Ozempic interactions to avoid

Ozempic interacts with sulfonylureas, insulins, and certain medical conditions

By Chad Shaffer, MD | Jan. 18, 2024

Key takeaways

Ozempic, like all GLP1 agonists, carries a black box warning on its label about the possible association between their use and thyroid C-cell tumors, a rare thyroid cancer.
Concerns and questions exist about a link between Ozempic (and its fellow drug class members) and pancreatitis, a dangerous inflammatory condition of the pancreas, as well as diabetic retinopathy complications of the eye.
Part of the GLP1 agonists’ mechanism of action is slowing the stomach propulsion of its contents, and in turn, this allows some pills to have more time to get absorbed, leading to higher drug levels of meds like thyroid hormone.
Other Ozempic mechanisms include the promotion of insulin secretion and reduction in glucagon section, two actions that bring blood glucose down, possibly even too low, in the setting of other drugs that reduce blood sugar.
Should a contraindication or reason to avoid Ozempic appear in one’s medical history, talk to the prescribing healthcare provider immediately. If any adverse effects from an interaction are noticed, such as lightheadedness or vision changes, get medical attention immediately.

Drug interactions | Food interactions | Other interactions | Avoiding interactions | When to see a doctor

Ozempic (semaglutide) has been the talk of the nation, more so for its use for weight loss rather than its actual Food and Drug Administration (FDA) indication, type 2 diabetes mellitus. Despite being the most popular of the glucagon-like peptide-1 (GLP1) agonists, Ozempic’s high demand often leads people to overlook its serious side effects and potential drug interactions. Ozempic interacts with members of common drug categories, like antidepressants and thyroid hormone replacement. Those who use Ozempic can also encounter problems if there is a history of thyroid cancer, pancreatitis, kidney problems, or diabetic retinopathy. If newly prescribed or currently taking Ozempic, reaching out to the prescribing healthcare provider about concerns regarding these interactions is recommended. Preparation for that conversation will be provided in this article.

Ozempic drug interactions

Drug interactions with Ozempic largely fall into one of two categories. Medications whose absorption increases when taken concurrently with Ozempic are one variety, and drugs that cause reductions in blood glucose are another.

Sulfonylureas

An old but still useful drug class of oral medications for Type 2 diabetes mellitus, sulfonylureas signal the pancreas to make more insulin. As a result, blood sugar levels come down. Unfortunately, this can go too far, leading to abnormally low blood sugar, known as hypoglycemia. While Ozempic alone does not cause hypoglycemia, it can potentiate the risk of hypoglycemia with sulfonylureas. Riomet (metformin) is another of the diabetes medications that does not cause hypoglycemia by itself but can exacerbate the issue with sulfonylureas. Examples of the sulfonylurea drug class include:

Glipizide XL (glipizide extended-release)
Amaryl (glimepiride)
Micronase (glyburide)

Symptoms of hypoglycemia include weakness, dizziness, sweating, confusion, and shakiness. If any of these symptoms occur, enact the hypoglycemia management instructions from a doctor. Typically, this includes eating and drinking sugar-containing products and getting emergency medical attention if needed. Call a healthcare provider once the immediate symptoms have resolved for further medication instructions. Dose adjustments or closer monitoring of blood glucose may be necessary. Watch out for other medications that can contribute to lower blood sugar levels, such as quinolone antibiotics and selective serotonin reuptake inhibitor (SSRI) antidepressants.

Insulins

Based on learning about the sulfonylurea interaction with Ozempic, one could probably guess that insulins would be a problem, too. Injected insulin tells body tissues to take glucose out of the bloodstream and use it. The result is lower blood glucose. Hypoglycemia may occur if too much insulin is taken, insufficient food is eaten, or more glucose is burned off with activity.

Fast-acting insulins, such as Humalog Kwikpen (insulin lispro) and Novolog FlexPen (insulin aspart), generally create more risk of hypoglycemia than long-acting insulins, like Lantus Solostar (glargine insulin) and Levemir FlexPen (insulin detemir). Once again, it is ideal to speak to a healthcare team before taking insulin with Ozempic to ensure how to monitor for low blood sugar and respond if it happens. The GLP-1 agonist class is only to be used for the treatment of Type 2 and not Type 1 diabetes.

