Semaglutide can cause nausea: How to get relief

Nausea is the most common side effect of semaglutide, which is available by the brand names Ozempic, Wegovy, and Rybelsus. It usually happens when you first start the medication or increase your dose.

Semaglutide is an FDA-approved once-weekly glucagon-like peptide-1 (GLP-1) agonist used for treating type 2 diabetes. Semaglutide is also prescribed for long-term weight management in individuals who are obese (with a body mass index of 30 or higher) or overweight (with a body mass index of 27 or higher) with at least one weight-related condition such as cardiovascular disease, high blood pressure, or type 2 diabetes.

Let’s explore why and when nausea occurs with semaglutide injections, how to manage it, and consider lifestyle changes, prescription anti-nausea medications like Zofran (ondansetron) and alternatives for those experiencing severe nausea.

Does semaglutide cause nausea?

Yes, nausea is the most common side effect of semaglutide, and the likelihood of experiencing nausea increases with higher doses.

Sstudies show that nausea is the most common stomach-related side effect, affecting 15-50% of people, especially in the first 4-5 weeks of treatment.

Regardless of the semaglutide dose and form, or whether you’re using it for diabetes or obesity, there’s a chance you may experience nausea.

Apart from nausea, other common side effects of Ozempic (semaglutide) include vomiting, diarrhea, constipation, and stomach pain. Appetite loss, headaches, and fatigue are also reported.

While rare, semaglutide can cause serious side effects like hypoglycemia (low blood sugar), pancreatitis (inflammation of the pancreas), gallbladder problems (gallstones), and vision changes.

What causes nausea with semaglutide?

The exact cause of nausea from semaglutide isn’t fully understood, but it’s thought to be related to how the medication affects the digestive system and the central nervous system.

Semaglutide slows down the movement of food from the stomach to your small intestine, causing food to stay in your stomach for a longer time (delayed gastric emptying), which can cause feelings of fullness and discomfort. This delay in digestion may lead to nausea and other stomach issues.

Another theory is that semaglutide, which belongs to a group of medications called GLP-1 receptor agonists, may cause nausea by activating GLP-1 receptors in the brain, which helps control appetite and blood sugar levels. However, this activation can also trigger nausea.

Another reason could be that, as semaglutide suppresses appetite, reduces your hunger and makes you feel fuller, eating larger portions of food might cause nausea, bloating, or discomfort.

People who are most likely to experience nausea from semaglutide include those who are new to the medication, those who start with a higher dose, are used to eating spicy foods, or those who have a sensitive stomach. Nausea is also more common in the first few weeks of treatment.

How common is nausea with semaglutide?

In clinical trials of Ozempic and Wegovy, nausea was reported in:

• 15.8% of people taking a 0.5 milligram (mg) dose
• 20.3% of people taking a 1 mg dose
• 44% of people taking a 2.4 mg dose

Nausea is a common side effect of semaglutide, but it’s also seen with other similar medications in the GLP-1 receptor agonist class. Here’s a comparison of nausea incidence in other weight loss medications:

• Liraglutide (Victoza, Saxenda): A medication primarily used for the treatment of type 2 diabetes and weight management. Nausea occurs in about 20% to 30% of people taking this medicine.
• Dulaglutide (Trulicity): A medication used primarily for the treatment of type 2 diabetes and as an off-label medication for weight loss. Around 10% to 20% of individuals report nausea.
• Exenatide (Byetta, Bydureon): A medication primarily used to manage type 2 diabetes. Nausea affects approximately 20% to 30% of people taking this medicine.

While nausea is a common side effect of all these medications, its severity and frequency may vary, and it often improves as the body adjusts to the medication.

How long does nausea last with semaglutide?

Since everyone responds differently to medication, there’s no specific time for how long semaglutide nausea will last or when side effects will happen. However, nausea is most common in the first 8 to 12 weeks of treatment.

A study found that nausea was at its worst about 20 weeks after starting treatment, then improved. On average, each episode of nausea lasted about eight days.

You may feel nauseous when you first start semaglutide or after each dose increase, but it should get better as your body adjusts to the medication.

