Who Should Not Take Ozempic?

Ozempic (semaglutide) has become one of the most prescribed medications for type 2 diabetes and, through its sister drug Wegovy, for weight loss. While it's highly effective for many people, it's not appropriate for everyone. Understanding who should not take Ozempic is crucial for your safety. This guide covers the absolute contraindications (situations where you should never take it), relative contraindications (situations requiring extra caution), and important drug interactions to be aware of. Always discuss your complete medical history with your healthcare provider before starting any new medication.

Absolute Contraindications

These are situations where Ozempic should NOT be taken under any circumstances:

Personal or family history of medullary thyroid carcinoma (MTC) - Semaglutide caused thyroid C-cell tumors in rodent studies. While the relevance to humans is uncertain, the risk is considered too high for those predisposed to this rare cancer.
Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) - This genetic condition significantly increases MTC risk, making GLP-1 medications contraindicated.
Known hypersensitivity to semaglutide - If you've had an allergic reaction to semaglutide or any ingredients in Ozempic, you cannot take it.
Pregnancy - Ozempic may cause fetal harm. It should be discontinued at least 2 months before planned pregnancy.
Breastfeeding - It's unknown whether semaglutide passes into breast milk; not recommended during breastfeeding.

The FDA requires a black box warning on Ozempic regarding thyroid C-cell tumor risk. This is the most serious warning type the FDA issues.

History of Pancreatitis

Pancreatitis (inflammation of the pancreas) requires careful consideration: The concern: GLP-1 receptor agonists, including semaglutide, have been associated with cases of acute pancreatitis in clinical trials and post-marketing reports. While a direct causal relationship hasn't been definitively established, the association warrants caution. Who's at higher risk: • Previous history of pancreatitis • History of gallstones (gallstones can cause pancreatitis) • Heavy alcohol use • Very high triglyceride levels • Certain medications that increase pancreatitis risk If you have a history of pancreatitis: • Discuss the risks and benefits thoroughly with your provider • Some providers may still prescribe with careful monitoring • Others may recommend alternative treatments • If prescribed, know the warning signs of pancreatitis

Symptoms of pancreatitis include severe abdominal pain that may radiate to the back, nausea, vomiting, and fever. Seek immediate medical attention if these occur.

Diabetic Retinopathy

If you have diabetic eye disease, particularly diabetic retinopathy, you need to be aware of potential risks: What the research shows: In clinical trials, rapid improvements in blood sugar control with semaglutide were associated with temporary worsening of diabetic retinopathy in some patients. This appears to be related to the speed of glucose improvement rather than the medication itself. Who should be cautious: • Anyone with existing diabetic retinopathy • Particularly those with proliferative diabetic retinopathy • Patients with a history of diabetic macular edema Recommendations: • Have a comprehensive eye exam before starting Ozempic • Inform your ophthalmologist you're starting treatment • Monitor for visual changes during treatment • Schedule regular eye exams during therapy • Report any vision changes immediately This doesn't necessarily mean you can't take Ozempic, but close monitoring is essential.

The worsening of diabetic retinopathy appears to be temporary in most cases and related to rapid blood sugar changes. Gradual dose titration may help minimize this risk.

Kidney Disease

Ozempic requires caution in patients with kidney problems: How kidneys are affected: • Semaglutide itself doesn't require dose adjustment for kidney function • However, the side effects of Ozempic can impact kidney health • Nausea, vomiting, and diarrhea can cause dehydration • Dehydration can worsen kidney function or cause acute kidney injury Higher risk situations: • Chronic kidney disease (especially stages 4-5) • History of acute kidney injury • Taking other medications that affect kidneys (NSAIDs, certain blood pressure medications) • Limited fluid intake ability Precautions if you have kidney disease: • Stay well hydrated • Report prolonged nausea, vomiting, or diarrhea immediately • May need more frequent kidney function monitoring • Your provider may start at lower doses with slower titration

Cases of acute kidney injury have been reported in patients taking GLP-1 medications, often in the setting of dehydration from GI side effects. Maintain adequate hydration.

Gastroparesis and GI Disorders

Gastrointestinal conditions may make Ozempic problematic: How Ozempic affects the GI system: Semaglutide works partly by slowing gastric emptying—food stays in your stomach longer, which helps with satiety but can worsen certain conditions. Conditions requiring caution: • Gastroparesis (delayed stomach emptying) - Ozempic can significantly worsen this condition • Severe gastroesophageal reflux disease (GERD) • History of bowel obstruction • Inflammatory bowel disease (Crohn's, ulcerative colitis) • History of severe constipation Why this matters: • Slowed gastric emptying can cause severe nausea and vomiting • May worsen reflux symptoms • Can affect absorption of oral medications • May increase risk of bowel obstruction in predisposed individuals If you have GI conditions: • Discuss thoroughly with your gastroenterologist • May need to start at even lower doses • Requires careful monitoring • May not be appropriate depending on severity

Mental Health Considerations

Recent attention has focused on potential mental health effects: What we know: The FDA and EMA have been investigating reports of suicidal thoughts and self-harm in patients taking GLP-1 medications, including semaglutide. As of early 2025, no definitive causal link has been established, but monitoring continues. Who should be cautious: • History of depression, especially severe or treatment-resistant • History of suicidal ideation or attempts • Bipolar disorder • Other serious mental health conditions Recommendations: • Inform your provider of any mental health history • Have a mental health management plan in place • Monitor for mood changes when starting treatment • Know warning signs and have emergency contacts ready • Don't discontinue mental health medications without guidance Important context: • Weight loss itself can affect mood and mental health • Body image changes can have psychological impacts • Some people experience improved mental health with weight loss • The relationship is complex and individual

Keep a mood journal when starting Ozempic. Track any changes in your emotional state, sleep, or thought patterns and discuss with your healthcare provider.

