Ozempic: Uses, Dosing, and How It Compares to Wegovy

What is Ozempic approved for?

Ozempic is a once-weekly subcutaneous injection of semaglutide, a GLP-1 receptor agonist [1]. The label says semaglutide stimulates insulin release and lowers glucagon release in a glucose-dependent way and causes a minor delay in gastric emptying; it also says the mechanism by which semaglutide reduces cardiovascular risk is not established [1].

The current label lists three uses, all in adults with type 2 diabetes [1]:

• improving blood sugar alongside diet and exercise;
• reducing the risk of major adverse cardiovascular events — cardiovascular death, non-fatal heart attack, non-fatal stroke — in adults with type 2 diabetes and established cardiovascular disease;
• reducing the risk of sustained eGFR decline, end-stage kidney disease and cardiovascular death in adults with type 2 diabetes and chronic kidney disease.

Ozempic is not approved for weight loss [1]. Safety and efficacy in pediatric patients have not been established [1].

Two safety points sit at the top of the label. Ozempic is contraindicated in people with a personal or family history of medullary thyroid carcinoma or MEN 2, and in people with a prior serious hypersensitivity reaction to semaglutide or to an excipient; anaphylaxis and angioedema have been reported [1]. Its boxed warning covers thyroid C-cell tumors seen in rodents at clinically relevant exposures — whether semaglutide causes these tumors, including medullary thyroid carcinoma, in humans is unknown [1].

How is Ozempic dosed?

The prescribing information describes this dosing schedule: 0.25 mg once weekly for 4 weeks, followed by 0.5 mg; the dose may increase to 1 mg after at least 4 weeks on 0.5 mg and to 2 mg after at least 4 weeks on 1 mg [1]. The 0.25 mg dose is a starting dose, not a maintenance dose [1]. For the kidney indication, the label directs an increase to 1 mg after at least four weeks on 0.5 mg [1].

Injections go under the skin of the abdomen, thigh or upper arm, on the same day each week, at any time of day, with or without meals; the label advises a different site each week when injecting in the same body region [1]. If a dose is missed, administer it within 5 days; otherwise skip it [1]. When Ozempic is used with insulin, the two are given as separate injections and never mixed; the same body region is acceptable but not adjacent spots [1].

How well does Ozempic lower blood sugar?

Ozempic is indicated to improve glycemic control in adults with type 2 diabetes as an adjunct to diet and exercise [1]. Reductions in HbA1c reported in the label's trials (0.5 mg / 1 mg doses): monotherapy for 30 weeks, -1.4 / -1.6 points versus -0.1 on placebo; against sitagliptin 100 mg at 56 weeks, -1.3 / -1.5 versus -0.7; against insulin glargine at 30 weeks, -1.2 / -1.5 versus -0.9; and 1 mg against exenatide extended-release 2 mg at 56 weeks, -1.4 versus -0.9 [1]. In the monotherapy trial, HbA1c fell below 7% in 73% and 70% of people on 0.5 mg and 1 mg versus 28% on placebo [1].

SUSTAIN FORTE compared once-weekly semaglutide 2.0 mg with 1.0 mg for 40 weeks in 961 adults with type 2 diabetes on metformin. HbA1c fell 2.2 versus 1.9 points and weight 6.9 versus 6.0 kg (trial-product estimand) [4]; the Ozempic label reports HbA1c reductions of 2.1 versus 1.9 points, with HbA1c below 7% in 64% versus 56% [1].

Does Ozempic reduce heart attacks, strokes and kidney failure?

The cardiovascular indication rests on SUSTAIN-6, which randomized 3,297 adults with type 2 diabetes — 83% with established cardiovascular disease, chronic kidney disease, or both — to semaglutide 0.5 or 1 mg or placebo for 104 weeks [5]. The composite of cardiovascular death, non-fatal heart attack or non-fatal stroke occurred in 6.6% on semaglutide versus 8.9% on placebo (hazard ratio 0.74, 95% CI 0.58 to 0.95) [5].

The kidney indication rests on FLOW, which randomized 3,533 adults with type 2 diabetes and chronic kidney disease to semaglutide 1 mg weekly or placebo and stopped early at a planned interim analysis [6]. Kidney failure, a 50% or greater fall in eGFR, or kidney or cardiovascular death occurred in 18.7% on semaglutide versus 23.2% on placebo over a median 3.4 years (hazard ratio 0.76, 0.66 to 0.88) [6].

