Ozempic Drug Interactions You Should Know About

If you're taking Ozempic (semaglutide) — or about to start — it's important to understand how it interacts with other medications. Because Ozempic slows down how quickly your stomach empties, it can affect how your body absorbs other drugs you take by mouth.

This guide covers the major and moderate drug interactions, supplements and OTC medications to watch, food considerations, and what to tell your doctor before starting treatment.

How Drug Interactions Work with Ozempic

Ozempic's primary interaction mechanism is delayed gastric emptying. By slowing the rate at which food and medications leave your stomach, Ozempic can change how quickly — and how much — of an oral medication gets absorbed into your bloodstream.

This doesn't mean you can't take other medications with Ozempic. In most cases, it simply means your doctor may need to monitor you more closely or adjust timing and doses. For a deeper understanding of why Ozempic slows digestion, see our guide on how Ozempic works.

Medications That Interact with Ozempic

Major Interactions

Insulin and insulin secretagogues (sulfonylureas)

This is the most clinically significant interaction. When Ozempic is combined with insulin or sulfonylureas like glipizide (Glucotrol), glimepiride (Amaryl), or glyburide (DiaBeta), the risk of hypoglycemia (dangerously low blood sugar) increases significantly.

• Ozempic stimulates insulin release on its own, and adding it to insulin or sulfonylureas can double up on this effect
• Your doctor will likely reduce your insulin or sulfonylurea dose when you start Ozempic
• Monitor your blood sugar closely, especially during the first weeks and with each dose increase
• Know the signs of hypoglycemia: shakiness, sweating, confusion, rapid heartbeat, dizziness

Oral contraceptives (birth control pills)

Because Ozempic delays gastric emptying, it may reduce the absorption of oral birth control pills. This could potentially make them less effective at preventing pregnancy.

• Consider using a non-oral backup method of contraception (such as condoms, an IUD, or an implant) when starting Ozempic or increasing your dose
• Discuss with your doctor or gynecologist — they may recommend switching to a non-oral contraceptive method entirely
• This interaction is most relevant during the first few months as your body adjusts to delayed gastric emptying

Moderate Interactions

Oral medications in general

Any medication taken by mouth could potentially be affected by Ozempic's slowed gastric emptying. While clinical studies haven't shown dramatic absorption changes for most drugs, medications with narrow therapeutic windows — where small changes in blood levels matter — deserve extra attention.

Warfarin (Coumadin) and other oral anticoagulants

• Warfarin has a narrow therapeutic window, meaning small changes in absorption can affect how well your blood is thinned
• Your doctor should monitor your INR (blood clotting) more frequently when you start Ozempic, change doses, or stop taking it
• Report any unusual bleeding or bruising

Levothyroxine (Synthroid, Levoxyl)

• Levothyroxine absorption is sensitive to timing and stomach conditions
• Ozempic's effect on gastric emptying may alter how much levothyroxine gets absorbed
• Your doctor should monitor thyroid function (TSH levels) after starting Ozempic
• Continue taking levothyroxine on an empty stomach as directed — don't change your routine without medical advice

Supplements and OTC Medications to Watch

While Ozempic doesn't have specific FDA-listed interactions with supplements, there are practical considerations:

• Oral vitamins and minerals — Fat-soluble vitamins (A, D, E, K) and iron supplements may be absorbed differently due to delayed gastric emptying. If you take a daily multivitamin, continue as usual but mention it to your doctor.
• Antacids and acid reducers — Medications like omeprazole (Prilosec), famotidine (Pepcid), or calcium carbonate (Tums) are commonly used alongside Ozempic for GI symptoms. No major interactions are known, but check with your pharmacist if you're taking multiple GI medications.
• NSAIDs (ibuprofen, naproxen) — These are generally safe to take with Ozempic, but if you experience GI side effects like stomach pain or nausea, adding NSAIDs can make them worse. Use acetaminophen (Tylenol) as an alternative when possible.
• Herbal supplements — Supplements that affect blood sugar (cinnamon, berberine, bitter melon, fenugreek) could add to Ozempic's glucose-lowering effect. Let your doctor know about everything you take.

Food and Drink Interactions

Ozempic has no specific food interactions listed in its FDA labeling. You can take it with or without food, and there are no foods you need to strictly avoid. However:

• High-fat and large meals may worsen GI side effects (nausea, bloating, stomach pain), especially during dose titration. Smaller, lighter meals are often better tolerated.
• Alcohol — There's no direct interaction, but alcohol can lower blood sugar on its own. Combined with Ozempic (especially if you're also on insulin or sulfonylureas), this could increase the risk of hypoglycemia. Drink in moderation and monitor your blood sugar.
• Grapefruit — Unlike many medications, Ozempic is not affected by grapefruit. No need to avoid it.

What to Tell Your Doctor

Before starting Ozempic, give your doctor a complete picture:

1. All prescription medications — especially insulin, sulfonylureas, warfarin, levothyroxine, and oral contraceptives
2. Over-the-counter medications — including pain relievers, antacids, and allergy medications
3. Supplements and herbals — including vitamins, fish oil, and any blood-sugar-lowering supplements
4. Any planned surgeries — Ozempic slows gastric emptying, which can increase aspiration risk during anesthesia. Some anesthesiologists recommend stopping Ozempic before surgery. Discuss this with your surgical team.
5. If you're pregnant, planning pregnancy, or breastfeeding — Ozempic should be discontinued at least 2 months before a planned pregnancy

Keep an updated medication list in your phone or wallet. Anytime a new provider prescribes something, mention that you take Ozempic.

Final Thoughts

Ozempic's main interaction concern is its effect on gastric emptying, which can change how your body absorbs oral medications. The most important interactions to know about are with insulin, sulfonylureas, oral birth control, warfarin, and levothyroxine. For most other medications, the risk is low — but keeping your doctor informed about everything you take is always the safest approach.

For more on managing your Ozempic treatment, explore our guides on side effects, dosage and uses, and saving money on Ozempic. Need to fill your prescription? Medfinder can help you find a pharmacy with Ozempic in stock.