19 Side Effects of Semaglutide (Ozempic, Wegovy) for Type 2 Diabetes and Weight Loss

Imagine you’ve just started semaglutide, sold as Ozempic, Wegovy, and Rybelsus. You’re excited to experience the benefits of treatment, whether it’s better blood glucose (sugar) management, weight loss, or just generally feeling healthier.

But after a few days, you notice a queasy feeling in your stomach, maybe some nausea or even vomiting. This leaves you wondering if this is normal and if you should be concerned. You’re not alone — many people experience side effects like these when starting semaglutide.

Some semaglutide side effects can be bothersome and make the medication difficult for some people to tolerate. But the good news is that they usually subside over time. Although rare, some serious side effects have been linked to treatment. Here’s what you should know.

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Semaglutide (Ozempic, Wegovy, Rybelsus) side effects at a glance

Semaglutide belongs to a class of medications called glucagon-like peptide-1 (GLP-1) receptor agonists. These medications work by mimicking a gut hormone that causes your pancreas to release insulin, reduces glucose production in the liver, and slows down how quickly food leaves your stomach. It also works in the areas of the brain that regulate appetite and fullness.

While these actions can be beneficial for Type 2 diabetes and weight loss, they may also cause some side effects.

Common or mild semaglutide side effects include:

• Nausea

• Vomiting

• Diarrhea

• Constipation

• Gas and bloating

• Stomach pain or discomfort

• Acid reflux and burping

• Fatigue

• Decreased appetite

• Headache

• Hair loss

Rare but serious side effects that have been reported in people using semaglutide include:

• Pancreatitis (inflammation of the pancreas)

• Gallbladder issues, including gallstones

• Acute kidney damage

• Vision changes, including vision loss

• Severe low blood glucose (hypoglycemia)

• Gastroparesis (stomach paralysis)

• Intestinal blockage

Semaglutide also has a boxed warning for thyroid C-cell tumors. This is the FDA’s strictest warning for medications. Animal studies found an increased risk of thyroid C-cell tumors with semaglutide. But this risk hasn’t been confirmed in people.

EXPERT PICKS: WHAT TO READ NEXT

• Ozempic nausea: Are you feeling nauseated after starting Ozempic? Experts weigh in on how long it lasts and how to find relief.

• Pancreatitis risk: Can medications like Ozempic or Wegovy cause pancreatitis? Here’s what we know so far about semaglutide’s pancreatitis risk.

• Foods to avoid: Learn more about foods that can worsen Ozempic side effects, plus a few foods to consider adding to your diet.

Many semaglutide side effects improve as your body gets used to the medication. But in the meantime, there are tips and tricks you can try to find some relief. Below, we cover 19 semaglutide side effects and how to manage them.

1. Nausea and vomiting

Nausea is the most common semaglutide side effect. Up to 20% of people receiving Ozempic for Type 2 diabetes reported nausea during clinical trials. And nausea was even more common with Wegovy for weight loss. Vomiting tends to be less common than nausea.

You’re more likely to experience nausea and vomiting with higher semaglutide doses. That’s why your prescriber will increase your dose slowly over a few months to minimize these effects. For most people, side effects such as nausea should improve over time.

In the meantime, here are tips for managing nausea from semaglutide:

• Eat smaller, more frequent meals.

• Eat slowly and stop eating when you start to feel full.

• Avoid or minimize high-fat foods.

• Remain upright after you eat.

• Stay hydrated since dehydration can worsen nausea.

• Opt for low-fat, bland foods that are easy on your stomach.

• Try a home remedy, such as ginger.

If these changes don’t seem to help, talk to your healthcare team about medication options. They may recommend an over-the-counter (OTC) or prescription nausea medication for relief.

But if your nausea is accompanied by severe pain in your upper and middle abdomen, get medical attention right away. This could be a sign of pancreatitis, which has been reported with semaglutide. More on that later.

2. Diarrhea

Diarrhea is another common semaglutide side effect. Around 9% of people using it for Type 2 diabetes and 30% of people using it for weight loss reported diarrhea during clinical trials.

