How old do you have to be to take Ozempic?

If you or someone you love has type 2 diabetes, you may be wondering if Ozempic (semaglutide) could be a good fit. The medication lowers HbA1c levels (average blood sugar levels over the past 2–3 months) by two percentage points in less than a year, and it may also be prescribed off-label for weight loss. So, how old do you have to be to take Ozempic? Is there an Ozempic age limit? Is it safe for children or older adults?

Ozempic is available in both injection and pill forms, both of which are only approved for use in adults 18 and older. This Ozempic age limit applies to all of its approved indications, including:

• Lowering blood sugar levels in adults with type 2 diabetes, along with diet and exercise

• Reducing cardiovascular risk in adults with type 2 diabetes and heart disease

• Reducing the risk of kidney decline in adults with type 2 diabetes and chronic kidney disease (injection only)

Wegovy (semaglutide) is another medication that contains the same active ingredient as Ozempic, but in higher dosage strengths approved for weight loss. Unlike Ozempic, injectable Wegovy is approved for use in children ages 12 to 17 with obesity. 

Why is Wegovy approved for children but not Ozempic? It has to do with the fact that Wegovy was specifically studied for use in adolescents. “The pediatric indication requires dedicated clinical trials demonstrating safety and efficacy in that age group, which Wegovy has, and Ozempic does not,” says Omodamola Aje, MD, a board-certified endocrinologist.

Not yet, that is. A recent phase 3 clinical trial found that oral semaglutide (Ozempic pill) significantly improved blood sugar in children and teens ages 10 to 17 with type 2 diabetes. If approved, Ozempic would be the first oral GLP-1 treatment option for diabetes in this age group.

See if you qualify

The current lower age limit for Ozempic is 18 years old, but there is no upper age limit. In clinical trials, Ozempic was studied primarily in adults ages 18 to 64. However, about a quarter of study participants were 65 or older, including 3% who were 75 or older. 

“Ozempic can be safe and effective across age groups when used thoughtfully, but age-specific risks, particularly muscle loss in older adults and limited long-term data in younger populations, mean treatment decisions should always be individualized and closely monitored,” Dr. Aje says.

The US Food and Drug Administration (FDA) has not approved Ozempic for children. In the recent phase 3 trial, Ozempic was generally well tolerated by children 10 to 17 years old, with a safety profile similar to that seen in other studies of semaglutide.  

Other GLP-1 receptor agonists have also been shown to be effective at treating both type 2 diabetes and obesity in children, leading to significant reductions in blood sugar levels, body weight, body mass index (BMI), and blood pressure. 

As it stands today, the safety of Ozempic for children cannot be definitively established without large-scale clinical trials. And since it’s not yet approved for use in children, any prescription — for obesity, type 2 diabetes, or both — is technically off-label. Dr. Aje says any off-label use of Ozempic in children should be approached with caution. 

Beyond the medication’s known side effects — mostly GI-related issues like nausea, diarrhea, and constipation — there are other potential risks to consider when children take Ozempic, such as:

• The potential for disordered eating. Disordered eating is higher in children and teens with obesity. Pediatricians often recommend screening for disordered eating behaviors, such as binge eating, prior to prescribing GLP-1s. 

• The child’s mental health status. Living with obesity can negatively affect a child’s mental health, contributing to depression and anxiety — factors a healthcare provider should assess before starting Ozempic. While Ozempic treatment may help some children lose weight, it does not replace mental healthcare.

• The long-term risks of taking the medication. Ozempic is intended to be a chronic, potentially lifelong medication. Some research shows that long-term use may increase the risk of certain serious side effects, such as gallbladder issues.

Ozempic is safe for older adults ages 65 and up. In clinical trials, roughly one in four participants were 65 or older, and Ozempic has been shown to be highly effective in older adults — leading to significant reductions in both body weight and blood sugar levels.

However, Ozempic may pose more risks for someone in their 70s than someone in their 40s or 50s. These can include an increased risk of muscle loss, side effects, and polypharmacy (use of multiple medications) complications.

Muscle loss

While most weight loss includes some level of muscle loss, research shows that the percentage can be much higher in people taking GLP-1s — amounting to 15%–40% of their total weight loss.

Muscle loss can be a real problem for older adults, leading to a condition called sarcopenia. Characterized by a loss of muscle mass and strength, the risk of sarcopenia increases with age. Sarcopenia increases the risk of falls, frailty, and even death. Adults with type 2 diabetes are three times as likely to develop it.

