What Is Ozempic?

Losing weight is tough (understatement of the century), but keeping it off long-term is even harder. Some studies show that only 20% of people with overweight or obesity who lose weight with diet and exercise are able to keep it off (Contreras, 2019). 

But, don’t lose hope! There have been some major advancements in medicine in the past few years, with some highly effective medications now available. 

One option many turn to is Ozempic, a diabetes drug often prescribed off-label for weight loss. Keep reading to learn more about how this medication might be able to help you finally overcome your struggles with weight management.

What is Ozempic?

Ozempic (semaglutide) is a type of prescription medication called a glucagon-like peptide-1 receptor agonist (usually called a GLP-1 for short). It’s FDA-approved to help with blood sugar control in people with type 2 diabetes, and to lower the risk of cardiovascular events (like heart attack) in people who have both type 2 diabetes and heart disease (Novo Nordisk, 2022).

You might be wondering, “Where does weight loss come in?”

While Ozempic isn’t approved by the US Food and Drug Administration specifically for weight loss, its active ingredient, semaglutide, has been studied extensively for this purpose. Semaglutide is highly effective, when combined with diet and exercise, at helping people with overweight or obesity lose a signficant amount of weight (Davies, 2021).

In fact, semaglutide is available under a different brand name, Wegovy, which is FDA-approved for chronic weight management (but not for treating diabetes). Some providers choose to prescribe Ozempic off-label to help their patients lose weight, especially if their patients also have diabetes (but not always).

Can Ozempic help you lose weight? 

Although the FDA hasn’t approved Ozempic for weight loss, studies have shown this weekly injection can help you lose weight when combined with diet and exercise. 

Many studies have been done on semaglutide, the active ingredient in Ozempic, with some studies focusing on the dosing used in Ozempic as an anti-diabetes drug, and others focusing on the dosing used in Wegovy, the FDA-approved weight loss drug. 

The dosing of these two drugs is similar (but not the same—more on that below), but across the board, studies seem to confirm that people with diabetes taking these drugs lose less weight on average than people without diabetes using these drugs (Jensterle, 2022). This aligns with what’s been shown in clinical studies in general—with any weight loss intervention, losing weight is more difficult across the board for people with diabetes than without (Franz, 2017).

Still, the weight loss results are significant. In one trial, people with diabetes taking 1.0 mg of semaglutide (a common Ozempic dosage), along with diet and exercise, saw an average weight loss of 7% of their bodyweight over 68 weeks. The placebo group saw an average of 3.4% bodyweight loss in the same time period (Davies, 2021).  

Another study—also on people with diabetes—showed over 6% weight loss within 40 weeks, but this time, the study was on the highest dose of Ozempic combined with lifestyle interventions, plus metformin, another medication used for diabetes (Frias, 2021).  

How does Ozempic work?

Like other GLP-1 drugs, Ozempic acts the same way as the natural, appetite-regulating hormone GLP-1 acts in our bodies, only its effects last much longer. Naturally, GLP-1 kicks in right after we eat, but only remains active for about 2 minutes; semaglutide has the same effect as GLP-1, but lasts for about 7 days (Lee, 2017; Rubino, 2022).

GLP-1s are effective at treating diabetes because they bind to GLP-1 receptors, which then send messages to the pancreas to release insulin into the bloodstream when glucose (blood sugar) levels spike. Increased insulin in the body brings blood sugar levels back down. Ozempic is effective at stabilizing blood glucose, which is important for people with diabetes since high blood sugar is the key marker of type 2 diabetes.

Another way Ozempic keeps blood sugar stable, and one of the primary ways it helps with weight loss, is it slows down digestion and keeps food in the stomach for longer. This limits how much sugar gets released into the bloodstream, and also lowers food intake by decreasing appetite. 

Finally, GLP-1 receptor agonists like Ozempic tell the brain you’re full after eating, which adds another layer of appetite regulation. 

Together, all these functions control diabetes and weight, helping to prevent potential issues from type 2 diabetes and obesity.

Ozempic side effects

Side effects from Ozempic are common, but manageable for most people. The biggest culprits are nausea, vomiting, diarrhea, abdominal pain, and constipation—in other words, all related to the gastrointestinal system. This is because Ozempic acts directly on the digestive tract by slowing down digestion. While these side effects are unpleasant and worse at higher doses, less than 4% of people dropped out of the drug trials due to these issues (Novo Nordisk, 2022).

Ozempic warnings and contraindications

For most people, Ozempic is safe and effective, but not everyone should take it. 

Ozempic comes with a black box warning (the FDA’s strongest warning) about its potential association with a certain type of thyroid cancer called medullary thyroid carcinoma. This risk has only been observed in studies on rodents, so we don’t know if the same risk exists in humans. To be on the safe side, if you have any personal or family history that puts you at higher risk for thyroid cancer—including a condition called multiple endocrine neoplasia syndrome type 2 (MEN 2)—your healthcare professional won’t prescribe Ozempic to you (Novo Nordisk, 2022). 

