Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.
Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.
The electronic medicines compendium (emc) no longer publishes a Summary of Product Characteristics for this product, which usually means it is no longer marketed in the UK. The patient leaflet below is kept for reference, but the product may not be available.
If you were prescribed this medicine, other products containing Semaglutide may still be available. Do not stop your treatment — ask your pharmacist or GP what to use instead.
for
Ozempic® contains the active substance semaglutide. It helps your body reduce your blood sugar level only when blood sugar is too high and can help prevent heart disease in patients with type 2 diabetes mellitus (T2DM). It also helps to slow down deterioration of kidney function in patients with T2DM by a mechanism beyond blood glucose lowering. Ozempic® is used to treat adults (aged 18 years and older) with type 2 diabetes when diet and exercise is not enough: • on its own – when you cannot use metformin (another diabetes medicine) or • with other medicines for diabetes – when they are not enough to control your blood sugar levels. These may be medicines you take by mouth or inject such as insulin. It is important that you continue with your diet and exercise plan as told by your doctor, pharmacist or nurse. 2.
e Ozempic®
Do not use Ozempic® • if you are allergic to semaglutide or any of the other ingredients of this medicine (listed in section 6). Warnings and precautions Talk to your doctor, pharmacist or nurse before using this medicine. This medicine is not the same as insulin and you should not use it if: • you have type 1 diabetes – a condition where your body does not produce any insulin • you develop diabetic ketoacidosis – a complication of diabetes with high blood sugar, breathing difficulty, confusion, excessive thirst, a sweet smell to the breath or a sweet or metallic taste in the mouth. Ozempic® is not an insulin and should therefore not be used as a substitute for insulin.
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If you know that you are due to have surgery where you will be under anaesthesia (sleeping), please tell your doctor that you are taking Ozempic®. Stomach and gut problems and dehydration During treatment with this medicine, you may feel sick (nausea) or be sick (vomiting), or have diarrhoea. These side effects can cause dehydration (loss of fluids). It is important that you drink plenty of fluids to prevent dehydration. This is especially important if you have kidney problems. Talk to your doctor if you have any questions or concerns. Severe and on-going stomach pain which could be due to acute pancreatitis If you have ever had pancreatitis (inflammation of the pancreas) which may cause severe pain in the stomach and back which does not go away; see section 4. Low blood sugar (hypoglycaemia) Combining a sulfonylurea or an insulin with this medicine might increase the risk of getting low blood sugar levels (hypoglycaemia). Please see section 4 for the warning signs of low blood sugar levels. Your doctor may ask you to test your blood sugar levels. This will help your doctor decide if the dose of the sulfonylurea or insulin needs to be changed to reduce the risk of low blood sugar. Diabetic eye disease (retinopathy) If you have diabetic eye disease and are using insulin, this medicine may lead to a worsening of your vision, and this may require treatment. Tell your doctor if you have diabetic eye disease or if you experience eye problems during treatment with this medicine. In case you have potentially unstable diabetic eye disease, it is not recommended that you use Ozempic® 2 mg. Sudden changes to your eyesight If you notice a sudden loss of vision or rapidly worsening eyesight during treatment with semaglutide, urgently contact your doctor. This may be caused by a very rare side effect called non-arteritic anterior ischaemic optic neuropathy (NAION) (See section 4: Serious side effects). Your doctor will refer you for an eye examination by an ophthalmologist and you may have to stop treatment with semaglutide. Patients with delayed stomach emptying (gastroparesis) If you have slow (delayed) stomach emptying (called gastroparesis), use of Ozempic® may lead to serious or severe gastrointestinal adverse events. Talk to your doctor before using Ozempic®. Children and adolescents This medicine is not recommended in children and adolescents aged under 18 years as the safety and efficacy in this age group have not yet been established. Other medicines and Ozempic® Tell your doctor, pharmacist or nurse if you are taking, have recently taken or might take any other medicines, including herbal medicines or other medicines you bought without a prescription. In particular, tell your doctor, pharmacist or nurse if you are using medicines containing any of the following: • Warfarin or other similar medicines taken by mouth to reduce blood clotting (oral anticoagulants). You may need frequent blood tests to check how quickly your blood clots. • If you are using insulin, your doctor will tell you how to reduce the dose of insulin and will recommend you to monitor your blood sugar more frequently, in order to avoid hyperglycaemia
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(high blood sugar) and diabetic ketoacidosis (a complication of diabetes that occurs when the body is unable to break down glucose because there is not enough insulin). Pregnancy and breast-feeding If you are pregnant or breast-feeding, think you might be pregnant, or are planning to have a baby, ask your doctor for advice before taking this medicine. This medicine should not be used during pregnancy, as it is not known if it affects an unborn baby. Therefore, use of contraception is recommended while using this medicine. If you wish to become pregnant, discuss how to change your treatment with your doctor as you should stop using this medicine at least 2 months in advance. If you become pregnant while using this medicine, talk to your doctor right away, as your treatment will need to be changed. Do not use this medicine if you are breast-feeding, as it is unknown if it passes into breast milk. Driving and using machines Ozempic® is unlikely to affect your ability to drive and use machines. If you use this medicine in combination with a sulfonylurea or insulin, low blood sugar (hypoglycaemia) may occur which may reduce your ability to concentrate. Do not drive or use machines if you get any signs of low blood sugar. See section 2, 'Warnings and precautions' for information on increased risk of low blood sugar and section 4 for the warning signs of low blood sugar. Talk to your doctor for further information. Sodium content This medicine contains less than 1 mmol sodium (23 mg) per dose, that is to say essentially 'sodiumfree'. 3.
