Ozempic and gastroparesis: Why it happens and what to do about it

In this article:

• Ozempic gastroparesis: Why it happens
• What are the symptoms of gastroparesis?
• What else can cause gastroparesis?
• Can Ozempic cause permanent gastroparesis?
• What to do if you develop gastroparesis on Ozempic

In this article

• Ozempic gastroparesis: Why it happens
• What are the symptoms of gastroparesis?
• What else can cause gastroparesis?
• Can Ozempic cause permanent gastroparesis?
• What to do if you develop gastroparesis on Ozempic

Ozempic (semaglutide) is getting increased attention for its ability to control blood sugar levels for people with Type 2 diabetes and assist with weight loss. Although Ozempic and other glucagon-like peptide-1 receptor agonists (GLP-1 agonists) have proven benefits, some adverse effects have come to attention—some of which can be severe. One adverse condition linked to Ozempic is gastroparesis, which happens when the stomach struggles to empty its contents. 

Ozempic gastroparesis: Why it happens

Gastroparesis is a functional problem of the stomach. It happens when the stomach, a muscle, cannot contract enough to move food along to the small intestine normally. There is no blockage to blame; the stomach just doesn’t churn as it should. 

Ozempic stimulates GLP-1 receptors, which play a role in the movement of food from the stomach. Although this may explain the association between Ozempic and gastroparesis, no one is exactly sure of the mechanism.

Delayed gastric emptying is one way in which Ozempic reduces appetite. This partly explains why it may be prescribed off-label for weight loss, even though it isn’t approved by the Food and Drug Administration (FDA) for that indication. Novo Nordisk, the manufacturer of Ozempic, sells a separate drug that’s FDA approved for weight loss:  Wegovy. It has the same active ingredient as Ozempic (semaglutide) but is specifically FDA approved for weight loss. In contrast, Ozempic is approved for managing Type 2 diabetes and reducing the risk of cardiovascular events in people with diabetes and known heart disease. 

RELATED: Wegovy vs. Ozempic

When stomach emptying goes from simply slower to a problematic state, it is termed gastroparesis. In one study published in JAMA, people taking GLP-1 agonists had more than three times the incidence of gastroparesis than those taking an alternative obesity drug, Contrave (bupropion-naltrexone). And a large analysis of the issue reported that 5.1% of people experience gastroparesis on GLP-1 agonists.

What are the symptoms of gastroparesis?

Symptoms of gastroparesis can range from subtle to profound. On the mild end of the symptom spectrum, people may experience nausea, bloating, reduced appetite, and early satiety (feeling full sooner). More severe symptoms can involve vomiting, stomach pain, and malnutrition or dehydration from too little intake. The condition can even lead to a bezoar, which is a ball of undigested, retained food material in the stomach.

Keep in mind that abdominal pain during Ozempic treatment can be from other serious gastrointestinal issues besides gastroparesis. The drug has been linked to pancreatitis, a dangerous inflammatory condition of the pancreas, and it has been associated with gallbladder attacks. It is helpful to know these potential risks before starting Ozempic.

Another hazard posed by gastroparesis is related to surgical procedures. To reduce the risk of aspirating or breathing in regurgitated stomach contents, patients undergoing surgery routinely fast for a period of time to make sure their stomachs are empty. But if they have gastroparesis, their stomach may still be full even after an overnight fast. The American Society of Anesthesiologists has advised that GLP-1 agonists, including Ozempic, be stopped for a week in advance of surgery to reduce this risk.

What else can cause gastroparesis?

Gastroparesis does not just come from Ozempic. Other GLP-1 drugs could be associated with the issue, too. The drug class also includes Trulicity (dulaglutide), Victoza (liraglutide), Saxenda (liraglutide), Mounjaro (tirzepatide), Zepbound (tirzepatide) and Rybelus (oral semaglutide). The condition can even come from other medicine types, like proton pump inhibitors for acid reflux and Parkinson’s disease medication. 

Besides medications, some health conditions can cause gastroparesis, including diabetes mellitus. If diabetic gastroparesis is present, Ozempic and other GLP-1 agonists may not be a good choice, according to a 2020 review.

If a different diabetes medication is needed, options include biguanides, sulfonylureas, and sodium-glucose cotransporter 2 inhibitors (SGLT-2 inhibitors). These are not associated with gastroparesis. If cost is a factor in switching medication, particularly when it comes to the GLP-1 agonists or SGLT-2 inhibitors, a SingleCare discount card can help you save.

Can Ozempic cause permanent gastroparesis?

Media reports have come out about prolonged gastroparesis even after stopping the drug, but further investigation is needed to determine how long the problem can last.

Typically, once someone stops taking Ozempic, gastric emptying will slowly improve over the following four to five weeks as the drug is eliminated from the system. Published case reports illustrate this more common scenario. An association between GLP-1 agonists and permanent gastroparesis has not been determined. Additional studies are needed.

What to do if you develop gastroparesis on Ozempic

If you are having any side effects from Ozempic, including any that might be coming from gastroparesis, you should talk to your healthcare provider immediately. They may recommend reducing or stopping the medication, or they may recommend a gastric emptying study to evaluate the symptoms.

A review on the topic of gastrointestinal side effects with GLP-1 agonists provides some helpful gastroparesis prevention tips. Examples include eating slower, having smaller but more frequent meals, and not lying down or exercising after meals.