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Long-term side effects of Ozempic

Learn how Ozempic can affect long-term health and ways to reduce risks
Racheal Ede
By | Dec. 3, 2025 Medically reviewed by Jessica Swirble, Pharm.D.
Ozempic pen: Long-term side effects of Ozempic

Key takeaways

  • Potential long-term side effects of Ozempic include diabetic retinopathy, acute kidney injury, and mood disturbances.

  • Gastrointestinal problems are the most common side effects of Ozempic.

  • Keep a symptom journal and report any unusual side effects to your healthcare provider.

In this article:

Ozempic is a glucagon-like peptide 1 receptor agonist (GLP-1RA). It is approved for controlling blood sugar levels in adults with Type 2 diabetes to be used in combination with healthy eating and regular exercise. Off-label, your healthcare provider may prescribe Ozempic for weight loss.

Like most drugs, Ozempic can cause adverse effects such as mood disorders and gastrointestinal issues. This article covers the most common and potential long-term side effects that Ozempic may cause, along with strategies to manage them.

Common side effects of Ozempic

Gastrointestinal symptoms, including nausea, vomiting, diarrhea, and constipation, are the most common side effects associated with Ozempic. 

“Skin changes are common, including something known as ‘Ozempic face’ which is due to rapid loss of fat, which can result in a hollowed look, wrinkles, sunken eyes, and sagging jowls,” says Wiljon Beltre, board-certified and fellowship-trained surgeon specializing in bariatric and metabolic surgery, in Orlando.

Other common side effects include:

  • Abdominal pain
  • Indigestion
  • Gastroesophageal reflux disease (GERD)
  • Flatulence (gas)
  • Injection site reactions
  • Hypoglycemia (low blood sugar)
  • Gastritis (inflammation of the stomach lining)

Serious side effects of Ozempic

While less common, Ozempic may also cause serious side effects, including:

  • Thyroid tumors
  • Acute kidney injury
  • Serious hypersensitivity reactions (e.g., angioedema—swelling of tissues in the face, eyes, and lips)
  • Acute gallbladder disease
  • Pancreatitis (inflammation of the pancreas)
  • Cholelithiasis (gallstones)
  • Diabetic retinopathy

What are the long-term side effects of Ozempic?

“The most common long-term side effects I see in my patients on Ozempic are nausea, diarrhea, or constipation. I have also seen several patients develop hypotension (low blood pressure) and dizziness on Ozempic, especially in those on blood pressure medications,” says Jennifer Brown, MD, a dual board-certified physician in family medicine and obesity medicine, in West Virginia.

The following are some long-term side effects associated with Ozempic:

Gastrointestinal issues 

“The most common side effect I see in patients on Ozempic is chronic nausea. In my experience, the nausea usually resolves after a few weeks, but some patients have ongoing nausea,” Dr Brown says. 

She also adds that, “Ozempic is associated with gastroparesis, characterized by significantly delayed gastric emptying. There is some concern that gastroparesis can be permanent for some patients, even after stopping Ozempic.”

Thyroid cancer 

Ozempic is contraindicated in patients with a personal or family history of medullary thyroid cancer (MTC) or Multiple Endocrine Neoplasia type 2 (MEN2) syndrome.

This is because there are findings suggesting that the use of semaglutide, like Ozempic, for long periods (1 to 3 years) increases the risk of thyroid cancers.

Anxiety and Depression 

Ozempic may increase the risk of mood disturbances. A case report published in the Journal of Innovations in Clinical Neuroscience noted that a patient who was treated with Ozempic for Type 2 diabetes started experiencing symptoms of major depression within four weeks of starting the medication. The patients had symptoms such as irritability, anxiety, sleep difficulties, and loss of interest in leisure activities, and these improved after they discontinued Ozempic.

A large community-based cohort study found that individuals treated with GLP-1RAs such as Ozempic were at higher risk of developing anxiety, depression, and suicidal thoughts, compared to the group who were not on GLP-1RAs. The occurrence rate of these mental health disorders increased the longer patients remained on GLP-1RAs. 

At one year, the incidence rate was 15.29% in the GLP-1RA group versus 7.63% in the non-GLP-1RA group. By three years, rates rose to 29.62% in the GLP-1RA group versus 16.45% in the non-GLP-1RA group, and at five years, to 39.64% in the GLP-1RA group versus 23.38% in the non-GLP-1RA group.

