Emily Wright, a Toronto elementary school teacher, started taking the drug Ozempic in 2018 as a way to control her food cravings and blood sugar in her battle with Type 2 diabetes.
Soon after starting the drug, she said she started to lose a substantial amount of weight.
“But that came at a great cost for me. That came at the cost of constant vomiting and nausea,” she told Global News.
“I used to get these horrible smelling sulfur burps that smell like rotten eggs from the food fermenting in my stomach,” adding that at the time, those side effects were”livable.”
“The doctor said those side effects would eventually go away. As I started to lose weight, I remained on Ozempic, and within one year I was able to lose over 80 pounds,” Wright said.
Fast forward two years and the symptoms were worsening. She was hospitalized for severe nausea and dehydration. She could not stop vomiting.
“I was treated for dehydration or what they call ‘cyclic vomiting-like symptoms’,” Wright said, adding that the food that she ate felt like it was fermenting and rotting in her stomach.
She was then diagnosed with gastroparesis, which causes stomach paralysis, and was given medication to speed up her food digestion and help with her nausea.
While nausea and vomiting are common side effects for people taking Ozempic, extreme reactions like Wright’s are not, according to medical experts and the company.
Ozempic is a class of medication called GLP-1 agonists used to treat Type 2 diabetes and often prescribed off-label for obesity. It’s been approved in Canada since 2018 for diabetes, but not approved to treat weight loss.
The full list of side effects includes nausea, nausea, vomiting, diarrhea, stomach pain and constipation, according to the Ozempic website. Stomach paralysis is not mentioned.
Wright said she was hospitalized several times over a period of two years due to recurring symptoms. However, in November 2022, she decided to change her gastrointestinal doctor.
The new doctor believed Ozempic may be connected to her symptoms, she said.
“And that was the first time a doctor told me that I need to try and get off Ozempic to see if my symptoms would improve,” Wright said.
When she started taking Ozempic she said she was 280 pounds and now she is down to 130 pounds.
Since going off the drug, she said her symptoms have not improved and has had to take a leave of absence from her job.
She said she doesn’t know if Ozempic caused her condition, but believes it may have exacerbated it.
“I’m on medication, which I will likely have to be on for the rest of my life to speed up the motility of my stomach, as well as daily nausea medication to combat vomiting,” Wright said. “Ultimately, this helps me to be able to stay out of the hospital.”
She also has a health-care nurse come into my home three times a week in order to give me IV fluids for dehydration.
Dr. Ravi Retnakaran, an endocrinologist and professor of medicine at the University of Toronto, said although nausea is one of the most common side effects of Ozempic (and all other medications in this drug class), a severe reaction such as Wright’s is very rare.
“The GI side effects, they are real. A lot of people will get them, but generally, they’re not going to cause people to be unable to take the medication,” he said. “There is, of course, a subset of patients in whom that occurs. The nausea is too much, and they can’t take it.”
It is puzzling, he said, that Wright, continued to experience symptoms even after discontinuing Ozempic.
He further explained that diabetes itself can impact the gut and cause gastrointestinal issues.
The rise of Ozempic
Ozempic is a class of medication called GLP-1 agonists used to treat Type 2 diabetes and often prescribed off-label for obesity, as the version of the drug officially meant for weight loss is not available in Canada.
The drug, whose active ingredient is called semaglutide, is made by Novo Nordisk and there is no generic equivalent.
Its fame skyrocketed in use after celebrities and ordinary people on TikTok reported that their doctors prescribed it “off label” for weight loss.
“Ozempic is authorized for use in adult patients with type 2 diabetes mellitus in combination with other measures, such as diet and exercise or other therapies, to improve glycemic control,” a spokesperson from Health Canada told Global News in an email sent Wednesday.
“The product has not been authorized for use in Canada to treat weight loss. Health Canada continues to monitor the safety of medicines once they are on the Canadian market to help ensure that the benefits of the product continue to outweigh the risks,” the spokesperson added.