Levothyroxine

The absorption of medications by our gastrointestinal tract depends on a few variables: transit time through the gut. If a pill has more time to be absorbed, a larger amount can end up in our system. Synthroid (levothyroxine), used for thyroid hormone replacement, is an example that typifies this. Taking Ozempic with levothyroxine led to more thyroid hormone exposure in a 2021 research study.

Although it is the most recommended treatment for hypothyroidism or underactive thyroid, levothyroxine is notoriously finicky when it comes to absorption. Recommendations include taking it on an empty stomach and not at the same time of day as other meds. Monitoring thyroid levels is advisable when changing how levothyroxine is taken; likewise, additional monitoring may be worthwhile if Ozempic is started alongside thyroid hormone. The relevance of this interaction may amount to little, based on the fact that, to date, other medication absorption changes have not proven significant.

Ozempic food interactions

Ozempic is a once-weekly subcutaneous (under the skin) injection and can be done without regard to when or which foods are eaten that day. Likewise, Wegovy, the brand name, is an injectable semaglutide that the FDA approves for weight loss and can be dosed with or without food. Alternatively, the same active ingredient, semaglutide, is produced as oral Rybelsus, which is approved for Type 2 diabetes mellitus. Novo Nordisk, the manufacturer of Rybelus, advises that the pill be taken 30 minutes before the first meal.

Other Ozempic interactions

Ozempic may negatively interact with certain underlying medical conditions. While researchers have yet to elucidate these interactions’ significance fully, the potential risk is crucial to understand.

Ozempic and thyroid cancer

Studies of semaglutide in rodents discovered higher rates of thyroid C-cell tumors. This type of tumor, known as medullary thyroid carcinoma (MTC), is rare in humans but can be seen in individuals with Multiple Endocrine Neoplasia syndrome type 2 (MEN2). Although no one knows if semaglutide is associated with MTC in humans, the FDA has taken the precaution of placing their highest warning, a black box warning on Ozempic, warning anyone with a personal or family history of MEN2 against taking the drug.

Ozempic and pancreatitis

Pancreatitis is an inflammatory condition of the pancreas which, when severe, can be life-threatening. GLP1 agonists have been associated with cases of pancreatitis. Despite a drug trial not finding a higher risk with semaglutide, anyone with a history of pancreatitis or with risk factors for pancreatitis, like high triglycerides or alcohol intake, may want to avoid the med. Be aware that that same drug trial found a lower risk of heart disease complications, such as heart attack, in patients taking semaglutide.

If abdominal pain is experienced while taking Ozempic, get medical attention quickly. Pancreatitis is one potential cause, but GLP1 agonists have also been associated with gallbladder problems, including gallstones. The drug’s tendency to slow intestinal motility can result in common side effects, like bloating and constipation, which can produce abdominal pain.

Ozempic and diabetic retinopathy

One of the feared complications of diabetes mellitus, diabetic retinopathy, causes vision loss due to sugar-related damage to blood vessels in the retina of the eye. Complications of diabetic retinopathy occurred at a higher rate among patients newly treated with semaglutide in a study analyzed in 2018. This may be attributed to rapid improvement in glucose control, but more research is needed. At this point, if pre-existing diabetic retinopathy exists, talk to a healthcare professional about it before starting Ozempic.

How to minimize Ozempic interactions

Getting ahead of the problem of drug interactions is the best bet in avoiding Ozempic interactions. Keep a list of prescription drugs, over-the-counter pills, and supplements, along with an account of all prior and current health problems. Share this information with a healthcare team, all the prescribing providers, and pharmacists. This will help them keep a watch out for interactions.

Be vigilant about watching for signs of an interaction with Ozempic. For example, one may benefit from checking sugar levels more regularly or asking for thyroid blood tests to be done if taking levothyroxine.

When to talk to a healthcare provider about Ozempic interactions

There is no need to hesitate to get medical advice from a healthcare provider with any concerns about taking Ozempic. When prescribed Ozempic for the first time or while taking it, simply request that the prescribing practitioner check for interactions with other medications and underlying conditions. If symptoms of an interaction develop, such as abdominal pain, hypoglycemia, or blurred vision, the matter takes on a sense of urgency.