It’s also not recommended to take Ozempic if you have a history of the following, as there’s a chance Ozempic could worsen these conditions (Novo Nordisk, 2022): 

• Pancreatitis

• Diabetic retinopathy

• Hypoglycemia

• Acute kidney injury

• Acute gallbladder disease

Ozempic is also not approved in people who are pregnant and should be stopped at least two months before trying to get pregnant.

Ozempic dosage

Ozempic comes in four doses—0.25 mg, 0.5 mg, 1.0 mg, and 2.0 mg. Your provider will start you at the lowest dose and slowly ramp up your dose based on how you’re responding to the drug. For some people, a lower dose is more tolerable because the side effects are lower, and they may get all the weight loss and diabetes control results they need from a lower dose. For others, as long as they’re able to tolerate the side effects, a higher dose might be necessary to help them lose enough weight and control their blood sugar (if they have diabetes). 

The typical dosing schedule for weekly semaglutide is as follows: 

• Weeks 1–4: 0.25 mg once a week 

• Weeks 5–8: 0.5 mg once a week

• Weeks 9–12: 1.0 mg once a week

• Week 13 and beyond: 2.0 mg once a week

Once you’ve reached the maximum dose you can tolerate, you’ll stay at that dose long-term. To keep seeing weight loss effects from Ozempic, you’ll need to stay on the drug. If you stop taking it, you will most likely regain the weight you’ve lost. That’s because obesity and overweight are medical conditions, much like high blood pressure. A person with high blood pressure needs to keep taking their medicine to keep their blood pressure down—and the same idea applies to treating overweight and obesity with Ozempic.

How to use Ozempic

Ozempic comes in an injectable pen that has multiple doses. You can easily turn a dial on the pen to select the dose prescribed by your provider. When it’s time for your injection, you’ll attach a new needle to the pen, then dispose of the needle safely in a sharps container (you can get one from your local pharmacy or online) after you complete your injection. 

It’s important to read through all of the following instructions carefully before your first injection. 

How to store your medication

Your injection pen should be stored in the refrigerator (between 36–46ºF) before you use it for the first time. If there’s still medication left in the pen after you use it for the first time, you can then store it outside the fridge (between 59–86ºF) for up to 56 days. 

When to take your dose

Inject Ozempic once a week, on the same day each week (it can help to set a weekly reminder in your calendar). You can take Ozempic with or without food. 

Get your medication ready

1. Before you start preparing your medication, wash your hands with soap and water. 

2. Remove the pen from the package and make sure it shows the correct medication and dosage, and that it’s before the expiration date. 

3. Next, inspect the medication. The medication should clear and colorless. If it has any debris or particles in it, or if it has a color, don’t use the medication. Contact your pharmacy and your healthcare provider for further guidance. 

Attach a new needle

If the medication looks clear, colorless, and particle-free, attach a new needle as follows: 

1. Tear the paper tab off a new needle, but don’t remove the needle’s cap just yet. 

2. Hold the pen in one hand. In your other hand, hold the capped needle between your thumb and forefinger. Push the needle straight onto the pen, then turn the needle clockwise until it’s tight on the pen. 

3. Pull off the outer needle cap and put aside. Do not throw the outer cap away.

4. Next, pull off and discard the inner needle cap. 

Always use a new needle for each injection. Do not reuse needles, and never share needles with other people. Do not use a bent or damaged needle. 

Check the medication flow

Every time you use a new pen, it’s important to check that the medication is flowing properly to ensure you’re getting all the medication you need. To check the flow:

1. Turn the dose selector until the dose counter shows the flow check symbol, which looks like two dots and a dash: ••–.

2. Hold the pen with the needle pointing up.

3. Press and hold in the dose button until the dose counter shows 0. The 0 must line up with the dose pointer. 

4. A small drop of Ozempic should appear at the needle tip.

   1. If no drop appears, repeat Steps 1–3 up to six times. If this does not cause a drop to appear, replace the needle and repeat Steps 1–3 once more. If a drop of Ozempic still does not appear, contact your pharmacy or provider, as you may need a new pen. 

Select your dose

Turn the dose selector until the dose counter shows your prescribed dose.

1. If you have an Ozempic 2 mg pen, you can only select doses of 0.25 mg or 0.5 mg. Follow the dosing instructions from your provider to select the correct dose.

2. If you have an Ozempic 4 mg pen, you can only select doses of 1 mg.

3. If you have an Ozempic 8 mg pen, you can only select doses of 2 mg.

Inject your medication

1. Choose a spot on your stomach, thigh, or upper arm to inject the medication. Ozempic is a subcutaneous injection, meaning it gets injected just under the skin, not into a muscle. Don’t inject your medication into the exact same spot every week, as this can cause irritation.

2. Use an alcohol wipe to clean your chosen injection site.  

3. Pinch the skin with one hand and press the pen firmly against your skin with the other hand, inserting the needle into the skin. Make sure you can see the dose counter. 