Similar to nausea and vomiting, you’re more likely to experience diarrhea with higher semaglutide doses. As mentioned above, your prescriber will slowly increase your dose over time to minimize this side effect. It should also improve over time.

A few tips for managing diarrhea from semaglutide include:

• Avoid or minimize foods that can worsen diarrhea, such as fatty or fried foods, milk, and caffeinated drinks.

• Minimize foods and drinks that can cause gas, such as beans, dairy products, and carbonated beverages.

• Avoid alcoholic beverages, since they can irritate the digestive tract.

• Drink enough fluids to replace what you’re losing.

Talk to your healthcare team if your diarrhea is persistent or affecting your daily activities. They can determine the best next steps, which may include lowering your dose or extending the time between dose increases.

3. Constipation

Along with diarrhea, constipation can also happen with semaglutide. And some people may even experience both side effects. Similar to the other side effects discussed above, constipation tends to improve over time.

But if you’re feeling constipated, a few small adjustments to your daily routine may help provide relief. Examples of these include:

• Drink enough water.

• Engage in regular physical activity.

• Slowly incorporate more fiber-rich foods into your diet.

• Try a toilet stool to make it easier to have a bowel movement.

• Establish a regular bathroom routine.

If needed, your healthcare team may recommend an OTC laxative if these lifestyle changes aren’t enough.

4. Gas and bloating

You may also experience gas and bloating from semaglutide. Similar to other gastrointestinal (GI) side effects, dietary and lifestyle changes may help. Examples include eating smaller meals and foods that are lower in fat. Adding fiber can also help, but doing this too quickly can worsen gas and bloating. Two additional servings a day is a good place to start.

If needed, your healthcare team may recommend an OTC anti-gas remedy, such as simethicone (Gas-X) for bloating relief. You can also try an enzyme such as alpha galactosidase (Beano) to prevent bloating from certain gas-producing foods.

5. Stomach pain

Mild stomach pain is another common GI semaglutide side effect. Similar to nausea, vomiting, and diarrhea, this should subside over time. Using the tips listed above can also help minimize this side effect.

Severe stomach pain can be a sign of more serious problems, such as pancreatitis or gallbladder problems (like gallstones). Contact your healthcare team right away if this develops.

6. Fatigue

Fatigue is a common side effect of Wegovy, reported by 11% of people using it in clinical trials. Fatigue was also reported in less than 5% of people using Ozempic, and it wasn’t reported at all with Rybelsus.

There are a few reasons why you might be tired or fatigued after starting semaglutide. These can include dips in your blood glucose levels, less energy from reduced food intake, and dehydration from the GI side effects.

Feelings of fatigue should be temporary, but here are a few tips for boosting your energy in the meantime:

• Ensure you’re getting enough rest by maintaining a regular sleep schedule.

• Stay hydrated since dehydration can worsen fatigue.

• Eat a well-balanced, nutrient-dense diet.

• Incorporate more movement into your routine.

• Ensure your blood glucose levels aren’t dropping too low.

Talk to your healthcare team if your fatigue isn’t improving or if it’s severe. They may need to adjust your medications or check for an underlying cause.

7. Burping

Some people experience acid reflux symptoms while taking semaglutide, which can include burping or belching. In fact, this has been referred to as the “Ozempic burp” since it can have a distinct smell and taste.

If you’re experiencing burps or other acid reflux symptoms from semaglutide, here are a few tips that may help:

• Avoid or minimize foods and drinks that can trigger heartburn, such as greasy, spicy, and fried foods, caffeine, and alcohol.

• Stay upright after eating.

• Sleep with the head of your bed raised about 6 inches.

• Wear loose-fitting clothes to avoid putting pressure on your stomach.

For fast relief, your healthcare team may suggest an OTC antacid. Let them know if your symptoms get worse or won’t go away.

8. Changes to your face (Ozempic face)

Some people taking semaglutide may notice less fullness in their face. In fact, this phenomenon has been referred to as “Ozempic face.”

Ozempic isn’t approved for weight loss, but some people using it lose weight. And facial fat loss is one potential effect of fast and significant weight loss. This can also result in looser skin and wrinkles that are more noticeable.

