Who Shouldn’t Take Ozempic? Key Contraindications and Risks to Know

Ozempic (semaglutide) is an injection for Type 2 diabetes with a growing list of potential uses. Ozempic can be effective, but it’s not right for everyone. In fact, the manufacturer has a short list of contraindications — situations where you shouldn’t use Ozempic at all. 

There are also situations where using it might come with risks. For example, you may have heard that people with thyroid problems shouldn’t use Ozempic. But that’s not the whole story. Here’s who shouldn’t use Ozempic and why.

What is Ozempic?

Ozempic is a once-weekly injection used to treat Type 2 diabetes in adults. It’s also approved for its heart and kidney benefits for certain people with diabetes. Ozempic belongs to the glucagon-like peptide-1 (GLP-1) medication class and works by:

• Stimulating insulin release from the pancreas when you eat

• Reducing the amount of sugar made by the liver

• Slowing how quickly food leaves your stomach

• Reducing hunger and making you feel full

Who shouldn’t take Ozempic?

Ozempic is safe and effective for many people. But it may not be right for you, depending on your health history. Your healthcare team can help determine if the potential benefits outweigh the risks for your specific situation.

Personal or family history of certain thyroid cancers

Animal studies have shown a risk of thyroid C-cell tumors with GLP-1 medications like Ozempic. There’s no definitive proof that Ozempic causes these tumors in people. But the FDA gave Ozempic a boxed warning (its strongest medication warning) to call attention to this potential risk.

Certain conditions can increase the risk of developing thyroid C-cell tumors. As a result, Ozempic is not recommended if you have:

• A personal or family history of medullary thyroid cancer

• An inherited condition called multiple endocrine neoplasia syndrome type 2

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Other thyroid problems, such as an under- or overactive thyroid or different types of thyroid cancer, may be OK with Ozempic. Your healthcare team can assess your individual risk.

History of pancreatitis

Although rare, some people have reported pancreatitis (inflammation of the pancreas) while using GLP-1 medications like Ozempic. If you’ve had pancreatitis in the past, your healthcare team may recommend avoiding Ozempic.

The overall risk seems low, and it’s not yet clear whether Ozempic directly causes pancreatitis. But there’s limited research on how safe it is for people who’ve had pancreatitis before. So healthcare professionals may take a cautious approach and suggest other options until more research comes out.

Severe gastrointestinal conditions

Ozempic slows down how fast your stomach empties. This can help you feel full longer and help steady blood sugar levels after meals. But Ozempic and other GLP-1s have also been linked to gastroparesis, a condition where the stomach empties much slower than normal. This can lead to symptoms such as severe nausea and vomiting, bloating, and early fullness.

It’s not yet confirmed that Ozempic directly causes gastroparesis. But some people have reported it happening or worsening while using GLP-1 medications. People who already have digestive issues, especially those affecting movement in the gut, may be more likely to have serious complications.

Because of this, your healthcare team may recommend a different treatment option if you have a history of severe gastrointestinal (GI) issues, especially gastroparesis. 

EXPERT PICKS: WHAT TO READ NEXT

• Ozempic and pancreatitis: Pancreatitis (swelling of the pancreas) has been reported in people taking Ozempic. But does Ozempic actually cause pancreatitis?

• Ozempic and your thyroid: Get the facts on Ozempic and thyroid health, including who may need to avoid it.

• Can’t take GLP-1s? Explore alternatives to glucagon-like peptide-1 (GLP-1) medications for weight loss.

Serious allergic reaction to Ozempic’s ingredients

You shouldn’t use Ozempic if you’ve had a serious allergic reaction (such as anaphylaxis) to semaglutide or any of Ozempic’s other ingredients — this is considered a contraindication. You should also tell your prescriber if you’ve had a reaction to a different GLP-1. They can determine if Ozempic is a safe alternative.

Not all GLP-1 medications contain the same ingredients. For example, Ozempic pens contain multiple doses, so they have ingredients (such as preservatives) that single-dose GLP-1s don’t have. By sharing your allergy list with your care team, they can determine if you’re a good candidate for Ozempic, or if another GLP-1 is a better fit. 

Pregnancy and nursing

Ozempic usually isn’t recommended during pregnancy. That’s because there’s limited human data on how it may affect a growing fetus. But animal studies suggest potential risks. There’s also limited safety data on nursing while using Ozempic. In this case, your healthcare team may recommend against it.

Ozempic stays in the body for a long time. To ensure it’s completely gone from your system, your care team will likely tell you to stop Ozempic at least 2 months before trying to conceive. Tell your healthcare team if you get pregnant while using Ozempic. They may recommend switching to a diabetes medication that experts consider safer during pregnancy, such as insulin.

It’s a good idea to discuss your family planning goals with your healthcare team before starting Ozempic. They can give you personalized guidance on potential benefits, risks, and timing for your specific situation.

Other considerations

Ozempic was first approved in 2017. Studies have shown that it’s effective, and most people use it without serious issues. But researchers are still learning about its long-term safety, especially in people with certain health conditions.

There are a few situations where you may still be able to use Ozempic, but with extra caution and monitoring. These include:

• A history of gallstones, which may be more likely with medications like Ozempic

• Past or current eating disorders, since it can cause weight loss

• Depression or other mood disorders, which have been reported with GLP-1s

• Diabetes-related eye problems, which may get worse with GLP-1 treatment

Having one of these health conditions doesn’t automatically rule out Ozempic. But your healthcare team may suggest a different treatment or keep a closer eye on how you respond to the medication.

Can you use Ozempic if you don’t have diabetes?

Yes, Ozempic can be prescribed to people without diabetes. But prescribers do this off-label, meaning that you’d be using Ozempic in a way that hasn’t been approved by the FDA. Ozempic is approved to treat Type 2 diabetes, but many healthcare professionals prescribe it to people without diabetes to help them lose weight.

That said, Ozempic isn’t specifically approved for weight loss. A related medication, Wegovy, contains the same active ingredient (semaglutide) and is approved for weight loss. But if you’re considering using Ozempic for weight loss, keep in mind that:

• Semaglutide, Ozempic’s active ingredient, isn’t meant for cosmetic or minor weight loss. It’s intended for people considered obese or with significant weight-related health risks. Researchers also haven’t studied semaglutide in people without diabetes who aren’t considered overweight or obese.

• Stopping Ozempic often leads to regaining weight unless it’s paired with long-term lifestyle changes.

• Widespread off-label use can contribute to medication shortages, making it harder for people with Type 2 diabetes who use Ozempic to access the medication they need.

How do you know if Ozempic is safe for you?

If you have one of the health conditions covered above, a GLP-1 medication like Ozempic may not be the best option. But the only way to know for sure is by talking to your healthcare team. They know your health history and can determine if Ozempic is safe to use. Be sure to share any history of:

• Thyroid conditions or cancer

• Pancreatitis or gallbladder problems

• Digestive issues

• Allergic reactions to medications

• Pregnancy or plans to become pregnant

This information helps your healthcare team personalize your treatment and reduce the risk of serious side effects.

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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:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

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