How to use Ozempic®
Always use this medicine exactly as your doctor has told you. Check with your doctor, pharmacist or nurse if you are not sure. How much to use • The starting dose is 0.25 mg once a week for four weeks. • After four weeks your doctor will increase your dose to 0.5 mg once a week. • Your doctor may increase your dose to 1 mg once a week if your blood sugar is not controlled well enough with a dose of 0.5 mg once a week. • Your doctor may increase your dose to 2 mg once a week if your blood sugar is not controlled well enough with a dose of 1 mg once a week. Do not change your dose unless your doctor has told you to.
Ozempic® is given as an injection under the skin (subcutaneous injection). Do not inject it into a vein or muscle. • The best places to give the injection are the front of your thighs, the front of your waist (abdomen), or your upper arm. • Before you use the pen for the first time, your doctor or nurse will show you how to use it. Detailed instructions for use are on the other side of this package leaflet. When to use Ozempic® • You should use this medicine once a week on the same day each week if possible. • You can give yourself the injection at any time of the day – regardless of meals.
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To help you remember to inject this medicine once a week only, it is recommended to note the chosen weekday (e.g. Wednesday) on the carton and to write the date on the carton every time you have injected it. If necessary you can change the day of your weekly injection of this medicine as long as it has been at least 3 days since your last injection of it. After selecting a new dosing day, continue with once a week dosing. If you use more Ozempic® than you should If you use more Ozempic® than you should, talk to your doctor straight away. You may get side effects such as feeling sick (nausea). If you forget to use Ozempic® If you forgot to inject a dose and: • it is 5 days or less since you should have used Ozempic®, use it as soon as you remember. Then inject your next dose as usual on your scheduled day. • it is more than 5 days since you should have used Ozempic®, skip the missed dose. Then inject your next dose as usual on your scheduled day. Do not use a double dose to make up for a forgotten dose. If you stop using Ozempic® Do not stop using this medicine without talking to your doctor. If you stop using it, your blood sugar levels may increase. If you have any further questions on the use of this medicine, ask your doctor, pharmacist or nurse. 4.
Like all medicines, this medicine can cause side effects, although not everybody gets them. Serious side effects Common (may affect up to 1 in 10 people) • Complications of diabetic eye disease (retinopathy) – you should tell your doctor if you get eye problems, such as changes in vision, during treatment with this medicine. Uncommon (may affect up to 1 in 100 people) • Inflamed pancreas (acute pancreatitis) which could cause severe pain in the stomach and back which does not go away. This is a serious, potentially life-threatening condition. You should see a doctor immediately if you experience such symptoms. Stop using this medicine and seek urgent medical help if you experience: Severe, persistent pain in the stomach area (abdomen), with or without nausea and vomiting. This could be a sign of acute pancreatitis, which is serious and potentially life-threatening. Rare (may affect up to 1 in 1 000 people) • Severe allergic reactions (anaphylactic reactions, angioedema). You must get immediate medical help and inform your doctor straight away if you get symptoms such as breathing problems, swelling of face, lips, tongue and/or throat with difficulty swallowing and a fast heartbeat. Very Rare (may affect up to 1 in 10 000 people) • A medical condition of the eye called non-arteritic anterior ischaemic optic neuropathy (NAION), which may cause loss of vision without any pain. You should urgently contact your doctor if you notice sudden or gradually worsening eyesight (see section 2: "Sudden changes to your eyesight").
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Not known (frequency cannot be estimated from the available data) • Bowel obstruction. A severe form of constipation with additional symptoms such as stomach ache, bloating, vomiting etc. Other side effects Very common (may affect more than 1 in 10 people) • Feeling sick (nausea) – this usually goes away over time • Diarrhoea – this usually goes away over time • Low blood sugar (hypoglycaemia) when this medicine is used with medicines that contain a sulfonylurea or insulin Common (may affect up to 1 in 10 people) • Being sick (vomiting) • Low blood sugar (hypoglycaemia) when this medicine is used with oral diabetes medicine other than sulfonylurea or insulin The warning signs of low blood sugar may come on suddenly. They can include: cold sweat, cool pale skin, headache, fast heartbeat, feeling sick (nausea) or very hungry, changes in vision, feeling sleepy or weak, feeling nervous, anxious or confused, difficulty concentrating or shaking. Your doctor will tell you how to treat low blood sugar and what to do if you notice these warning signs. Low blood sugar is more likely to happen if you also take a sulfonylurea or insulin. Your doctor may reduce your dose of these medicines before you start using this medicine. • • • • • • • • • • • • • • •
Indigestion Inflamed stomach ('gastritis') – the signs include stomach ache, feeling sick (nausea) or being sick (vomiting) Reflux or heartburn – also called 'gastro-esophageal reflux disease' (GERD) Stomach pain Bloating of the stomach Constipation Burping Gall stones Dizziness Tiredness Weight loss Less appetite Gas (flatulence) Increase of pancreatic enzymes (such as lipase and amylase) Headache.