SELECT is not an Ozempic trial. It gave semaglutide 2.4 mg — the weight-management dose — to 17,604 adults with established cardiovascular disease and a BMI of 27 or more but no diabetes; the same three-part composite fell from 8.0% to 6.5% (hazard ratio 0.80, 0.72 to 0.90) [7]. Cardiovascular death on its own was 2.5% versus 3.0% (hazard ratio 0.85, 0.71 to 1.01), and the label table notes superiority was not confirmed for that component [7].

How does Ozempic compare with Wegovy?

Ozempic is labeled for type 2 diabetes and has no weight-loss indication [1]. Ozempic's maximum labeled dose is 2 mg weekly [1].

The headline weight data come from the 2.4 mg weight-management dose, not Ozempic's labeled doses. In STEP 1, 1,961 adults with obesity or overweight and no diabetes lost a mean 14.9% of body weight on semaglutide 2.4 mg over 68 weeks versus 2.4% on placebo [2]. In STEP 2, adults with overweight or obesity and type 2 diabetes lost 9.6% of body weight on semaglutide 2.4 mg versus 3.4% on placebo over 68 weeks [8]. In STEP UP, weekly semaglutide 7.2 mg produced a mean 18.7% loss, against 15.6% on 2.4 mg and 3.9% on placebo, in 1,407 adults with obesity and no diabetes over 72 weeks [9]. The current Wegovy label allows up to 7.2 mg weekly in adults who tolerate 2.4 mg for at least 4 weeks and need more weight loss [17].

What are the side effects and label warnings?

Gastrointestinal effects dominate. In the label's pooled placebo-controlled trials in type 2 diabetes, nausea occurred in 20.3% on 1 mg versus 6.1% on placebo, vomiting in 9.2% versus 2.3%, diarrhea in 8.8% versus 1.9% and constipation in 3.1% versus 1.5%; any gastrointestinal reaction occurred in 36.4% versus 15.3%, and 3.8% versus 0.4% stopped treatment for a gastrointestinal reason [1]. Most reports of nausea, vomiting and diarrhea came during dose escalation [1].

The Ozempic prescribing information says acute pancreatitis has been observed and that treatment should be discontinued if pancreatitis is suspected; it also lists acute gallbladder disease, acute kidney injury from dehydration after vomiting or diarrhea, hypoglycemia when combined with insulin or a sulfonylurea, serious hypersensitivity, diabetic retinopathy complications, and pulmonary aspiration during general anesthesia or deep sedation [1].

On retinopathy, a two-year cardiovascular trial in type 2 diabetes found complications in 3.0% on semaglutide versus 1.8% on placebo, and 8.2% versus 5.2% among people who already had retinopathy [1].

Severe gastrointestinal reactions are also listed. The label says Ozempic is not recommended in people with severe gastroparesis, and postmarketing reports include ileus, intestinal obstruction and severe constipation with fecal impaction; the label does not state that semaglutide causes gastroparesis [1].

NAION, a sudden vision loss from optic nerve damage, is not mentioned in the current US labels. In Europe, EMA's safety committee concluded in June 2025 that it is a very rare side effect of semaglutide medicines, affecting up to 1 in 10,000 people, and advised stopping semaglutide if it is confirmed [10].

Pregnancy is not a contraindication in the label. The label says Ozempic should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus, and that it should be discontinued at least two months before a planned pregnancy because of the long washout period [1].

What does Ozempic interact with?

With insulin or a sulfonylurea, the risk of hypoglycemia rises, including severe hypoglycemia, and the label advises considering a lower dose of the insulin or sulfonylurea when starting [1].

Semaglutide delays gastric emptying and can change the absorption of oral drugs, so the labels advise closer monitoring for narrow therapeutic index drugs [1]. In the label's clinical pharmacology trials with the 1 mg injection, semaglutide did not affect the absorption of the oral medicines tested [1].

Oral contraceptives: semaglutide labels carry no advice to add a barrier method or switch methods [1]. A study of 43 postmenopausal women with type 2 diabetes found no reduction in the bioavailability of ethinyl estradiol or levonorgestrel during semaglutide treatment; levonorgestrel exposure (AUC) was 20% higher at steady state (ratio 1.20, 90% CI 1.15 to 1.26) and ethinyl estradiol exposure was 11% higher [11].

What happens when Ozempic is stopped?

The withdrawal data come from the 2.4 mg weight-management dose, not Ozempic's labeled doses. In STEP 4, 803 adults who had completed a 20-week run-in were randomized to continue semaglutide 2.4 mg or switch to placebo for 48 weeks: weight changed by -7.9% on continued treatment and +6.9% on placebo, a difference of 14.8 percentage points [15]. In the STEP 1 off-treatment extension, 327 participants who had lost a mean 17.3% regained 11.6 percentage points within a year of stopping, for a net loss of 5.6% [16].