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Ozempic (semaglutide injection) is a once-weekly injectable medication that is used to lower blood sugar levels in adults with type 2 diabetes. However, taking Ozempic with certain other medications can result in drug interactions and increase the risk of serious adverse effects. Knowing about the risk can help you avoid potentially serious and life-threatening drug interactions. Please continue reading to learn about some of the other drugs that can interact with Ozempic.

What drugs should not be taken with Ozempic?

Certain other medications can interact with Ozempic and affect the effectiveness of Ozempic or other drugs. Other interactions can increase the risk of serious adverse events. For example, taking Ozempic with certain other drugs can result in severe hypoglycemia (dangerously low blood sugar). Certain drug interactions between Ozempic and oral medications can influence how the body absorbs the oral drugs. As a result, it can cause the other medications not to work as well. Some of the possible interactions of Ozempic include:

• Other diabetes treatments, including insulin medications and oral medications that can lower blood glucose. Ozempic and other diabetes medications taken together can increase the risk of hypoglycemia (low blood sugar). Your doctor may see fit to reduce your insulin dose.

• Antimalarials such as chloroquine and hydroxychloroquine. When used with Ozempic, this interaction can further lower blood sugar.

• Anticoagulants such as warfarin. Ozempic can make warfarin less effective.

• Antibiotics such as clarithromycin. This interaction can further lower blood sugar.

• Certain blood pressure medications, such as beta blockers like atenolol, propranolol, and metoprolol. Beta-blockers can mask certain symptoms of low blood sugar, such as tremors and rapid heart rate. This can make it harder for you to tell when your blood sugar is low. It can also cause hypoglycemia by itself and decrease the effect of this drug. 

• Heart failure medications such as digoxin. Ozempic can make digoxin less effective.

• Antiseizure medications such as phenytoin. Ozempic may affect the effectiveness of phenytoin.

To prevent interactions between Ozempic and your other medications, including certain herbal supplements, give your healthcare provider a complete list of your medications, including prescription drugs, over-the-counter medications, herbal remedies, and products in supplement form.

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What foods should be avoided when taking Ozempic?

Ozempic works best to lower blood sugar when it is used in combination with healthy lifestyle changes such as a reduced-calorie diet and increased physical activity. Therefore, it is best to avoid certain foods like high-fat, processed, and high-sugar foods and drinks while on this medication. These same foods can also make Ozempic side effects worse, including nausea, vomiting, diarrhea, abdominal pain, and constipation.

Can you drink alcohol while taking Ozempic?

It is best to avoid alcohol while taking Ozempic. While there is no direct interaction between Ozempic and alcohol, drinking alcohol can either cause your blood sugar levels to spike or drop to dangerously low levels. Moderate amounts of alcohol can raise your blood sugar levels, especially with sugary cocktails or alcoholic beverages that are high in carbohydrates. Over time, excessive alcohol intake requires the liver to process alcohol instead of releasing glucose, leading to a drop in blood sugar. 

In addition, alcohol can add extra calories to your diet and make Ozempic less effective. Alcohol can also lower inhibitions and make you less likely to follow a healthy diet and exercise routine.

When should you not use Ozempic?

You should not use Ozempic if you have a personal or family history of thyroid cancer. Ozempic has been linked to an increased risk of thyroid C cell tumors, including medullary thyroid carcinoma and multiple endocrine neoplasia syndrome type 2 (MEN 2). There is a boxed warning (the FDA’s most serious warning) for Ozempic regarding thyroid cancer. Special care should also be taken if you have suicidal thoughts. You should contact your doctor to find out what course of action to take.

You should also not take Ozempic if you have a history of an allergic reaction to Ozempic, other semaglutide formulations (Wegovy, Rybelsus), or other similar drugs such as liraglutide (Victoza, Saxenda), dulaglutide (Trulicity), lixisenatide (Adlyxin, in Soliqua), or exenatide (Byetta, Bydureon).

How do diabetes medications like Ozempic lower blood sugar?

Ozempic belongs to a group of drugs called glucagon-like peptide-1 receptor agonists (GLP-1 RAs). It and other diabetes medications from this drug class work by mimicking the effects of a natural hormone called GLP-1 in the body. GLP-1 causes increased insulin secretion and decreased glucagon secretion in response to high blood glucose levels. Insulin and glucagon are hormones that regulate blood glucose levels. 

Taking Ozempic to manage blood sugar levels helps to lower the risk of heart disease, heart attack, stroke, damage to blood vessels, and other complications of diabetes. In addition to regulating the blood sugar level, Ozempic can also help with a modest amount of weight loss. 

Do you need lab tests while on Ozempic?

There are no specific recommendations for Ozempic and lab tests. Follow your doctor’s instructions for measuring your blood sugar levels regularly. Your healthcare professional will also order fasting blood glucose and hemoglobin A1c periodically to assess how diabetes is controlled. They may order other blood tests and urine tests to check for unwanted effects. For example, your kidney function tests may need to be closely monitored if you have a history of kidney problems.

Note: Your doctor may order laboratory tests to check drug levels of NTI (narrow therapeutic index) drugs if they prescribe Ozempic. NTI meds are medications for which a very small difference in dose or blood concentration can lead to therapeutic failure or an increased risk of potentially life-threatening drug reactions. Ozempic causes delayed gastric emptying and can affect the absorption of oral medications. 

Examples of NTI drugs are phenytoin, warfarin, digoxin, and levothyroxine, among many more. 

If you are taking oral semaglutide by mouth (brand name Rybelsus), make sure you follow the dosing instructions carefully and take it separately from your other oral medications. Ozempic interactions with oral medications are less likely since it is subcutaneous semaglutide (taken by injection and not by mouth).

What are the risks of taking Ozempic?

Ozempic can help people with type 2 diabetes manage blood sugar levels. However, taking Ozempic can increase the risk of certain medical conditions, such as thyroid cancer, pancreatitis, gallbladder problems, diabetic retinopathy complications, kidney disease, and hypoglycemia (low blood sugar).

Some of the precautions you can take to lower your risk of Ozempic drug interactions and adverse effects include:

• Give your doctor a list of all your medications and other treatments to prevent drug interactions with Ozempic.

• Give your doctor a complete health history before starting Ozempic treatment. Tell your doctor if you have health conditions such as thyroid carcinoma, kidney problems, gallbladder problems, pancreatitis, or diabetic retinopathy.

• Read the patient package insert and prescription carefully and take Ozempic exactly as prescribed. 

• Never share your Ozempic pens with others.

• Make sure you know how to recognize low blood sugar and what to do if you are experiencing hypoglycemia. 

• Call your healthcare professional or seek immediate medical attention in the emergency room if you develop severe abdominal pain or other serious problems while taking Ozempic. 

Note: This medication guide is for information purposes only. It is not a substitute for professional medical advice. Talk to your doctor or pharmacist to learn Ozempic drug effects and more detailed information about other medications with which Ozempic can interact.