Uncommon (may affect up to 1 in 100 people) • Change in the way food or drink tastes • Fast pulse • Injection site reactions – such as bruising, pain, irritation, itching and rash • Allergic reactions like rash, itching or hives • A delay in the emptying of the stomach. Not known (frequency cannot be estimated from the available data) • Change in skin sensation.
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Reporting of side effects If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via Yellow Card Scheme Website: https://yellowcard.mhra.gov.uk or search for MHRA Yellow Card in the Google Play or Apple App Store By reporting side effects you can help provide more information on the safety of this medicine. 5.
Ozempic®
Keep this medicine out of the sight and reach of children. Do not use this medicine after the expiry date which is stated on the pen label and carton after 'EXP'. The expiry date refers to the last day of that month. Before opening: Store in a refrigerator (2 °C-8 °C). Do not freeze. Keep away from the cooling element. Keep the pen cap on in order to protect from light. During use: • •
You can keep the pen for 6 weeks when stored at a temperature below 30 °C or in a refrigerator (2 °C-8 °C) away from the cooling element. Do not freeze Ozempic® and do not use it if it has been frozen. When you are not using the pen, keep the pen cap on in order to protect from light.
Do not use this medicine if you notice that the solution is not clear and colourless or almost colourless. Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment. 6.
What Ozempic® contains • The active substance is semaglutide. • 1.5 mL: One mL solution for injection contains 1.34 mg semaglutide. One pre-filled pen contains 2 mg semaglutide in 1.5 mL solution. Each dose contains 0.5 mg of semaglutide in 0.37 mL. • 3 mL: One mL solution for injection contains 0.68 mg semaglutide. One pre-filled pen contains 2 mg semaglutide in 3 mL solution. Each dose contains 0.5 mg of semaglutide in 0.74 mL. • The other ingredients are: disodium phosphate dihydrate, propylene glycol, phenol, water for injections, sodium hydroxide/hydrochloric acid (for pH adjustment). See also section 2, 'Sodium content'. What Ozempic® looks like and contents of the pack Ozempic® is a clear and colourless or almost colourless solution for injection in a pre-filled pen. 1.5 mL: Each pre-filled pen contains 1.5 mL of solution, delivering 4 doses of 0.5 mg. 3 mL: Each pre-filled pen contains 3 mL of solution, delivering 4 doses of 0.5 mg.
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Ozempic® 0.5 mg solution for injection is available in the following pack sizes: 1 pen and 4 disposable NovoFine® Plus needles. 3 pens and 12 disposable NovoFine® Plus needles. Not all pack sizes may be marketed. Marketing Authorisation Holder and Manufacturer Novo Nordisk A/S Novo Allé DK-2880 Bagsværd Denmark This leaflet was last revised in 11/2025. Ozempic® and NovoFine® are trademarks owned by Novo Nordisk A/S, Denmark © 2025 Novo Nordisk A/S Ozempic® 0.5 mg Solution for injection in pre-filled pen semaglutide
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Instructions on how to use Ozempic® 0.5 mg solution for injection in pre-filled pen Please read these instructions carefully before using your Ozempic® pre-filled pen. Talk to your doctor, nurse or pharmacist about how to inject Ozempic® correctly. Start by checking your pen to make sure that it contains Ozempic® 0.5 mg, then look at the illustrations below to get to know the different parts of your pen and needle. If you are blind or have poor eyesight and cannot read the dose counter on the pen, do not use this pen without help. Get help from a person with good eyesight who knows how to use the Ozempic® pre-filled pen. Your pen is a pre-filled dial-a-dose pen. It contains 2 mg of semaglutide, and you can only select doses of 0.5 mg. One unused pen contains four doses of 0.5 mg.
Ozempic® pre-filled pen and needle (example) Pen cap
Outer needle cap
Inner needle cap
Needle
Use the table inside the lid of the carton to keep track of how many injections you have taken and when you took the injections.
Paper tab Pen window
Your pen is designed to be used with 30G, 31G, and 32G disposable needles up to a length of 8 mm. NovoFine® Plus needles are included in the pack.
Pen label
Please note: Your pen may differ in size from the pen shown in the picture. These instructions apply to all Ozempic® 0.5 mg pens.
Dose counter Dose pointer Dose selector Dose button
Important information Pay special attention to these notes, as they are important for safe use of the pen. 1. Prepare your pen with a new needle A • Check the name and coloured label of your pen, to make sure that it contains Ozempic® 0.5 mg. This is especially important if you take more than one type of injectable medicine. Using the wrong medicine could be harmful to your health. • Pull off the pen cap. •
Check that the solution in your pen is clear and colourless. Look through the pen window. If the solution looks cloudy or coloured, do not use the pen.
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B
Flow check symbol
•
•
• •
Take a new needle. Check the paper tab and the outer needle cap for damages that could affect sterility. If any damage is seen use a new needle. Tear off the paper tab.
