4 Ozempic Interactions You Should Know About

Ozempic (semaglutide) is a popular once-weekly injectable used to treat Type 2 diabetes. It works by stimulating insulin release after meals and reducing glucose (sugar) production by the liver. It also slows down how fast your stomach empties. These effects can help manage your blood glucose. But if you’re taking multiple medications, they can also cause drug interactions.

Most commonly, Ozempic interactions can result in low blood glucose (hypoglycemia). This risk is highest when it’s taken with insulin and insulin-releasing medications. In other cases, Ozempic may affect how your body absorbs medications that you take by mouth.

Several of these interactions can be managed up front. So, as you’re getting started on Ozempic — or adding another medication to it — your prescriber may make some adjustments ahead of time. Make sure they have your current medication list for review. Below, we’ll review four notable Ozempic interactions you should know about.

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1. Insulin

If you’re taking insulin as part of your treatment plan, your prescriber may also add Ozempic to the mix. However, this combination can increase your risk of hypoglycemia.

When taken on its own, Ozempic doesn’t usually cause hypoglycemia. That’s because it stimulates your pancreas to release insulin in response to food. But the insulin you inject works to lower your blood glucose even if you haven’t eaten. When taken together, your blood glucose levels could drop too low. If this happens, you may feel shaky, anxious, or sweaty.

Your prescriber may manage this interaction ahead of time when you’re starting either medication. This includes lowering your Ozempic or insulin dosage to prevent hypoglycemia.

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It’s also a good idea to check your blood glucose regularly during treatment. Let your prescriber know if your readings are too high or too low. Your medications can be adjusted to help keep your blood sugar in your target range.

2. Sulfonylureas

Sulfonylureas are oral pills that are used to treat Type 2 diabetes. Examples include medications like glipizide (Glucotrol), glimepiride (Amaryl), and glyburide (Diabeta, Glynase).

Sulfonylureas also work by telling your pancreas to produce insulin. But unlike Ozempic, this happens whether you’ve eaten or not. They also help your body use insulin more effectively.

Because of how they work, the most common sulfonylurea side effect is hypoglycemia.

Combining Ozempic with a sulfonylurea can increase the risk of hypoglycemia. So, your prescriber will likely take the same precautions as with insulin.

Tell your prescriber if you’re experiencing hypoglycemia episodes with this combination. They may further adjust your sulfonylurea dose.

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3. Glinides

Glinides are a class of oral medications used to treat Type 2 diabetes. Examples include repaglinide and nateglinide (Starlix). Similar to sulfonylureas, glinides work by telling your pancreas to release insulin. But they work faster and for a shorter period of time, so they’re taken before each meal.

The interaction between Ozempic and glinides is similar to insulin and sulfonylureas. This combination can increase your risk of hypoglycemia. And your prescriber may manage this interaction in a similar way.

4. Oral medications

One of the ways Ozempic works to lower blood glucose is by slowing the passage of food out of the stomach. This causes a slow rise in blood glucose over time, rather than sharp spikes in blood glucose after a meal. It can also cause you to feel full sooner when eating. So, you tend to eat less when taking Ozempic.

However, slowed stomach emptying may also affect how you absorb certain oral medications, such as birth control pills, digoxin, and warfarin. Studies with Ozempic haven’t shown this to be a problem, but it’s still best to be cautious. For example, some women taking oral birth control pills have reported getting pregnant while using Ozempic. And a similar medication, Mounjaro (tirzepatide), lists birth control pills as a potential interaction.

Your prescriber can determine how this interaction may potentially affect you.

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Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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