Ozempic: understanding drugs, their uses and supervision

Ozempic overview: definition, composition and presentation

Ozempic is one of the major injectable treatments in the GLP-1 analog class, pharmacological reference A10BJ06. Developed by Novo Nordisk, it is aimed exclusively at adults with type 2 diabetes. Its active ingredient, semaglutide, is a synthetic peptide designed to mimic glucagon-like peptide-1 (GLP-1). This mechanism stimulates insulin secretion, slows down glucagon and slows gastric transit, thereby promoting glycemic control. These are essential aspects for type 2 diabetic patients, whose sugar regulation sometimes relies on a delicate balance.

Provided as an injectable solution, Ozempic comes in a single-use pre-filled pen for weekly subcutaneous administration – a modality generally appreciated by patients as it reduces the frequency of injections compared with some previous treatments. Different dosages are available in France: 0.25 mg, 0.5 mg, 1 mg and 2 mg. The opened pen can be stored for up to 6 weeks, in the refrigerator or at room temperature below 30°C – convenient for those who travel frequently or prefer to avoid strict cold storage.

• In summary, the essential characteristics of this drug:

  • Active substance: semaglutide

  • Category: GLP-1 analogues (A10BJ06)

  • Galenic : injectable solution with pre-filled pen

  • Path of administration: under the skin, once a week

  • Available presentations: 0.25, 0.5, 1 or 2 mg

  • Addressees: adults with type 2 diabetes

Before any use, it remains prudent to consult the official leaflet and seek advice from a healthcare professional – even if pen administration appears simple at first glance. Rigorous compliance and adherence to treatment play a real role in the effectiveness observed in real life.

Medical uses and prescription procedures

The use of Ozempic is carefully supervised and limited, in France as in Switzerland and Canada, to the management of type 2 diabetes in adults. The European Commission and the main health authorities now agree that Ozempic should only be prescribed in this specific context, and should always be combined with a suitable diet and regular exercise. Pharmacovigilance data show that the drug’s tolerability remains generally satisfactory in targeted patients, even if the medical service rendered (ASMR V) appears moderate, according to the HAS. In terms of efficacy, the SUSTAIN clinical trials highlighted an improvement in glycemic control (HbA1c), with a reduction in body weight observed in many cases – which is not always the case with other classes of treatment.

The official indication excludes the management of simple obesity, although the temptation to use “off-label” is gaining ground with some prescribers, particularly for patients at high cardiovascular risk or with co-morbidity factors. In real-life practices, patient-physician discussions sometimes dwell on this potential; however, HAS remains clear on regulatory limits.

• Prescribing plans:

  • Use alone for patients who cannot tolerate metformin or are contraindicated to it.

  • In combination:

    • Metformin

    • SGLT2 inhibitors

    • Basal insulin

The dosage classically starts at 0.25 mg/week, then increases every 4 weeks, which reduces the risk of digestive side effects – the progression may seem slow to some, but it is precisely intended to promote long-term adherence.

• Points of vigilance :

  • Strictly contraindicated in children and adolescents

  • Not recommended during pregnancy and breastfeeding

  • Enhanced monitoring if combined with insulin or sulfonamides, to reduce the risk of hypoglycemia

• Specific adjustments :

  • For elderly subjects: adaptation according to renal function and tolerance

  • In combination:

    • With metformin: potentially cumulative glycemic effect

    • With SGLT2 or other GLP-1 analogues: caution on therapeutic duplication

    • With insulin glargine: frequent adaptation required

Don’t hesitate to discuss the choice of treatment with your GP – a pharmacist will also be able to advise you, particularly on the pace of adjustment or expected reactions, because in practice, multi-disciplinary support significantly improves compliance.

Side effects and associated risks

Administration of Ozempic exposes you to a variety of side effects, the intensity of which varies greatly from one individual to another. Digestive problems remain the most frequent; nausea and diarrhea can be surprising at the start of treatment, but tend to subside thereafter – a nurse specialized in diabetology sometimes remarks that patients “get used to it” around the 4th or 5th week.

• Common side effects:

  • Nausea, diarrhea, vomiting

  • Loss of appetite or increased satiety

  • Constipation, abdominal pain

Also worth noting: some see a fairly marked reduction in weight, linked in part to reduced energy intake; however, this effect is not systematic or equivalent in all.

• Rarer but serious risks :

  • Acute pancreatitis (any intense abdominal pain should prompt consultation)

  • Possible deterioration in renal function in already fragile subjects, especially elderly or high-risk patients

  • Aggravation of diabetic retinopathy, especially in those with a previous history – regular ophthalmological follow-up is therefore recommended for this population

  • More severe hypoglycemia when combined with insulin or a sulfonamide

• Specific recommendations:

  • Strictly not recommended during pregnancy or breast-feeding

  • Strictly contraindicated in children

  • Ophthalmological check-up advised in diabetics with ocular history

On the pharmaco-vigilance front, the ANSM and EMA have stepped up the collection of reports, particularly in view of the rise in off-label use and informal online purchases – often relayed by young women on TikTok or other social networks. Overall tolerance remains solid, but the public health issues associated with detour are the subject of recurring communication campaigns in pharmacies.

If you notice an unexpected effect, even outside the classic risks listed in the package insert, it’s still advisable to quickly notify a qualified professional and/or report via the Health Insurance portal. This will enable more effective monitoring at national level.

