasy, sick feeling. Smaller meals eaten slowly, and going easy on fried or greasy food, may help.¹² Our guide to what to eat on Ozempic has Novo Nordisk's own nausea tips. Call your care team if nausea stops you eating or drinking.
• Vomiting. Take regular sips of fluid.¹² Vomiting can dehydrate you, and the label warns that dehydration can lead to kidney injury.¹ Call your care team if you can't keep fluids down or it keeps happening.
• Diarrhea. Keep drinking through the day to replace lost fluids.¹ Call your care team if it's severe or doesn't settle.
• Constipation. Ask your care team whether more fluids and fiber-containing foods, such as fruit, vegetables and whole grains, would suit you. Call them if it's severe or comes with stomach pain, because severe constipation and bowel blockage have been reported since approval.¹
• Stomach pain, indigestion and burping. Ask your care team whether smaller, plainer meals might help with mild discomfort. Stomach pain that is severe or won't go away needs urgent attention; see the warning signs below.

Check with your prescriber or pharmacist before taking any other medicine for side effects.

Less talked-about Ozempic side effects

Less common, and easy to miss in the label.

• Hair loss. Ozempic's label lists alopecia only among reports made after approval, without a trial percentage.¹ At Wegovy's 2.4 mg dose, hair loss was reported by 3.3% against 1% on placebo, more often by women (4%) than men (0.9%), and that label says it was associated with weight reduction.³ No label describes it as sudden or permanent.
• Burping and "sulfur burps". Belching (eructation) was reported by 2.7% on 0.5 mg and 1.1% on 1 mg, against none on placebo.¹ "Sulfur burps" isn't a label term, and the label says nothing about smell.
• Tiredness, dizziness and taste changes. The label lists fatigue, dizziness and a change in taste (dysgeusia) among other reactions reported by more than 0.4% of people, and headache among reports made after approval.¹
• Injection-site reactions. Discomfort or redness where you inject was reported by 0.2% in the trials.¹ The label asks you to use a different injection site each week when injecting in the same body region; see Ozempic injection sites.
• A slightly faster heart rate. Heart rate rose by an average of 2 to 3 beats per minute on Ozempic, against a fall of 0.3 on placebo.¹
• Changes in skin sensation. Dysesthesia, meaning altered skin sensation such as burning or skin pain, appears among Ozempic's reports made after approval.¹

"Ozempic face": what it is, and what it isn't

"Ozempic face" isn't a label term or a diagnosis. It's an informal name for the loss of fullness in the face that can follow rapid weight loss. Cleveland Clinic describes it as a side effect of "the rapid weight loss the medication can bring" rather than of the medicine itself, and notes that it isn't limited to Ozempic.¹⁰

The American Academy of Dermatology goes further, saying GLP-1 medicines affect collagen and muscles as well as fat, which can make the face look older.¹¹ That is one professional body's view rather than a settled finding. If changes in your face bother you, it's worth raising with your prescriber.

Ozempic tablets: side effects of the pill

Since January 2026, Ozempic is also the US name for a once-daily semaglutide tablet for type 2 diabetes, made in 1.5, 4 and 9 mg strengths.² The label's side-effect figures come from the Rybelsus tablet trials: nausea was reported by 11–20% on the 7 and 14 mg doses, against 6% on placebo, followed by stomach pain, diarrhea, a smaller appetite, vomiting and constipation.²

The tablet is taken on an empty stomach in the morning with up to 4 ounces of water.² It isn't in Handle's medicine list by name yet: add it under "Something else" with its name, amount and daily schedule, and doses, check-ins, weight and the report work the same. Our Ozempic tracker guide explains how to record the tablets.

Serious Ozempic side effects

These are uncommon. The label lists them as warnings, and the figures come from its trials.

