Ozempic: what it is used for, dosage and side effects

What Ozempic is and which active substance it contains

Ozempic contains the active substance semaglutide. Semaglutide belongs to the GLP-1 receptor agonists, a group of substances that imitate the action of a natural gut hormone, glucagon-like peptide 1. That hormone is released after a meal and takes part in regulating blood sugar and in the feeling of fullness.

The medicine comes as a pre-filled pen for injection under the skin. It is not a tablet and it is not insulin, although in type 2 diabetes it is often used alongside other medicines that lower blood sugar. In the European Medicines Agency data for the Maltese market it is listed with the active substance semaglutide and the route of administration: subcutaneous.

Telling apart medicines with the same active substance matters more here than usual. Semaglutide is on the Maltese list under several names, with different strengths and different authorised uses: Ozempic, Rybelsus, which is the form taken by mouth, and Wegovy, which is authorised for weight management and which we describe on /medicines/wegovy/. Swapping one for another is not justified in itself, and that decision belongs to a doctor.

Details of the composition, the strengths and the excipients are in the patient information leaflet in your pack. The list of medicines authorised in Malta is kept by the Medicines Authority, the body that authorises medicines here and monitors their safety.

The authorised use, and why that is not the same as weight loss

Ozempic is used in adults with type 2 diabetes when diet and physical activity have not brought blood sugar under satisfactory control. It may be prescribed on its own or together with other diabetes medicines, including insulin.

An authorised use is the frame in which a medicine was studied and approved, not a description of everything that can happen during treatment. Within that frame, Ozempic is not a weight loss medicine. Weight loss in some patients is a described consequence of how semaglutide acts, but it is not the use this product is authorised for, so a request for a prescription cannot be based on it.

Other medicines from the same or a related group are authorised for weight management. We describe them on /medicines/wegovy/, /medicines/saxenda/ and /medicines/mounjaro/, and there is a general overview of the group in the category /weight-loss-injections/. If you are unsure whether your own situation is about blood sugar or about weight, the two guides /health-guide/type-2-diabetes-symptoms/ and /health-guide/obesity-and-bmi/ explain what each of them means.

Type 1 diabetes and diabetic ketoacidosis are not conditions this medicine is intended for. Where a doctor prescribes a medicine outside its authorised use, that is a decision the doctor has to justify and supervise, and a questionnaire cannot replace it.

How semaglutide works

Semaglutide binds to GLP-1 receptors and sets off several effects at once. It increases the release of insulin from the pancreas, and it does so mainly when blood sugar is raised. At the same time it reduces the release of glucagon, the hormone that pushes blood sugar up.

Because that action depends on the blood sugar level, the risk of low blood sugar when the medicine is used on its own is lower than with some other groups. The risk does rise in combination with insulin or with a sulfonylurea, so in those cases a doctor often adjusts the doses of those other medicines.

The active substance also slows the emptying of the stomach and acts on the areas of the brain that regulate appetite. That is why many people eat less during treatment and lose some weight. Slower stomach emptying is also what explains the digestive complaints that are most common at the start.

The action is long lasting, so the medicine is not injected every day. The interval between injections is stated in the patient information leaflet and is set by a doctor. The full effect on blood sugar is not visible after the first injection; it builds up while the dose is stepped up. The effect is judged by a doctor from laboratory results, not by the patient from how they feel.

Dosage and use: what the doctor decides

The dose and the schedule for increasing it are set by a doctor. With GLP-1 receptor agonists, stepping up gradually is usual: treatment starts at a lower dose, which is then raised after a set period until a dose is reached that the patient tolerates and that gives the wanted effect. Going gradually reduces nausea and other digestive complaints.

We do not quote specific strengths, quantities or intervals on this page, because they depend on the pack and on the doctor's decision. They are in the patient information leaflet in your pack and in the instruction given to you by the doctor who is following your treatment.

The medicine is injected under the skin, and it makes sense to change the injection site. Do not share a pen with anyone else, even if you change the needle. The rules for storage and refrigeration are on the pack and in the leaflet.

If you miss an injection, follow the leaflet for your own pack; the rule differs depending on how much of the interval has passed. Doubling up on your own is not appropriate. Do not stop treatment by yourself, even when you feel better: stopping suddenly in type 2 diabetes means losing control of blood sugar, and any change of dose or a stop is something you agree with your doctor.

Side effects and when to contact a doctor

Side effects most often affect the digestive system: nausea, vomiting, diarrhoea or constipation, burping and a feeling of bloating. They are usually stronger after a dose increase and settle down over time in most people. Smaller meals, eating more slowly and avoiding very fatty food all help.