Keep in mind the benefits of semaglutide on your health outweigh these effects. But if you’re concerned about possible changes to your appearance, talk to your healthcare team. They can suggest treatments for lessening the appearance of wrinkles or increasing fullness in your face.

9. Headache

Semaglutide isn’t known to directly cause headaches. But certain semaglutide side effects, such as dehydration, can result in headaches. So it’s a good idea to keep hydrated, especially if you’re experiencing diarrhea or vomiting during treatment.

If you’ve been prescribed semaglutide for Type 2 diabetes, it’s possible that your blood glucose may drop too low. This can result in headaches and other symptoms, such as shakiness and sweating. More on this later.

10. Rebound weight gain

Semaglutide treatment has been associated with weight loss. Wegovy, in particular, is approved to help people manage their body weight long term. And as long as you continue semaglutide, you’ll typically sustain the weight you’ve lost. But if you stop using it, it’s possible to gain some (or all) of the weight back. This is sometimes called rebound weight gain.

If you want to stop semaglutide and are concerned about rebound weight gain, talk to your healthcare team. They can help you come up with a plan, which may include tapering off the medication. Make sure that you have a sustainable exercise routine, since this has been shown to help lessen rebound weight gain.

11. Low blood glucose

Low blood glucose (hypoglycemia) isn’t very common with semaglutide on its own. That’s because it works by telling your body to release insulin in response to a meal specifically.

But combining semaglutide with other blood glucose-lowering medications, such as insulin and sulfonylureas, raises the risk of hypoglycemia. So your prescriber may need to change the dose of these medications when starting semaglutide.

If you have Type 2 diabetes, checking your blood glucose levels regularly can help you detect and address hypoglycemia quickly. Not everyone experiences symptoms, but a few common ones to watch for include headache, shakiness, and sweating.

12. Vivid dreams

Some people using Ozempic or Wegovy have reported vivid or abnormal dreams. Experts don’t know for sure why this may happen. And it’s not entirely clear yet if this side effect is linked to semaglutide itself.

Keep in mind that several other medications can cause vivid dreams. Tell your prescriber if they start happening after you start Wegovy, Rybelsus, or Ozempic, especially if these dreams are interfering with your sleep or quality of life. They can help determine the potential cause and next steps.

13. Hair loss

Losing weight quickly can result in hair shedding or loss. This may be one of the reasons why some people using Wegovy or Ozempic are reporting hair loss during treatment. During Wegovy’s clinical trials, 3% of people receiving the medication reported this side effect.

This type of hair loss, called telogen effluvium, is usually temporary. Hair loss you may be experiencing from Wegovy or Ozempic should subside as your body adjusts. Keep in mind this may take several months.

Since these medications can also affect your appetite, be sure you’re getting enough vitamins, minerals, and protein. If you’re not, this can also contribute to hair loss. Your healthcare team can help you ensure you’re getting adequate nutrition during treatment.

14. Pancreatitis

Although rare, pancreatitis has been reported with semaglutide. But it’s not clear yet if this is from semaglutide or another cause.

Pancreatitis can be life-threatening if it’s left untreated. Seek immediate medical attention if you develop severe abdominal pain, nausea and vomiting, and/or jaundice (yellowing of skin and eyes).

Before starting semaglutide, tell your prescriber if you have a history of acute pancreatitis. They may recommend a different medication for you.

15. Gallbladder disease

Gallbladder disease, including gallstones, has been reported with semaglutide, but it isn’t common. It was reported in less than 2% of people taking semaglutide in clinical trials.

Symptoms of gallbladder problems include upper stomach pain, fever, and jaundice. You may also notice clay-colored stools. Tell your prescriber right away if these develop.

Talk to your healthcare team about ways you can avoid gallbladder problems while taking semaglutide. This may include dietary changes and routine physical activity.

16. Kidney damage

Research has shown that semaglutide may have kidney benefits. But in rare cases, acute kidney damage has also been reported. This seems to be primarily related to severe GI side effects that lead to dehydration. Taking medications that cause you to get rid of excess water, such as diuretics (water pills), may also increase your risk.