Cardiovascular concerns

“Ozempic can cause tachycardia (elevated heart rate) and low blood pressure, which is usually related to rapid weight loss and not the medication itself,” Dr. Brown says. 

However, she adds that, “Ozempic generally has a positive cardiac effect. Research shows reduced cardiovascular mortality in patients with diabetes who take Ozempic.” A study found that GLP-1RAs such as Ozempic reduced the risk of heart attacks and strokes in patients with Type 2 diabetes. 

Acute kidney injury

The FLOW study revealed that Ozempic may have protective effects on the kidneys. They found that it slowed the progression of kidney disease in patients with Type 2 diabetes and chronic kidney disease (CKD).

However, researchers advise monitoring individuals with stage 3b to 4 CKD, especially those who experience severe gastrointestinal side effects that might cause dehydration. This may increase the risk of acute kidney injury. Acute kidney injury occurs when the kidneys are unable to filter waste products from the blood, and it develops within days or even hours.

Diabetic Retinopathy 

Ozempic may be associated with the progression of diabetic retinopathy (damage to the blood vessels in the retina).

Hence, experts recommend more frequent eye exams for individuals taking Ozempic, especially those with mild diabetic retinopathy. Instead of the standard six-month interval, patients with mild retinopathy are advised to schedule follow-up appointments every three months to monitor for any progression. The good news is that any worsening of diabetic retinopathy is typically manageable and may be temporary, with improvement often seen after 12 to 18 months.

Ozempic has also been associated with a blinding eye disease known as non-arteritic anterior ischemic optic neuropathy (NAION). However, there’s not enough conclusive evidence to discourage patients from using the medication.

How long do Ozempic long-term side effects last?

“Side effects like nausea, vomiting, and diarrhea tend to be short-term and may flare up when you first start the meds or when dosages are increased. Generally, these symptoms will resolve over time (usually within three months) or once you stop taking the meds,” Dr. Beltre says.

How to avoid or manage Ozempic long-term side effects

Side effects are common with most medications. The best you can do is to adopt safe medication-taking habits to reduce your chances of developing those potential long-term effects associated with Ozempic, and here are ways to do that:

  1. Stick to your dosage

Read the medication label carefully to reduce the risk of dosing errors, adverse reactions, and interactions. “Dosages should always be increased gradually, as recommended by your doctor, so that your body has time to adjust properly. Never change your dose without talking to your healthcare provider first,” Dr. Beltre says.

Usually, Ozempic should be taken once weekly, on the same day each week, at any time of day.

  1. Follow healthy eating habits

Gastrointestinal side effects like nausea are common with Ozempic. Some tips to reduce nausea include: 

  • Eat bland, low-fat foods like rice.
  • Eat watery foods like soup.
  • Eat slowly.
  • Do not lie down immediately after eating.
  • Avoid greasy or fried foods.
  1. Stay hydrated

“I also recommend that patients on Ozempic stay well-hydrated and track their daily fluid intake. This helps prevent tachycardia and hypotension,” Dr. Brown says.

  1. Change injection sites

To avoid skin reactions, alternate injection sites such as under the skin of your stomach, abdomen, thigh, or upper arm after every weekly injection. If you notice any unusual reactions, inform your healthcare provider.

  1. Keep your healthcare provider in the loop

Make all decisions in collaboration with your healthcare provider. If you feel you need to reduce or increase the dose, or discontinue the medication, talk to them before making any decisions.

  1. Keep a symptom journal

“It can also be useful to keep a symptom journal and bring this to follow-up appointments with your doctor; this can ensure any side effects are recorded and dosages can be altered if needed,” Dr Beltre says.

Ozempic alternatives

Apart from Ozempic, there are alternatives approved by the U.S. Food and Drug Administration (FDA) for blood sugar control in adults with Type 2 diabetes.

Examples of injectables that may pass as Ozempic alternatives include:

In addition, there are oral alternatives like Actos (pioglitazone), Amaryl (glimepiride), Metformin extended-release, and Glucotrol (glipizide). Your healthcare provider may also recommend non-pharmaceutical options, including lifestyle habits such as maintaining a regular exercise routine, optimizing your sleep schedule, reducing stress levels, and following a balanced diet.

 

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