Supply tensions, regulatory developments and reimbursement

Since 2023, supply difficulties for Ozempic have increased in France, Switzerland and several other European countries, affecting the continuity of care for type 2 diabetes patients – some have thus found themselves in prolonged disruption, which has prompted renewed attention from the health authorities, notably the ANSM and the EMA via the PRAC. The Assurance maladie issued official alerts as early as March 2024, stipulating strict priority for the population targeted by the AMM (type 2 diabetic adults exclusively), reminding us that use for weight loss in non-diabetic users leads to genuinely eligible patients being deprived of vital treatment.

City pharmacies have been given a supply and restriction plan, which sometimes includes verification of the indication and reinforced traceability. Awareness-raising campaigns in pharmacies have been organized locally, with prevention messages about misuse and counterfeiting, also on the rise.

If in doubt about availability or reimbursement, the best thing to do is ask your pharmacist – some patients have reported longer dispensing times or a change in reimbursement rates depending on stocks. It is therefore advisable to keep up to date with regulatory developments, which can change rapidly depending on public health policies decided at European level.

Our opinion

Faced with the rapid emergence of new treatments for type 2 diabetes, Ozempic appears to be an innovative solution, even if caution is still called for. Its efficacy in certain profiles, notably in overweight subjects or those suffering from cardiovascular complications, is appreciated – although it should be remembered that these benefits do not apply to the whole population, and that real adherence depends on medical follow-up. Tolerance has also proved acceptable, with digestive effects remaining the main obstacle for many users, and possibly generating resistance or early discontinuation of treatment.

It has to be admitted that, on social networks, its potential as an aid to weight loss is the talk of the town, to the point of creating tensions in pharmacies and diverting attention from the real issue: guaranteeing priority access to patients who need it, preserving the benefit-risk on a collective scale, and combating inappropriate use, which jeopardizes the ethics of the healthcare system and the safety of users.

Misuse, controversies and public health issues

The misuse of Ozempic, particularly as a weight-loss drug, has since 2023 affected an increasingly wide audience, beyond type 2 diabetes patients. The multiplication of content relayed on TikTok – with, for example, challenges between young women aiming for a rapid “transformation” – fuels the product’s popularity, often without consideration of the risks. In some cases, users seek out the drug from complacent doctors, on the internet, or via discussion groups, far from any supervision.

• Classical forms of misuse :

  • Injection by non-diabetics, often encouraged by online testimonials

  • Buying on the internet, via informal channels where counterfeits are becoming more frequent

  • Sharing pens or “tips” on social networks

  • Prescription under influence or after campaign relayed by well-followed influencers

Unsupervised use can have serious effects, including severe hypoglycemia, major digestive disorders, pancreatitis, intestinal obstruction and even unexpected allergic reactions. More worryingly, the appearance of counterfeit products (notably reported by Swiss and Canadian authorities) amplifies the risk for the population as a whole.

Organizations such as ANSM, EMA and Assurance maladie are therefore stepping up prevention campaigns, aimed at patients and caregivers alike; pharmacies often act as local relays to remind people of official warnings, sometimes via posters or awareness-raising sessions in the queue.

In terms of collective responsibility:

• Strengthen medical monitoring and therapeutic education, to avoid any misuse

• Protect stocks by reserving batches for patients defined by the AMM

• Prolong vigilance on any unusual alert, whether from patients, social networks or health agencies

• Develop further public health policies around drug detour, with ethical reflection as a backdrop

In case of doubt – about an unusual prescription, the obscure provenance of a pen, or advice found on the internet – it’s better to discontinue use and take the advice of a known physician, rather than risk serious consequences for an aesthetic purpose.

Therapeutic alternatives and practical recommendations

When continuation of Ozempic becomes impossible (discontinuation, adverse effects too severe, formal contraindication), several other GLP-1 analogues remain available, often with different administration or reimbursement schemes. The choice depends on the patient’s profile: some treatments are better suited to subjects at high cardiovascular risk, while others are preferred for their ease of administration. In practice, patients benefit from an individual assessment, often during a multidisciplinary concertation meeting where the opinions of endocrinologists, cardiologists and sometimes pharmacists are crossed.

• Trulicity (dulaglutide): weekly injection, solid side-effect and efficacy profile (regularly cited during hospital staff meetings)

• Victoza (liraglutide): daily injection, of particular interest in patients with high cardiac risk

• Exenatide : available in weekly or twice-daily formulations, with digestive tolerance to be monitored

• Other alternatives (Baqsimi, Lyxumia) exist, depending on local supply and HAS recommendations

Keep in mind:

• Strictly follow the prescribed injection protocol and don’t improvise, even if using the pen seems intuitive

• Report any unusual side effects as soon as they occur, especially if the reaction is intense or unexpected

• Abstain from all purchases outside pharmacies or official channels (counterfeiting, here, is not just a theoretical risk, but a reality that has been reported several times)

• Keep abreast of health and regulatory developments (notably via your pharmacist or health insurance)

• Maintain a regular dialogue with your healthcare team, especially when access to treatment changes or the slightest unexpected effect

At the end of the day, even if management can sometimes seem complex for type 2 diabetic patients, serious medical follow-up and good information help optimize the benefit-risk ratio, guarantee the efficacy of the chosen protocol, and reduce the – now very real – temptation to misuse it.