Here are a few tips for lowering your risk of kidney damage from semaglutide:

• Drink plenty of water throughout the day, especially if you have side effects such as diarrhea.

• Tell your healthcare team if any GI side effects are persistent or severe.

• Be cautious with medications that can affect kidney function, such as nonsteroidal anti-inflammatory drugs.

• Attend all follow-up appointments, since your healthcare team may want to monitor your kidney function during treatment.

Tell your healthcare team right away if you’re not urinating very much or at all, or notice swelling in your arms or legs.

17. Allergic reactions

Severe allergic reactions to semaglutide, such as anaphylaxis, are rare, but still possible. Call 911 or get immediate medical attention if you have swelling of the face, tongue, or throat, or shortness of breath after your dose.

Mild allergic reactions can include itching, rash, or redness at the injection site. Stopping semaglutide isn’t always necessary with mild reactions. But make sure to still tell your healthcare team about your reaction.

Don’t use oral or injectable semaglutide if you’re allergic to any of their ingredients. And there’s a chance you could have an allergic reaction to semaglutide if you’ve had a reaction to a medication in the same class.

18. Thyroid tumors

Semaglutide has a boxed warning from the FDA about a risk of thyroid C-cell tumors. This is because animal studies found that rodents developed thyroid tumors when exposed to GLP-1 receptor agonists. However, human studies have yet to confirm this risk.

Still, you shouldn’t use semaglutide if you or your family have a history of medullary thyroid cancer, or if you have multiple endocrine neoplasia (MEN) type 2. Contact your healthcare team immediately if you notice signs or symptoms of thyroid cancer. These include a lump in your neck as well as neck or jaw pain.

19. Stomach paralysis (gastroparesis)

One of the ways semaglutide works is by slowing down how quickly food leaves your stomach (called gastric emptying). This appears to be a temporary effect. But some people have reported severe stomach paralysis (gastroparesis) while using the medication. It’s possible this was from semaglutide or an underlying condition.

However, one recent study found that semaglutide (and a similar medication called liraglutide) had higher rates of stomach paralysis in people using them for weight loss. This was compared to people taking Contrave (bupropion / naltrexone), a weight-loss pill.

Gastroparesis symptoms, such as nausea, vomiting, and fullness after eating, are very similar to common semaglutide side effects. If these symptoms occur, it doesn’t necessarily mean there’s a problem, since they’re generally expected with treatment. But if they’re severe, aren’t going away, or get worse, tell your prescriber right away.

There have also been cases of intestinal paralysis (ileus) with semaglutide. Because of this, the FDA has added ileus to the list of potential side effects. In some cases, ileus can result in a bowel obstruction (blockage). During the same study mentioned above, there were also higher rates of bowel obstruction with semaglutide and liraglutide compared to Contrave.

Does semaglutide cause long-term side effects?

Ozempic, Rybelsus, and Wegovy have been on the market for less than 10 years. So researchers are still studying their potential long-term side effects, such as how they might affect the thyroid and GI tract. The FDA also continues to review side effects that are reported with these medications while they’re on the market.

Currently, the longest semaglutide trial followed people receiving Wegovy for up to 5 years. During this time, people who received a placebo (an injection without medication) reported serious side effects at a higher rate than those who received semaglutide.

When should you contact your prescriber about side effects from semaglutide?

Many semaglutide side effects may improve on their own with continued treatment. But if mild GI side effects don’t subside over the course of a few weeks, contact your prescriber. And if they’re severe at any point, get medical attention right away. This may be a sign of something more serious.

Hypoglycemia isn’t common with semaglutide. But it’s good to know the indicators of low blood glucose and how to treat it. Contact your prescriber if you’re finding that your blood glucose levels are dropping too low with semaglutide. They may need to adjust your medication regimen.

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Written by:

Zuri C. Hawkins-Jarrett, PharmD, MPH, BCPS

Zuri Hawkins-Jarrett graduated with her doctorate in pharmacy from The University of Georgia College of Pharmacy. She completed her residency training with Piedmont Columbus Regional in ambulatory care.

Written 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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