C
Make sure to attach the needle correctly.
D
Push the needle straight onto the pen. Turn until it is on tight. The needle is covered by two caps. You must remove both caps. If you forget to remove both caps, you will not inject any solution.
• •
Pull off the outer needle cap and keep it for later. You will need it after the injection, to safely remove the needle from the pen. Pull off the inner needle cap and throw it away. If you try to put it back on, you may accidentally stick yourself with the needle.
E
F
A drop of solution may appear at the needle tip. This is normal, but you must still check the flow, if you use a new pen for the first time. See step 2 'Check the flow with each new pen'. Do not attach a new needle to your pen until you are ready to take your injection. Always use a new needle for each injection. This may prevent blocked needles, contamination, infection and inaccurate dosing. Never use a bent or damaged needle. 2. Check the flow with each new pen A • If your pen is already in use, go to step 3 'Select your dose'. Only check the flow before your first injection with each new pen. •
•
Turn the dose selector to the flow check symbol ( ) right past '0'. Make sure the flow check symbol lines up with the pointer. Hold the pen with the needle pointing up. Press and hold in the dose button until the dose counter returns to '0'. The '0' must line up with the dose pointer. A drop of solution should appear at the needle tip.
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Flow check symbol selected
B
A small drop may remain at the needle tip, but it will not be injected. If no drop appears, repeat step 2 'Check the flow with each new pen' up to 6 times. If there is still no drop, change the needle and repeat step 2 'Check the flow with each new pen' once more. Dispose of the pen and use a new one if a drop of solution still does not appear. Always make sure that a drop appears at the needle tip before you use a new pen for the first time. This makes sure that the solution flows. If no drop appears, you will not inject any medicine, even though the dose counter may move. This may indicate a blocked or damaged needle. If you do not check the flow before your first injection with each new pen, you may not get the prescribed dose and the intended effect of Ozempic®. 3. Select your dose A • Turn the dose selector to select 0.5 mg. Keep turning until the dose counter stops and shows 0.5 mg.
0.5 mg selected
Only the dose counter and dose pointer will show that 0.5 mg has been selected. You can only select 0.5 mg per dose. When your pen contains less than 0.5 mg, the dose counter stops before 0.5 is shown. The dose selector clicks differently when turned forwards, backwards or past 0.5 mg. Do not count the pen clicks. Always use the dose counter and the dose pointer to see that 0.5 mg has been selected before injecting this medicine. Do not count the pen clicks. Only doses of 0.5 mg must be selected with the dose selector. 0.5 mg must line up precisely with the dose pointer to ensure that you get a correct dose. How much solution is left A • To see how much solution is left, use the dose counter: Turn the dose selector until the dose counter stops. If it shows 0.5, at least 0.5 mg is left in your pen. If the dose counter stops before 0.5 mg, there is not enough solution left for a full dose of 0.5 mg. Dose counter stopped: 0.5 mg left
If there is not enough solution left in your pen for a full dose, do not use it. Use a new Ozempic® pen. 4. Inject your dose A • Insert the needle into your skin as your doctor or nurse has shown you. • Make sure you can see the dose counter. Do not cover it with your fingers. This could interrupt the injection. •
Press and hold down the dose button. Watch as the dose counter returns to '0'. The '0' must line up with the dose pointer. You may then hear or feel a click.
•
Continue pressing the dose button while keeping the needle in your skin.
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B
• •
•
Count slowly to 6, while keeping the dose button pressed. If the needle is removed earlier, you may see a stream of solution coming from the needle tip. If so, the full dose will not be delivered.
C
Remove the needle from your skin. You can then release the dose button. If blood appears at the injection site, press lightly.
D
Count slowly: 1-2-3-4-5-6
You may see a drop of solution at the needle tip after injecting. This is normal and does not affect your dose. Always watch the dose counter to know how many mg you inject. Hold the dose button down until the dose counter returns to '0'. How to identify a blocked or damaged needle
•
Lead the needle tip into the outer needle cap on a flat surface without touching the needle or the outer needle cap. Once the needle is covered, carefully push the outer needle cap completely on. Unscrew the needle and dispose of it carefully as instructed by your doctor, nurse, pharmacist or local authorities. Put the pen cap on your pen after each use to protect the solution from light.
B
C
When the pen is empty, throw it away without a needle on as instructed by your doctor, nurse, pharmacist or local authorities. Never try to put the inner needle cap back on the needle. You may stick yourself with the needle.
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Always remove the needle from your pen immediately after each injection. This may prevent blocked needles, contamination, infection, leakage of solution and inaccurate dosing. Further important information • Always keep your pen and needles out of the sight and reach of others, especially children. • Never share your pen or your needles with other people. • Caregivers must be very careful when handling used needles to prevent needle injury and crossinfection. Caring for your pen Treat your pen with care. Rough handling or misuse may cause inaccurate dosing. If this happens you might not get the intended effect of this medicine. • Do not leave the pen in a car or another place where it can get too hot or too cold. • Do not inject Ozempic® which has been frozen. If you do that, you might not get the intended effect of this medicine. • Do not inject Ozempic® which has been exposed to direct sunlight. If you do that, you might not get the intended effect of this medicine. • Do not expose your pen to dust, dirt or liquid. • Do not wash, soak or lubricate your pen. It may be cleaned with a mild detergent on a moistened cloth. • Do not drop your pen or knock it against hard surfaces. If you drop it or suspect a problem, attach a new needle and check the flow before you inject. • Do not try to refill your pen. Once empty, it must be disposed of. • Do not try to repair your pen or pull it apart.
