The most important things to know about the Ozempic pill

If you have type 2 diabetes, you have a range of medication options for helping manage your blood sugar — and the newest one of those choices is the Ozempic pill. It’s a glucagon-like peptide-1 receptor agonist (aka GLP-1) that you take as a daily pill as opposed to a weekly injection. That may sound more appealing — especially if you’re nervous about shots — but there are some key things to know when considering if the Ozempic pill is right for your health needs. 

The Ozempic pill  is a brand name for the medication semaglutide that is approved by the Food and Drug Administration (FDA) for type 2 diabetes management. Taken as a daily pill, it’s in the class of medications known as GLP-1s. These medications mimic the GLP-1 hormone to improve insulin response, control appetite, and help you feel full longer — all things that can lead to better blood sugar control.

Currently, there is no generic version of oral semaglutide (the active ingredient in the Ozempic pill) because the brand is still protected under its patent. 

The Ozempic pill is approved to help those with type 2 diabetes manage their blood sugar. It’s been shown to lower A1C and reduce the risk of major cardiovascular events such as stroke and heart attack, in adults with type 2 diabetes who are at high cardiovascular risk - including those who have established heart disease or chronic kidney disease.

When combined with regular physical activity and healthy eating, the Ozempic pill can help lower A1C levels in people with type 2 diabetes. Research shows that the Ozempic pill lowers A1C levels by an average of 1% to 1.3%, depending on the dose.

While the Ozempic pill can help with modest weight loss, it is not a weight loss medication; other oral medications that target the GLP-1 receptor have much greater effects on weight loss. For example, in one-year studies, patients lost an average 4.7% of their body weight on the Ozempic pill. Compared with two oral GLP-1s that are approved specifically for weight-loss, people lost 11% on the Foundayo pill (a newer type of oral medication called a small-molecule GLP-1) and 14.7% on the Wegovy pill.

Taken as an oral medication, the Ozempic pill mimics a natural hormone in the body, glucagon-like peptide 1, that keeps blood sugar levels controlled. Your body produces GLP-1 whenever you eat, signaling to the pancreas to release insulin as a way to control blood sugar. The Ozempic pill has the same impact as the naturally occurring hormone, but for an extended period of time.

GLP-1 medications like the Ozempic pill also slow the rate of stomach emptying, which not only helps you feel full for longer — contributing to modest weight loss — but is another factor for improving insulin response.

Many GLP-1s are delivered through an injection pen, but because the Ozempic pill is a tablet, it may be appealing to those who'd rather not go the injection route.

The Ozempic pill comes in three dosages:

• 1.5 mg

• 4 mg

• 9 mg

No matter which dose you’re taking, you should have the pill in the morning with a small bit of water 30 minutes before your first meal or beverage. It’s important to follow these directions. If you take the medicine with food in your stomach, it may lessen the effect of the Ozempic pill.

There is a recommended Ozempic pill dosing schedule, but your provider may tweak it depending on how your body is responding to the medication. Here’s how it tends to go:

• Days 0-30: 1.5 mg is the starting daily dose to reduce G.I. side effects, but not intended to lower blood sugar

• Days 31-60: 4 mg daily dose 

• Days 61+: 4 mg daily dose; may increase to 9 mg daily dose (if needed)

The Ozempic pill can have side effects similar to other medications that have semaglutide as an active ingredient, though the intensity, duration, and frequency of side effects can range from person to person. Here’s what to look out for.

The most common side effects for the Ozempic pill are: 

• Nausea

• Constipation

• Decreased appetite

• Diarrhea

• Stomach pain

• Vomiting

These don’t happen to everyone. At the highest Ozempic Pill dose (9 mg), about 20% of people have nausea and 11% have abdominal pain, for example. Similar to other GLP-1 medications, you’re most likely to experience side effects when first starting the drug or when you’re increasing the dosage. For the full list of side effects, visit the Ozempic pill site.

The most serious side effect mentioned for the Ozempic pill is the risk of thyroid tumors. However, this warning is based on animal studies. Researchers haven’t found a connection to people taking the Ozempic pill and these tumors. That said, the manufacturer of the Ozempic pill urges anyone to let their healthcare provider know if they get a lump or swelling in your neck, or have hoarseness, trouble swallowing, or shortness of breath while taking the Ozempic pill. 

If you are comfortable giving yourself an injection, you can talk with your provider about other GLP-1s approved for the treatment of Type 2 Diabetes, like the injectable form of Ozempic (semaglutide), Mounjaro (tirzepatide), Victoza (liraglutide), and Trulicity (dulaglutide). In addition to GLP-1s, other medications that can lower blood sugar include:

• Metformin

• DPP-4 inhibitors like linagliptin (Tradjenta) and sitagliptin (Januvia)

• SGLT2 inhibitors like empagliflozin (Jardiance) and dapagliflozin (Farxiga)

• Sulfonylureas like glimepiride (Amaryl) and glyburide (Diabeta)

• TZDs like rosiglitazone (Avandia) and pioglitazone (Actos)

According to the FDA, you should be aware that some people in the Ozempic pill trials developed the following health issues:

• Pancreatitis

• Diabetic retinopathy complications

• Hypoglycemia

• Hypersensitivity reactions

• Acute kidney injury

• Acute gallbladder disease

These outcomes were rare and didn’t occur in significant enough numbers for the FDA to issue a caution about the medication.

There is also insufficient data about use of semaglutide in pregnant women and there is some evidence in animal studies that a fetus could be affected by the drug during pregnancy. Because of that, GLP-1 medications including Ozempic are not recommended for use during pregnancy or while breastfeeding.

Before starting any medication, it’s important to discuss what you’re already taking with your provider — some over-the-counter or prescription drugs may interact with the Ozempic pill. These include: 

• Blood sugar-lowering medications

• Diuretics

• Thyroid medications

• Blood pressure medications

Also, be cautious when drinking alcohol when taking the Ozempic pill, since that may affect blood glucose levels in the form of either hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar), depending on how much and how often you drink. Particularly avoid drinking alcohol on an empty stomach or following exercise when taking the Ozempic pill, which can increase risk of hypoglycemia.

Like all medications, the cost of the Ozempic pill with insurance depends on your actual plan, your yearly deductible, and copay amounts. That said, if you have health insurance, you can pay as little as $25 for up to a 3-month prescription for the injection pen or the pill, according to the manufacturer Novo Nordisk. The retail price for the Ozempic pill that’s approved for type 2 diabetes ranges from $149 to $299 per month for uninsured or self-pay, depending on if you’re a new patient and what dose you’re taking. 

The Ozempic pill is a type 2 diabetes medication taken as a daily pill. It does not result in the same weight loss as injectable GLP-1s. People who take the Ozempic pill start out on the lowest dose and gradually work their way up to one that controls their blood sugar adequately. Side effects tend to be mild, like nausea. As with any medication, it's essential to talk with your health provider about your goals for diabetes control to see if the Ozempic pill might be a fit for your needs.