Tips to relieve nausea from semaglutide

Side effects from semaglutide are usually easy to manage at home with over-the-counter medicine and diet changes. Here’s how to ease nausea from semaglutide or at least feel better when it happens:

1. Start at a low dose and gradually increase

Starting with a lower dose of semaglutide and gradually increasing the dose can help reduce stomach side effects like nausea. This allows your body to get used to the medication at a slower pace, making it easier to tolerate.

If the nausea doesn’t go away, tell your doctor. They may keep you on your current dose longer before increasing it. This approach, known as gradual dose adjustment, gives your body more time to adjust to the medication at a slower pace, potentially reducing side effects like nausea.

By extending the time before increasing the dose, your body may become more tolerant to semaglutide, which can help alleviate discomfort.

Your doctor will also assess the severity and duration of the nausea. If it is mild to moderate, it may resolve as your body adapts over time. However, if it is severe or persistent, your doctor might adjust the treatment plan by either keeping the dose the same or adding other measures, such as anti-nausea medications or lifestyle changes, to manage the symptoms.

2. Inject before going to sleep

Semaglutide can affect how much nausea you’ll feel. Some people find taking it with food or before bed helps reduce the nausea. Taking it at night may help you sleep through the worst of the nausea.

Check with your doctor before changing the time you take the medication to make sure it fits with your other medications and daily routine.

3. Make adjustments to your diet

For better weight loss with semaglutide, combine it with a healthy diet and exercise. Taking the medication consistently and tracking progress is also key to reaching and maintaining weight loss goals.

To help reduce nausea:

• Eat smaller, more frequent meals throughout the day instead of big ones.
• Avoid greasy, fried, spicy, and heavy meals

Other foods to avoid:

• Salty foods
• Processed foods
• Acidic foods like tomatoes
• Alcohol
• Caffeine
• Carbonated drinks

Focus on bland, easy-to-digest foods like:

• Toast
• Potatoes
• Fish
• Chicken
• Rice
• Tofu
• Yogurt

To ease nausea, eat these foods 30 minutes after taking semaglutide:

• Apples
• Mint
• Crackers
• Ginger drinks

Eat something as soon as you wake up and then small meals every 3-4 hours about 5-6 meals a day to manage nausea, stomach pain, and other gastrointestinal side effects.

4. Stay hydrated

Staying hydrated is key to managing nausea from semaglutide. Drinking water or other hydrating fluids in small sips throughout the day will help with nausea and prevent dehydration.

If your nausea is severe or lasts a long time, try not to drink during meals and for 30 to 60 minutes before and after eating.

Eating foods with high water content like soups, broths, and watermelon or cucumbers can be especially helpful for nausea. These foods are gentle on the digestive system, easy to digest, and will keep you hydrated.

Soups and broths are also comforting and warm, and can help with stomach discomfort. The liquid will help with dehydration which is a concern when you’re feeling nauseous and vomiting.

These foods and supplements can nourish you while being less likely to trigger or worsen nausea compared to heavier, more solid meals.

5. Avoid exercise or activity right after meals

Exercise is good but not when you’re feeling nauseous. Try to schedule your workouts away from meal times and don’t do intense activity after eating.

Don’t lie down after meals as it can make side effects worse. When you feel nauseous, sit still until it passes. Moving around can make it worse. Instead, relax and distract yourself by watching TV or reading.

A light walk, and fresh air can help with nausea by relaxing and improving digestion. When you walk slowly it can stimulate the movement of food through the digestive system which may help with the feeling of fullness or discomfort that comes with nausea. The gentle movement will encourage blood flow and help relieve any tension in your body that’s causing nausea.

Breathing in cool fresh air can calm the body and reduce dizziness or lightheadedness that comes with nausea. Being outdoors in natural light can also lift your mood and reduce stress which can help with nausea. Just make sure to walk slowly and don’t do strenuous activity as intense movement can worsen the symptoms.

6. Try over-the-counter remedies

For mild to moderate nausea, there are several natural remedies. Ginger is one, you can take as a tea, add to food or eat as candy.

Peppermint is another option as a tea or in aromatherapy. Some people find relief from indigestion by massaging peppermint oil on their stomachs.

If the above doesn’t work for you, you can try anti-nausea (antiemetic) meds. OTC antacids and antihistamines may help.