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Ozempic 0.5 mg solution for injection in pre-filled pen comes as injection containing 0.5mg. Always follow the dose your doctor or pharmacist has given you, and read the leaflet that comes with the medicine.
The active substance in Ozempic 0.5 mg solution for injection in pre-filled pen is semaglutide.
Medicines with the same active substance, strength and form include: Wegovy 0.5 mg, FlexTouch solution for injection in pre-filled pen. They are interchangeable only if your prescriber or pharmacist says so.
This leaflet reproduces the patient information leaflet approved for Ozempic 0.5 mg solution for injection in pre-filled pen, as published on the electronic medicines compendium (emc). The version printed inside your medicine’s packaging is the one that applies to you.
Whether a medicine is available over the counter or on prescription only depends on its licence. Check the leaflet, or ask your pharmacist — they can tell you straight away.
The text above reproduces the patient information leaflet approved for this medicine, restructured for easier reading.
Ozempic is indicated for the treatment of adults with insufficiently controlled type 2 diabetes mellitus as an adjunct to diet and exercise
• as monotherapy when metformin is considered inappropriate due to intolerance or contraindications
• in addition to other medicinal products for the treatment of diabetes.
For trial results with respect to combinations, effects on glycaemic control and cardiovascular events, peripheral arterial disease, renal outcomes and the populations studied, see sections 4.4, 4.5 and 5.1.
Posology
The starting dose is 0.25 mg semaglutide once weekly. After 4 weeks the dose should be increased to 0.5 mg once weekly. After at least 4 weeks with a dose of 0.5 mg once weekly, the dose can be increased to 1 mg once weekly to further improve glycaemic control. After at least 4 weeks with a dose of 1 mg once weekly, the dose can be increased to 2 mg once weekly to further improve glycaemic control.
Semaglutide 0.25 mg is not a maintenance dose. Weekly doses higher than 2 mg are not recommended.
When Ozempic is added to existing metformin and/or thiazolidinedione therapy or to a sodium-glucose cotransporter 2 (SGLT2) inhibitor, the current dose of metformin and/or thiazolidinedione or SGLT2 inhibitor can be continued unchanged.
When Ozempic is added to existing therapy of sulfonylurea or insulin, a reduction in the dose of sulfonylurea or insulin should be considered to reduce the risk of hypoglycaemia (see sections 4.4 and 4.8).
Self-monitoring of blood glucose is not needed in order to adjust the dose of Ozempic. Blood glucose self-monitoring is necessary to adjust the dose of sulfonylurea and insulin, particularly when Ozempic is started and insulin is reduced. A stepwise approach to insulin reduction is recommended.
Missed dose
If a dose is missed, it should be administered as soon as possible and within 5 days after the missed dose. If more than 5 days have passed, the missed dose should be skipped, and the next dose should be administered on the regularly scheduled day. In each case, patients can then resume their regular once weekly dosing schedule.
Changing the dosing day
The day of weekly administration can be changed if necessary, as long as the time between two doses is at least 3 days (>72 hours). After selecting a new dosing day, once-weekly dosing should be continued.
Special populations
Elderly
No dose adjustment is required based on age.
Renal impairment
No dose adjustment is required for patients with mild, moderate or severe renal impairment. Experience with the use of semaglutide in patients with severe renal impairment is limited.
Hepatic impairment
No dose adjustment is required for patients with hepatic impairment. Experience with the use of Semaglutide in patients with severe hepatic impairment is limited. Caution should be exercised when treating these patients with semaglutide (see section 5.2).
Paediatric population
The safety and efficacy of semaglutide in children and adolescents below 18 years have not yet been established. No data are available.
Method of administration
Subcutaneous use.
Ozempic is to be injected subcutaneously in the abdomen, in the thigh or in the upper arm. The injection site can be changed without dose adjustment. Ozempic should not be administered intravenously or intramuscularly.
Ozempic is to be administered once weekly at any time of the day, with or without meals.
For further information on administration, see section 6.6.
Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
Traceability
In order to improve the traceability of biological medicinal products, the name and the batch number of the administered product should be clearly recorded.
General
Semaglutide should not be used in patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis. Semaglutide is not a substitute for insulin. Diabetic ketoacidosis has been reported in insulin-dependent patients whom had rapid discontinuation or dose reduction of insulin when treatment with a GLP-1 receptor agonist is started (see section 4.2).
There is no experience in patients with congestive heart failure NYHA class IV and semaglutide is therefore not recommended in these patients.
Aspiration in association with general anaesthesia or deep sedation
Cases of pulmonary aspiration have been reported in patients receiving GLP-1 receptor agonists undergoing general anaesthesia or deep sedation. Therefore, the increased risk of residual gastric content due to delayed gastric emptying (see section 4.8) should be considered prior to performing procedures with general anaesthesia or deep sedation.