Drug Interactions

Several medications interact with Ozempic: Diabetes medications: • Insulin and sulfonylureas (glipizide, glyburide, glimepiride) - Increased risk of hypoglycemia; doses often need reduction • Other GLP-1 medications - Should not be combined Medications affected by delayed gastric emptying: • Oral contraceptives - May have altered absorption; consider non-oral methods • Levothyroxine - May need timing adjustments • Antibiotics taken with food • Any medication with narrow therapeutic window Other considerations: • Warfarin - May need more frequent INR monitoring • Medications that cause nausea - Combined effects may be problematic • Diuretics - Increased dehydration risk with GI side effects What to do: • Provide a complete medication list to your provider • Include over-the-counter medications and supplements • Ask about timing of medications • Monitor for changes in medication effectiveness

If you take insulin or sulfonylureas for diabetes, your doses will likely need to be reduced when starting Ozempic to prevent dangerous low blood sugar.

Age Considerations

Age-related factors affect Ozempic suitability: Children and adolescents: • Ozempic is FDA-approved for type 2 diabetes in adults only • Wegovy (same drug, different dose) is approved for ages 12+ for obesity • Long-term effects in growing bodies not fully studied • Should only be used under specialist supervision in youth Older adults (65+): • Can generally use Ozempic safely • May be more susceptible to dehydration • Higher risk of hypoglycemia if on other diabetes medications • May need slower dose titration • GI side effects may be less tolerable • Consider nutritional status—unintentional weight loss can be harmful Very elderly (80+): • Risk-benefit analysis becomes more complex • Sarcopenia (muscle loss) is a greater concern • Falls risk may increase with weight loss • Quality of life considerations become paramount • Requires individualized assessment

Surgical Considerations

Planning surgery? Here's what you need to know: Why it matters: Ozempic delays gastric emptying significantly. Food (and medication) stays in the stomach longer than normal. This is a concern for anesthesia because of aspiration risk—stomach contents entering the lungs during sedation. Current recommendations: • The American Society of Anesthesiologists suggests holding GLP-1 medications before elective surgery • Recommendations vary: some suggest 1 week, others up to 2-3 weeks • This applies to procedures requiring sedation or anesthesia What to do: • Tell your surgeon and anesthesiologist you take Ozempic • Ask specifically how long to hold the medication • Follow fasting instructions carefully • Report any GI symptoms before surgery • Your surgery may need rescheduling if you have GI symptoms

Keep a medication card in your wallet noting that you take Ozempic. This information is critical for emergency medical personnel.

When to Talk to Your Doctor

Before starting Ozempic, have a thorough discussion if you have:

Any thyroid problems or thyroid nodules
Any history of pancreatitis or pancreatic disease
Diabetic retinopathy or other diabetic eye disease
Kidney disease or history of kidney problems
Liver disease
Digestive system disorders (gastroparesis, GERD, IBD)
History of depression, anxiety, or other mental health conditions
Plans to become pregnant or are breastfeeding
Upcoming surgical procedures
Taking insulin or sulfonylureas for diabetes
History of eating disorders

Bring a written list of all your medical conditions, medications (including supplements), and questions to your appointment. This ensures nothing is forgotten.

The Bottom Line

Ozempic is a powerful and effective medication, but it's not right for everyone. The absolute contraindications—personal or family history of medullary thyroid cancer, MEN 2 syndrome, and known allergy to semaglutide—are non-negotiable. Pregnancy and breastfeeding are also clear contraindications. Many other conditions fall into a gray area where Ozempic might still be appropriate with careful monitoring, dose adjustments, or additional precautions. These decisions should be made collaboratively with your healthcare provider, weighing the potential benefits against your specific risks. If you're considering Ozempic for diabetes management or weight loss, complete transparency about your medical history is essential. Don't minimize or forget to mention conditions that might seem unrelated—they could be crucial for your safety. Remember that this article provides general information based on current medical knowledge. Your individual situation may have unique factors that affect these recommendations. Always consult with qualified healthcare providers who know your complete medical history before starting or stopping any medication.

Sources & References

FDA Prescribing Information for Ozempic (semaglutide)
American Diabetes Association Standards of Medical Care in Diabetes
American Society of Anesthesiologists - GLP-1 Agonist Guidance for Elective Surgery
FDA Drug Safety Communication on GLP-1 Receptor Agonists
European Medicines Agency - Semaglutide Safety Review
National Kidney Foundation - GLP-1 Agonists and Kidney Disease