Tiredness, dizziness, headache and reactions at the injection site are also described. Because the medicine acts on the gallbladder and on the pancreas, a doctor pays particular attention to pain in the upper abdomen.

Stop using the medicine and seek medical help if you have severe and persistent abdominal pain, especially if it spreads to the back and comes with vomiting, or if you notice signs of an allergic reaction such as swelling of the face, lips or throat and difficulty breathing. In an emergency in Malta, call 112.

A change in vision during treatment is a reason to contact a doctor rather than to wait, particularly if you have diabetic eye disease. Information on how often each side effect occurs is in the patient information leaflet for your pack; we do not repeat those figures here, because they belong to the pack you actually hold.

Interactions, alcohol and when the medicine is not suitable

Slower stomach emptying can affect how medicines taken by mouth pass into the blood. For most medicines that has no practical meaning, but for those with a narrow margin between a useful and a harmful level, a doctor takes it into account. It is worth bringing to the assessment a complete list of everything you take, including products bought without a prescription, food supplements and herbal preparations.

The combination that needs most attention is treatment with insulin or with a sulfonylurea at the same time. In those combinations the risk of low blood sugar is higher, so a doctor often lowers the doses of those medicines and advises measuring blood sugar more often. It is worth being able to recognise the signs of low blood sugar, such as shaking, sweating, confusion and strong hunger.

Alcohol and this medicine are not directly incompatible, but the combination is not neutral either. Alcohol changes blood sugar by itself, puts a load on the pancreas and makes worse the digestive complaints that are most common with this treatment. In diabetes, the fall in blood sugar after alcohol comes late, often only during the night.

Before prescribing, a doctor checks the situations in which this treatment is not recommended or needs particular care: a past inflammation of the pancreas, more serious disease of the digestive system, gallbladder disease and advanced diabetic eye disease. Pregnancy, planning a pregnancy and breastfeeding are circumstances to discuss with a doctor before use, as is a family history of rare thyroid and endocrine disease.

Prescription status, cover and the price at the pharmacy

Ozempic is prescription only, so a pharmacy does not supply it without a prescription. The decision to prescribe belongs to a doctor, after an assessment of your medical information. We do not sell medicines and we do not ship them: our service is a medical assessment and the issuing of a document.

Whether this medicine is covered by the public health service in Malta, and on what terms, is decided by the health authorities and not by us. Our service is private and is not covered by them, so the price of the medicine at the pharmacy and our fee are two separate items that are worth keeping separate in your own budgeting.

The price of the medicine changes over time and depends on the pack and on the dose you have reached, which is why we do not quote it on an information page. A pharmacy will tell you the current amount, and a pharmacy is also the only lawful source of supply. We write about the relationship between the fee for an assessment and the price of the medicine in the article /blog/online-prescription-cost-malta/.

What we can do and what the fee covers

Our model is a medical questionnaire that a doctor reviews asynchronously, from the answers you give and any records you attach. There is no video call, no phone call and no live chat with a doctor. A questionnaire cannot replace a physical examination, so starting this kind of treatment for the first time needs a doctor who examines you and then follows you up.

If treatment for type 2 diabetes is already under way and this is only a continuation, you can ask for an assessment at /repeat-prescription/ for 24,90 €. Priority handling is available for an extra 9,90 €, which is not a promise of a deadline. If the continuation concerns a medicine authorised for weight management, the matching service is /weight-loss/ for 29,90 €. What a doctor looks at when renewing is described in /blog/repeat-prescription-without-a-visit/.

If the doctor issues a prescription, you receive the document by email as a PDF, drawn up in the standard EU cross-border format set out in Directive 2012/52/EU; its recognition in another member state is governed by Directive 2011/24/EU. There is no code to quote and the document is not entered in any Maltese state health record, so you go to the pharmacy with a printout or with the PDF on screen, together with photo identification. A pharmacy in Malta may dispense it; the decision rests with the pharmacist, who can refuse, for example where there is any doubt about the document or where the medicine is not available locally. What a pharmacy checks is explained in /blog/eu-prescription-maltese-pharmacy/.

The fee covers the doctor's assessment, not the issuing of a document. If the doctor declines on medical or legal grounds, we refund the fee. If we ask you for medical records, you have at least 7 days to reply. We then send a reminder and extend the deadline on request, and where the assessment still cannot be completed we close the request and refund the fee. The assessment is carried out by Damian Wojno, a doctor registered in Poland, licence no. 3211301, MEDINOW Sp. z o.o. He is not registered with the Medical Council of Malta, which keeps the register of doctors practising here; his licence to practise is Polish. Narcotic and psychotropic substances are excluded from cross-border prescriptions under Article 11(6) of Directive 2011/24/EU, and semaglutide is not in that group.