Gastrointestinal effects and dehydration
Use of GLP‑1 receptor agonists may be associated with gastrointestinal adverse reactions. This should be considered when treating patients, with impaired renal function as nausea, vomiting, and diarrhoea may cause dehydration, which in rare cases can lead to a deterioration of renal function (see section 4.8). Patients treated with semaglutide should be advised of the potential risk of dehydration in relation to gastrointestinal side effects and take precautions to avoid fluid depletion.
Acute pancreatitis
Semaglutide has not been studied in patients with a history of pancreatitis, and should be used with caution in these patients.
Acute pancreatitis has been reported in patients treated with GLP‑1 receptor agonists. This includes post-marketing reports of necrotising pancreatitis and reports with a fatal outcome. Patients should be informed of the symptoms of acute pancreatitis, including persistent, severe abdominal pain. Patients should be advised to seek immediate medical attention if they occur. If pancreatitis is suspected, semaglutide should be discontinued. If the diagnosis of pancreatitis is confirmed, semaglutide should not be restarted.
In the absence of other signs and symptoms of acute pancreatitis, elevations in pancreatic enzymes alone are not predictive of acute pancreatitis (see section 4.8).
Hypoglycaemia
Patients treated with semaglutide in combination with a sulfonylurea or insulin may have an increased risk of hypoglycaemia. The risk of hypoglycaemia can be lowered by reducing the dose of sulfonylurea or insulin when initiating treatment with semaglutide (see section 4.8).
Non-arteritic anterior ischaemic optic neuropathy (NAION)
Data from epidemiological studies may indicate an increased risk of non-arteritic anterior ischaemic optic neuropathy (NAION) during treatment with semaglutide. There is no identified time interval for when NAION may develop following treatment start. Patients reporting a sudden loss of vision (including partial loss) should be urgently referred for ophthalmological examination and treatment with semaglutide should be discontinued if NAION is confirmed (see section 4.8).
Diabetic retinopathy
In patients with diabetic retinopathy treated with insulin and semaglutide, an increased risk of developing diabetic retinopathy complications has been observed (see section 4.8). Caution should be exercised when using semaglutide in patients with diabetic retinopathy treated with insulin. These patients should be monitored closely and treated according to clinical guidelines. Rapid improvement in glucose control has been associated with a temporary worsening of diabetic retinopathy, but other mechanisms cannot be excluded.
There is no experience with semaglutide 2 mg in patients with type 2 diabetes with uncontrolled or potentially unstable diabetic retinopathy and semaglutide 2 mg is therefore not recommended in these patients.
Patients with gastroparesis
Semaglutide treated patients with gastroparesis may experience more serious or severe gastrointestinal adverse events. Semaglutide should be used with caution in these patients, and semaglutide is not recommended if gastroparesis is severe (see section 4.8).
Sodium content
This medicinal product contains less than 1 mmol sodium (23 mg) per dose, that is to say essentially 'sodium-free'.
Semaglutide delays gastric emptying and has the potential to impact the rate of absorption of concomitantly administered oral medicinal products. Semaglutide should be used with caution in patients receiving oral medicinal products that require rapid gastrointestinal absorption.
Paracetamol
Semaglutide delays the rate of gastric emptying as assessed by paracetamol pharmacokinetics during a standardised meal test. Paracetamol AUC0-60min and Cmax were decreased by 27% and 23%, respectively, following concomitant use of semaglutide 1 mg. The total paracetamol exposure (AUC0‑5h) was not affected. No clinically relevant effect on the rate of gastric emptying was observed with semaglutide 2.4 mg, following 20 weeks of administration of semaglutide, probably due to a tolerance effect. No dose adjustment of paracetamol is necessary when administered with semaglutide.
Oral contraceptives
Semaglutide is not anticipated to decrease the effect of oral contraceptives as semaglutide did not change the overall exposure of ethinylestradiol and levonorgestrel to a clinically relevant degree when an oral contraceptive combination medicinal product (0.03 mg ethinylestradiol/0.15 mg levonorgestrel) was co-administered with semaglutide. Exposure of ethinylestradiol was not affected; an increase of 20% was observed for levonorgestrel exposure at steady state. Cmax was not affected for any of the compounds.
Atorvastatin
Semaglutide did not change the overall exposure of atorvastatin following a single dose administration of atorvastatin (40 mg). Atorvastatin Cmax was decreased by 38%. This was assessed not to be clinically relevant.
Digoxin
Semaglutide did not change the overall exposure or Cmax of digoxin following a single dose of digoxin (0.5 mg).
Metformin
Semaglutide did not change the overall exposure or Cmax of metformin following dosing of 500 mg twice daily over 3.5 days.
Warfarin and other coumarin derivatives
Semaglutide did not change the overall exposure or Cmax of R- and S-warfarin following a single dose of warfarin (25 mg), and the pharmacodynamic effects of warfarin as measured by the international normalised ratio (INR) were not affected in a clinically relevant manner. However, cases of decreased INR have been reported during concomitant use of acenocoumarol and semaglutide. Upon initiation of semaglutide treatment in patients on warfarin or other coumarin derivatives, frequent monitoring of INR is recommended.