Wegovy — a higher dose version of the same drug semaglutide — was approved for weight loss for adults in 2021 in Canada but has never been sold here due to high global demand and supply shortages.
Semaglutide mimics the action of a gut hormone that kicks in after people eat, boosting the release of insulin, blocking sugar production in the liver and suppressing appetite. With a lower appetite and a greater feeling of fullness, people using these drugs eat less and lose weight.
There is another GLP-1 agonist drug on the market in Canada: for weight loss, it’s sold under the name Saxenda and for diabetes, it’s labeled as Victoza.
It’s Novo’s earlier and less effective weight-loss drug that contains the active ingredient liraglutide must be injected daily, as opposed to once a week with Ozempic.
Despite all of these drug’s successes, there are common side effects.
Why nausea is a common Ozempic side effect
In an email to Global News, a spokesperson from Novo Nordisk, the creator of Ozempic, said, “Patient safety is of utmost importance to Novo Nordisk, and we take all reports about adverse events from use of our medicines very seriously.”
Gastrointestinal events are well-known side effects of the GLP-1 class, explained Kate Hanna, a spokesperson for Novo Nordisk’s Canadian arm.
“For semaglutide, the majority of GI side effects are mild to moderate in severity and of short duration. GLP-1s are known to cause a delay in gastric emptying,” she said.
“While diabetes is a well-known risk factor, there are other risk factors that may increase the risk of gastroparesis such as obesity, gender (female), virus infection and nervous systems disease.”
Retnakaran, who has prescribed Ozempic to his diabetes patients, said the reason gastrointestinal problems are common, is because of how the class of medication works.
For example, he said Ozempic mimics a hormone already in the human body (GLP-1, a naturally occurring hormone that helps to regulate blood glucose levels).
Treatment with these medications causes “supraphysiologic levels of these hormones,” meaning higher levels than what your body normally has.
“And the high levels of hormones have various beneficial effects for glucose-lowering metabolism and weight control,” he explained.
“Amongst those effects is a slowing of gastric emptying. But there are likely other GI side effects that are that would explain why patients present with all sorts of GI concerns. The nausea is the main side effect, but usually is only transient.”
In extreme cases, like the one Wright describes, Retnakaran says it means a patient usually cannot tolerate the medication.
'Some weeks I vomit up to 200 times'
Wright told Global News that she understood taking Ozempic came with risks, but didn’t realize how much it could potentially impact her gastrointestinal health.
“I just want people to weigh the risks and the benefits before any medication,” she said.
“Understand how those side effects affect you and make a decision that’s best for you, for your health.
“When you experience side effects that aren’t normal, you need to advocate for yourself and tell your doctors that this isn’t something that you can deal with anymore.”
Retnakaran said despite the side effects he believes drugs like Ozempic have been shown to benefit many of his patients, by reducing cardiovascular and mortality risk for kidney disease, improving glucose control and helping with considerable weight loss.
“With any medication, there are risks and side effects. And that would be the same for Ozempic,” he said, adding that he believes going off the medication was the correct line of action for Wright.
Wright is eager to return to work full-time after taking a leave of absence in November 2022, especially since the medical bills have been piling up.
Ozempic is expensive — in most provinces, about $225 a pen that, depend on the dosage, can last anywhere from two weeks to a month or so — and not all insurance plans cover it.
“I have done every test that has been imagined, and I continue to suffer. So some weeks I can vomit up to 200 times, other days I might only vomit five or six times,” she said.
She added that if she could do it all over again, she would rather be 280 pounds and happy, than 130 pounds and sick.
“I lack hope that I’m going to get better,” Wright said.
“Without hope, it makes dealing with life so much more challenging because I don’t know when I’m going to be symptom-free and when I’m going to be able to return to my normal.”
— With files from Global News’ Kathryn Mannie, Nathaniel Dove and the Associated Press
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