• Pancreatitis. The label warns of acute pancreatitis, including fatal cases: persistent or severe stomach pain, sometimes spreading to the back, with or without vomiting. In the diabetes trials it was confirmed in 0.3 cases per 100 patient-years on Ozempic and 0.2 on comparison treatments.¹
• Gallbladder problems. Gallstones were reported by 1.5% on 0.5 mg and 0.4% on 1 mg, against none on placebo, and gallbladder inflammation and removal have been reported since approval.¹
• Kidney injury from dehydration. Mostly in people whose nausea, vomiting or diarrhea led to dehydration; some needed dialysis.¹
• Low blood sugar with other diabetes medicines. With a sulfonylurea, 17.3% on 0.5 mg and 24.4% on 1 mg had symptomatic low blood sugar confirmed by a glucose reading, and 0.8% and 1.2% had a severe episode. On Ozempic alone it was less common: 1.6% and 3.8%, with no severe episodes.¹ Your prescriber may adjust your other diabetes medicines.
• Diabetic eye disease. In SUSTAIN 6, a two-year trial, diabetic retinopathy complications affected 3.0% on semaglutide against 1.8% on placebo, and 8.2% against 5.2% in people who already had retinopathy.¹ The trial counted bleeding inside the eye, blindness, and conditions needing eye injections or laser treatment as complications.⁵
• Serious allergic reactions. Anaphylaxis and angioedema have been reported. A previous serious allergic reaction to semaglutide or any of Ozempic's ingredients means it isn't for you.¹
• Severe stomach and bowel problems. Severe stomach side effects were reported by 0.4–0.8%, against none on placebo, and bowel blockage (ileus or obstruction) and severe constipation have been reported since approval. Ozempic isn't recommended with severe gastroparesis.¹
• Aspiration during anesthesia. There have been rare reports of stomach contents entering the lungs during general anesthesia or deep sedation. The label asks you to tell your healthcare providers you take Ozempic before any planned surgery or procedure.¹ Guidance on what happens next differs between countries; in the UK, the regulator advises patients not to stop treatment without first discussing it with their doctor.⁸
• NAION. EU and UK regulators list this optic nerve condition, which can cause sudden loss of vision, as a very rare side effect of semaglutide, affecting up to 1 in 10,000 people. It isn't in the US label.^6,7
• Thyroid C-cell tumors (boxed warning). Semaglutide caused these tumors in rodents; it's unknown whether it does in humans. Tell your care team about a lump in your neck, trouble swallowing, shortness of breath or hoarseness that won't go away.¹

Who should not take Ozempic

The label is clear about who Ozempic isn't for, and about a few situations to plan for.

• Anyone with a personal or family history of medullary thyroid carcinoma (MTC), or with multiple endocrine neoplasia syndrome type 2 (MEN 2). This is the boxed warning.¹
• Anyone who has had a serious allergic reaction to semaglutide or any of Ozempic's ingredients.¹
• People with severe gastroparesis, for whom the label says it isn't recommended.¹
• Children: its safety and effectiveness haven't been established in pediatric patients.¹
• If you're planning a pregnancy, talk to your prescriber early: the label advises stopping Ozempic at least 2 months before a planned pregnancy, because semaglutide takes a long time to leave the body.¹ More in our Ozempic half-life guide.
• Never share an Ozempic pen with anyone else.¹

Tracking Ozempic side effects for your prescriber

A month from now, "I felt sick for a while after the last step up" is hard to pin down. A short daily record turns it into something your prescriber can see: which weeks, how often and how bad.

Handle keeps your Ozempic doses and injection sites, your daily check-in, weight and food on one timeline, and works the same for any semaglutide medicine; see our semaglutide tracker. It shows them side by side and doesn't claim that one explains another; making sense of it is for you and your prescriber. Our GLP-1 side effect tracker guide has more on keeping a symptom log, and our overview of GLP-1 side effects covers the whole class.

Questions to ask your prescriber about Ozempic

Good ones for the start of treatment and after any change. Weighing Ozempic against tirzepatide? Mounjaro vs Ozempic sets out the facts side by side.

1. Which side effects should I call you about, and which can I manage at home?
2. What should I do if I can't keep fluids down?
3. Do my other diabetes medicines, such as insulin or a sulfonylurea, need a closer look?
4. Given my history, how often should my eyes be checked?
5. I have a procedure coming up. Who should I tell, and what applies to me?