Women of childbearing potential
Women of childbearing potential are recommended to use contraception when treated with semaglutide.
Pregnancy
Studies in animals have shown reproductive toxicity (see section 5.3). There are limited data from the use of semaglutide in pregnant women. Therefore, semaglutide should not be used during pregnancy. If a patient wishes to become pregnant, or pregnancy occurs, semaglutide should be discontinued. Semaglutide should be discontinued at least 2 months before a planned pregnancy due to the long half‑life (see section 5.2).
Breast-feeding
In lactating rats, semaglutide was excreted in milk. As a risk to a breast-fed child cannot be excluded, semaglutide should not be used during breast-feeding.
Fertility
The effect of semaglutide on fertility in humans is unknown. Semaglutide did not affect male fertility in rats. In female rats, an increase in oestrous length and a small reduction in number of ovulations were observed at doses associated with maternal body weight loss (see section 5.3).
Semaglutide has no or negligible influence on the ability to drive or use machines. When it is used in combination with a sulfonylurea or insulin, patients should be advised to take precautions to avoid hypoglycaemia while driving and using machines (see section 4.4).
Summary of safety profile
In 8 phase 3a trials 4 792 patients were exposed to semaglutide up to 1 mg. The most frequently reported adverse reactions in clinical trials were gastrointestinal disorders, including nausea (very common), diarrhoea (very common) and vomiting (common). In general, these reactions were mild or moderate in severity and of short duration.
Tabulated list of adverse reactions
Table 1 lists adverse reactions identified in all phase 3 trials (including the long-term cardiovascular outcomes trial) and post-marketing reports in patients with type 2 diabetes mellitus (further described in section 5.1). The frequencies of the adverse reactions (except diabetic retinopathy complications, see footnote in Table 1) are based on a pool of the phase 3a trials excluding the cardiovascular outcomes trial (see text below the table for additional details).
The reactions are listed below by system organ class and absolute frequency. Frequencies are defined as: very common: (≥1/10); common: (≥1/100 to <1/10); uncommon: (≥1/1 000 to <1/100); rare: (≥1/10 000 to <1/1 000); very rare: (<1/10 000) and not known: (cannot be estimated from available data). Within each frequency grouping, adverse reactions are presented in order of decreasing seriousness.
Table 1 Frequency of adverse reactions of semaglutide
MedDRA system organ class
Very common
Common
Uncommon
Rare
Very Rare
Not known
Immune system disorders
Hypersensitivityc
Anaphylactic reaction
Metabolism and nutrition disorders
Hypoglycaemiaa when used with insulin or sulfonylurea
Hypoglycaemiaa when used with other oral antidiabetics (OAD)
Decreased appetite
Nervous system disorders
Dizziness
Headache
Dysgeusia
Dysaesthesiad
Eye disorders
Diabetic retinopathy complicationsb
Non- arteritic anterior ischaemic optic neuropathy (NAION)
Cardiac disorders
Increased heart rate
Gastrointestinal disorders
Nausea
Diarrhoea
Vomiting
Abdominal pain
Abdominal distension
Constipation
Dyspepsia
Gastritis
Gastro-oesophageal reflux disease
Eructation
Flatulence
Acute pancreatitis
Delayed gastric emptying
Intestinal obstructiond
Hepatobiliary disorders
Cholelithiasis
Skin and subcutaneous tissue disorders
Angioedemad
General disorders and administration site conditions
Fatigue
Injection site reactions
Investigations
Increased lipase
Increased amylase
Weight decreased
a) Hypoglycaemia defined as severe (requiring the assistance of another person) or symptomatic in combination with a blood glucose <3.1 mmol/L.
b) Diabetic retinopathy complications is a composite of: retinal photocoagulation, treatment with intravitreal agents, vitreous haemorrhage, diabetes-related blindness (uncommon). Frequency based on cardiovascular outcomes trial.
c) Grouped term covering also adverse events related to hypersensitivity such as rash and urticaria.
d) From post-marketing reports.
2-year cardiovascular outcomes and safety trial
In cardiovascular high risk population the adverse reaction profile was similar to that seen in the other phase 3a trials (described in section 5.1).
Kidney outcomes trial
In the FLOW trial in patients with type 2 diabetes mellitus and chronic kidney disease, safety data collection was limited to serious adverse events and selected predefined categories of adverse events regardless of seriousness. There were no new serious or severe adverse reactions identified in this trial.
Description of selected adverse reactions
Hypoglycaemia
No episodes of severe hypoglycaemia were observed when semaglutide was used as monotherapy. Severe hypoglycaemia was primarily observed when semaglutide was used with a sulfonylurea (1.2% of subjects, 0.03 events/patient year) or insulin (1.5% of subjects, 0.02 events/patient year). Few episodes (0.1% of subjects, 0.001 events/patient year) were observed with semaglutide in combination with oral antidiabetics other than sulfonylureas.
American Diabetes Association (ADA) classified hypoglycaemia occurred in 11.3% (0.3 events/patient year) of patients when semaglutide 1 mg was added to SGLT2 inhibitor in SUSTAIN 9 compared to 2.0% (0.04 events/patient year) of placebo-treated patients. Severe hypoglycaemia was reported in 0.7% (0.01 events/patient year) and 0% of patients, respectively.