People taking Ozempic may be able to maintain their muscle mass by increasing their protein intake and adding or intensifying a strength training routine. Older adults should be especially diligent with these measures given their increased risk of sarcopenia — research shows that Ozempic is associated with a greater loss of muscle mass and function in this age group.

Increased side effects

Some studies show that older adults are both more likely to experience Ozempic side effects like nausea and to quit taking Ozempic because of them.

While Ozempic is designed to lower blood sugar, it can sometimes lower it too much, leading to hypoglycemia. The risk of hypoglycemia on Ozempic is similar among older and middle-aged adults. However, the consequences can be more serious for older adults: severe hypoglycemia increases the risk of falls by 70%. 

Dehydration is another concern for older adults taking Ozempic. It tends to be more common with the medication in general, due to side effects such as vomiting and diarrhea. Dehydration increases the risk of falls, which are the leading cause of hospitalization and injury-related death in older adults. 

Polypharmacy risks

Polypharmacy — taking four or more medications simultaneously — is quite common in older adults, since more health conditions tend to develop with age. Polypharmacy increases the risk of falls, adverse side effects, and drug interactions.

For many older adults, starting Ozempic may mean adding another medication to the mix. However, research suggests that semaglutide may also allow older adults to reduce their overall medications. For example, it can lower blood pressure or cholesterol enough to allow someone to stop taking separate medications for those conditions. 

Because Ozempic is also approved to treat chronic kidney disease and cardiovascular risk in people with type 2 diabetes, some people may be able to consolidate several medications into one.

The oral form of Ozempic may add complexity to a daily routine. The tablet must be taken once daily in the morning on an empty stomach with a small amount of water, and at least 30 minutes must pass before eating, drinking, or taking other oral medications. For people already managing multiple medicines, this timing can make scheduling more challenging.

If you’re thinking about taking Ozempic, here are some things to consider based on your age — or in general: 

1. Other health conditions you have. Besides type 2 diabetes, Ozempic may be a good fit for people with metabolic complications such as insulin resistance or prediabetes, Dr. Aje says, as well as chronic kidney disease or heart disease. 

2. Prior attempts to manage diabetes through diet or exercise. If following a diabetes-friendly eating plan hasn’t adequately controlled blood sugar levels, you may be a good candidate for Ozempic. 

3. Current eating habits and nutritional status. Adolescents have increased nutritional needs, so it’s important that they continue to meet them despite having a reduced appetite on Ozempic, Dr. Aje says. Meanwhile, older adults may already have a reduced appetite, but need to consume significantly more protein while taking Ozempic.

4. Risk factors. Before prescribing Ozempic to older adults, Dr. Aje says she evaluates their baseline muscle mass, risk of sarcopenia and falls, polypharmacy, kidney function, and overall frailty.

5. Mental health and history of disordered eating. While weight loss on Ozempic may relieve some of the mental health issues related to obesity in adolescents, it can also contribute to new restrictive eating patterns such as anorexia or orthorexia nervosa (an obsession with healthy eating). 

6. Tolerance for side effects. Ozempic can have uncomfortable side effects like vomiting, nausea, and diarrhea, which may or may not be more common in older adults.

7. Comfort with taking the medication long-term, possibly for life. Ozempic is intended for long-term use, and stopping it can cause blood sugar levels to increase.

The biggest concern with Ozempic in older adults is balancing the medication’s metabolic benefits while minimizing the potential risks, Dr. Aje says. “I prioritize slower dose titration, emphasize resistance training, and ensure adequate protein intake to mitigate muscle loss. In the right patient, the benefits can be substantial, but it should never be a one-size-fits-all approach.”

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Ozempic can be a safe and effective medication for adults of all ages, but it hasn’t been approved for children and may carry more risks for older adults. Here’s what to remember before taking Ozempic if you’re on either end of the age spectrum:

• You must be 18 years old to use Ozempic, according to the FDA. Other GLP-1 receptor agonists have been approved for children, including Wegovy and Saxenda for weight loss, and Trulicity and Victoza for type 2 diabetes.

• The safety of Ozempic for children has not been established, but studies are ongoing. In addition to the medication’s known side effects, potential risks include disordered eating and mental health impacts.

• Adults over 65 can safely use Ozempic, but there are increased risks. These include a higher risk of muscle loss, side effects, and polypharmacy complications.