Antacids: Antacids work by neutralizing excess stomach acid which can sometimes cause nausea. This can be helpful if your nausea is accompanied by acid reflux or an upset stomach. Antacids come in chewable tablets, liquids, or effervescent forms and work quickly to relieve. They won’t work if the nausea is caused by factors other than excess stomach acid.

Antihistamines: Antihistamines are used to treat motion sickness but can also help with general nausea. They work by blocking certain signals in the brain that trigger nausea and vomiting. They can be helpful if nausea is accompanied by dizziness or a feeling of imbalance. One side effect of antihistamines is drowsiness so take them before bed or when you don’t need to be fully alert.

These OTC medications will give you short-term relief but don’t address the underlying cause of nausea and may not work for everyone.

Follow the instructions and consult with your doctor for medical advice if these remedies don’t work for you or if you have concerns about interactions with your other meds.

7. Try anti-nausea medications

If you’re experiencing nausea from semaglutide, prescription anti-nausea medications like Zofran (ondansetron) may help. This medication will give you short-term relief while your body adjusts to semaglutide.

Zofran (ondansetron) has been FDA-approved for years to treat nausea and vomiting from chemo, radiation, and surgery but is also used for general nausea.

Ondansetron is taken as needed and works in 30 to 60 minutes.

You can also try over-the-counter nausea relief medications like Pepto Bismol (bismuth subsalicylate).

8. Speak to a healthcare provider

Nausea is a common side effect of semaglutide and usually goes away as your body adjusts. If the nausea lasts too long or gets severe, it can impact your daily life. Your healthcare provider can help manage the symptoms and may adjust the dose or schedule of your medication if needed.

Severe or persistent nausea may include symptoms like nausea that lasts a long time or gets worse, nausea that doesn’t get better with home remedies, or nausea that interferes with daily activities like eating or drinking. You may also feel weak or dehydrated from vomiting. If you experience any of these, you should talk to your doctor.

Severe and persistent nausea is rare but report to your doctor as it could be a sign of a bigger problem. They may look into other options that can give you similar benefits with less gastrointestinal side effects such as:

Oral Semaglutide

Oral semaglutide is an alternative to the subcutaneous injection with the same active ingredient. Take once a day in the morning, 30 minutes before eating or drinking. It’s recommended for those who have trouble with injections or have reactions at the injection site.

Other GLP-1 Receptor Agonists

• Dulaglutide: A GLP-1 receptor agonist like semaglutide for blood sugar control and weight management can be a good option for some patients.
• Exenatide: Another injectable GLP-1 agonist for blood sugar control and weight loss like semaglutide.
• Liraglutide: Sold as Victoza, also controls blood sugar and helps with weight loss but can cause nausea like semaglutide.

Non-GLP-1 Alternatives

• Metformin: A common medication for type 2 diabetes that improves insulin sensitivity and lowers glucose production. It causes mild gastrointestinal side effects which are less severe than semaglutide.
• Bupropion: An antidepressant that also helps with weight loss and recommended for those who want to lose weight without the nausea from semaglutide.

Consult your healthcare provider before changing any medication. They can evaluate your needs, possible side effects, and drug interactions to find the best alternative for you.

When to seek medical assistance

If side effects like feelings of nausea are preventing you from doing your usual activities, contact your healthcare professional. If your symptoms are severe, such as extreme pain, or weakness, or if you can’t eat or drink for more than 24 to 48 hours, seek immediate medical help in an emergency room (ER).

Go to the ER right away if you experience any of the following:

• Pain on the right side of your stomach
• Nausea, vomiting, or diarrhea that doesn’t improve with medication
• Dizziness or lightheadedness
• Confusion
• Swelling or hardness in your stomach

Bottom line

Nausea is a common side effect of semaglutide, but it usually improves as your body adjusts to the medication.

To manage nausea, start with a low dose, eat smaller meals, try bland foods, stay hydrated, avoid spicy and fried foods, and try natural remedies like ginger or peppermint.

Talk to your healthcare provider for advice on how to handle nausea and find the best solution for you.

Remember, nausea often gets better as your body adjusts to the medication over time.

If nausea is severe or lasts too long, contact your healthcare provider for advice or consider alternative treatments.