In a 40-week phase 3b trial in patients receiving semaglutide 1 mg and 2 mg, the majority of the hypoglycaemic episodes (45 out of 49 episodes) occurred when semaglutide was used in combination with sulfonylurea or insulin. Overall, there was no increased risk of hypoglycaemia with semaglutide 2 mg.
Gastrointestinal adverse reactions
Nausea occurred in 17% and 19.9% of patients when treated with semaglutide 0.5 mg and 1 mg, respectively, diarrhoea in 12.2% and 13.3% and vomiting in 6.4% and 8.4%. Most events were mild to moderate in severity and of short duration. The events led to treatment discontinuation in 3.9% and 5% of patients. The events were most frequently reported during the first months on treatment.
Patients with low body weight may experience more gastrointestinal side effects when treated with semaglutide.
In a 40-week phase 3b trial in patients receiving semaglutide 1 mg and 2 mg, nausea occurred in similar proportions of patients when treated with semaglutide 1 mg and 2 mg, respectively. Diarrhoea and vomiting occurred in higher proportions of patients when treated with semaglutide 2 mg compared to semaglutide 1 mg. The gastrointestinal adverse reactions led to treatment discontinuation in similar proportions in the semaglutide 1 mg and 2 mg treatment groups.
In concomitant use with an SGLT2 inhibitor in SUSTAIN 9, constipation and gastro-oesophageal reflux disease occurred in 6.7% and 4% respectively of patients treated with semaglutide 1 mg compared to no events for placebo-treated patients. The prevalence of these events did not decrease over time.
Patients with gastroparesis may experience more serious or severe gastrointestinal effects when treated with semaglutide.
Acute pancreatitis
The frequency of adjudication-confirmed acute pancreatitis reported in phase 3a clinical trials was 0.3% for semaglutide and 0.2% for the comparator, respectively. In the 2-year cardiovascular outcomes trial the frequency of acute pancreatitis confirmed by adjudication was 0.5% for semaglutide and 0.6% for placebo (see section 4.4).
Diabetic retinopathy complications
A 2-year clinical trial investigated 3 297 patients with type 2 diabetes, with high cardiovascular risk, long duration of diabetes and poorly controlled blood glucose. In this trial, adjudicated events of diabetic retinopathy complications occurred in more patients treated with semaglutide (3%) compared to placebo (1.8%). This was observed in insulin-treated patients with known diabetic retinopathy. The treatment difference appeared early and persisted throughout the trial. Systematic evaluation of diabetic retinopathy complication was only performed in the cardiovascular outcomes trial. In clinical trials up to 1 year involving 4 807 patients with type 2 diabetes, adverse events related to diabetic retinopathy were reported in similar proportions of subjects treated with semaglutide (1.7%) and comparators (2.0%).
Non-arteritic anterior ischaemic optic neuropathy (NAION)
Results from several large epidemiological studies suggest that exposure to semaglutide in adults with type 2 diabetes may be associated with an approximately two-fold increase in the relative risk of developing NAION, corresponding to approximately one additional case per 10 000 person-years of treatment.
Discontinuation due to an adverse event
The incidence of discontinuation of treatment due to adverse events was 6.1% and 8.7% for patients treated with semaglutide 0.5 mg and 1 mg, respectively, versus 1.5% for placebo. The most frequent adverse events leading to discontinuation were gastrointestinal.
Injection site reactions
Injection site reactions (e.g. injection site rash, erythema) have been reported by 0.6% and 0.5% of patients receiving semaglutide 0.5 mg and 1 mg, respectively. These reactions have usually been mild.
Immunogenicity
Consistent with the potentially immunogenic properties of medicinal products containing proteins or peptides, patients may develop antibodies following treatment with semaglutide. The proportion of patients tested positive for anti-semaglutide antibodies at any time point post-baseline was low (1−3%) and no patients had anti-semaglutide neutralising antibodies or anti-semaglutide antibodies with endogenous GLP‑1 neutralising effect at end-of-trial.
Heart rate increase
Increased heart rate has been observed with GLP-1 receptor agonists. In the phase 3a trials, mean increases of 1 to 6 beats per minute (bpm) from a baseline of 72 to 76 bpm were observed in subjects treated with Ozempic. In a long-term trial in subjects with cardiovascular risk factors, 16% of Ozempic-treated subjects had an increase in heart rate of >10 bpm compared to 11% of subjects on placebo after 2 years of treatment.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via
Yellow Card Scheme
Website: https://yellowcard.mhra.gov.uk or search for MHRA Yellow Card in the Google Play or Apple App Store
Overdoses of up to 4 mg in a single dose, and up to 4 mg in a week have been reported in clinical trials. The most commonly reported adverse reaction was nausea. All patients recovered without complications.
There is no specific antidote for overdose with semaglutide. In the event of overdose, appropriate supportive treatment should be initiated according to the patient's clinical signs and symptoms. A prolonged period of observation and treatment for these symptoms may be necessary, taking into account the long half-life of semaglutide of approximately 1 week (see section 5.2).
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