4. Hold the button down until the dose counter turns to 0.

5. After the dose counter turns to 0, wait six seconds.

6. Remove the needle from your skin.

After administering the dose

1. Carefully remove the needle from the pen, then dispose of the needle in a sharps container (you can get one from your local pharmacy or online). Do not throw the needle into your regular trash.

2. Put the outer needle cap back onto your pen.

3. If your pen contains more medication, then store it in a safe location. If the pen contains no more medication, dispose of it in your sharps container or a heavy-duty plastic container.

Ozempic cost 

Ozempic is highly effective at controlling diabetes and helping with weight loss, but it can be quite costly. Without insurance, you can expect to pay around $1,000 per month out of pocket for Ozempic (GoodRx, 2022). Prices can vary depending on which pharmacy you use, so it’s a good idea to shop around a bit to find the best price.

Many insurance plans cover Ozempic, which can bring costs down considerably. Insurance coverage is more likely if you have diabetes; if you’re taking it off-label for weight loss, your insurance plan may have restrictions on coverage. 

You can contact your insurance provider and ask them if Ozempic (or another form of the active ingredient, semaglutide) is covered under your plan’s drug formulary. Your insurance plan may make you jump through some hoops to get authorization for coverage, but there are ways to get help with this process. Many healthcare provider offices have staff members dedicated to helping patients navigate insurance coverage. Another option is to explore our Ro Body program, which includes an insurance concierge service to help you get coverage. 

You may also be able to get coverage through Medicare or Medicaid. 

If you don’t have insurance coverage, there are some ways to save on Ozempic. You can get coupons through sites like GoodRx and SingleCare, or you can get a savings card through Novo Nordisk, the manufacturer of Ozempic (GoodRx, 2022; SingleCare, 2023; NovoCare, 2022).

Ozempic drug interactions

Ozempic is safe to use with most medications, but there are a couple of things to be aware of. Since one of the functions of Ozempic is to lower blood sugar levels, it could cause blood sugar levels to drop too much if mixed with insulin or other drugs that can cause low blood sugar. You may need closer monitoring if you’re taking these drugs together. 

Your Ozempic dosage may change if you take any of the following:

• Insulin: Lantus, Levemir, Humulin, or others

• Sulfonylureas: Glimepiride (Amaryl), glipizide (Glucotrol), or glyburide (Diabeta)

• Meglitinides: Nateglinide or repaglinide

One of Ozempic’s other main functions is slowing down gastric emptying, which can affect how your body absorbs oral medications. Your healthcare provider will likely monitor you if you’re taking any oral prescription drugs while on Ozempic to make sure you’re getting the effects you need from all your medications.

Ozempic vs. Wegovy

Ozempic and Wegovy are both injectable GLP-1 receptor agonists with the same active ingredient: semaglutide. Why would your provider prescribe one over the other, and how do they compare? 

There are three main differences between these drugs: 

• FDA-approval: Ozempic is FDA-approved for treating type 2 diabetes, while Wegovy is FDA-approved for weight loss. Ozempic is often prescribed off-label for weight loss. 

• Dosing: Ozempic is dosed at 0.25 mg, 0.5 mg, 1.0 mg, and 2.0 mg. Wegovy is dosed at 0.25 mg, 0.5 mg, 1.0 mg, 1.7 mg, and 2.4 mg. 

• Cost: The cost without insurance for Ozempic is around $1,000 per month, while Wegovy can cost around $1,500 out of pocket.

If you’re taking this for weight loss, your provider will likely want to prescribe Wegovy first, but may decide to prescribe Ozempic instead if you have trouble getting coverage for Wegovy. If you also have diabetes, you may have an easier time getting coverage for Ozempic.

How to get Ozempic

If you have type 2 diabetes that can’t be controlled with diet and exercise alone, you may be eligible for Ozempic. Your provider may also prescribe Ozempic off-label to help with weight control if you fit into one of the following categories: 

• Body mass index (BMI) of 30 or higher (classified as obesity)

• BMI of 27 or higher (classified as overweight), along with a weight-related condition, such as diabetes, heart disease, or high blood pressure 

You can get Ozempic through your primary care provider or look for a physician who specializes in obesity medicine. There are online options, as well, such as our Ro Body Weight Loss program, a comprehensive, 12-month program that includes: 

• Your GLP-1 medication (Ozempic, if that’s the most appropriate weight loss medication for you)

• A personalized treatment plan

• 1:1 health coaching

• A step-by-step curriculum

• Ongoing support from your provider

• Insurance concierge services to help you get coverage

Losing weight sustainably can be a real challenge for many people. Whether or not you have diabetes, Ozempic may be able to help you lose excess weight—and keep it off for as long as you stay on the drug. Speak with your healthcare provider to find out if it’s right for you.

Steve Silvestro, MD

Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.

Steve Silvestro, MD

Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.