• Last year, 3,316 semaglutide overdoses were reported by 55 poison control centers in the U.S.
• Compounded versions, which can contain semaglutide salts, are likely behind most of the overdoses.
• Experts recommend getting semaglutide from a reliable medical professional, and seeking medical attention immediately if you have trouble keeping down food or liquid after taking a semaglutide drug.
  

Taking too much Ozempic can yield dangerous results.

Reports of overdoses from semaglutide—products that include Wegovy and Ozempic—more than doubled between 2022 and 2023, from 1,447 to 3,316, according to data from America’s Poison Centers, which represents 55 poison control centers across the country.

The reports follow a trend: rates of reported semaglutide overdoses have been growing exponentially since 2019, when the poison control centers logged 196 reports. That jumped to 364 in 2020 and 607 in 2021. 

“You can have someone end up in the ER,” said Andrew Kraftson, MD, director of the Weight Navigation Program at Michigan Medicine, told Health. 

Here’s how the body reacts when you take too much semaglutide.

Shortages, Compounded Drugs, and Pressure From Insurance Companies

There are a few reasons that semaglutide overdoses might occur.

Since the drugs act as appetite suppressants, they slow the rate food moves through the gastrointestinal tract and make a person feel full for longer. 

Too much of this effect can be negative for the body.

"When someone takes too much semaglutide, these effects can be more pronounced leading to more significant nausea, vomiting, abdominal pain, or diarrhea,” said Kaitlyn Brown, PharmD, clinical managing director at the America’s Poison Centers. 

The company that makes semaglutide, Novo Nordisk, has recommendations for how patients should take the drug safely, including utilizing a step-up approach—starting with a smaller dose and working their way up.

This can cut back on the side effects, namely gastrointestinal effects like nausea, vomiting, and abdominal pain, that are more likely to occur if a person goes to a high dose right away.

But a combination of factors is pushing people to forgo this step-up approach, which is likely behind the rise in reported overdoses, Kraftson said.

Not all insurance companies cover semaglutide for weight loss, but when the drug is covered, people typically need to prove they’ve lost a certain portion of their weight within three to six months, depending on the insurance company.

If the patient fails to meet this benchmark, it’s considered a “treatment failure,” and insurance may pull coverage.

According to Kraftson, this pressure can prompt people using semaglutide to jump up to higher doses more quickly than they should.

“If you only have three months to meet 5% of the weight loss goal, and that first .25 milligram dose is really a safety dose rather than a weight loss dose, people are going to want to go up to the .5 milligram dose right away,” Kraftson said, adding that self-made deadlines, such as losing weight for a wedding, can also have the same effect.

Widespread shortages are also likely leading to some instances of semaglutide.

In his experience, Kraftson said patients often call around pharmacies asking if they have Wegovy or Ozempic in stock. Oftentimes, the pharmacies only have a higher dose than what is recommended at the start of a person’s weight loss plan.

“I get messages every day saying something like, ‘this pharmacy has 2.5 mg, can you just prescribe me that?’ when they haven’t ever been on anything,” Kraftson said. 

The voluntarily reported poison control data does not include whether a person overdosed while taking a compounded semaglutide or the brand name drugs, but Juliana Simonetti, MD, co-director of the Comprehensive Weight Management Program at the University of Utah, said she believes many of these overdoses happen when people seek out compounded semaglutide.

Kraftson explained that compounded versions of the semaglutide are likely responsible for many of the overdoses.

“It’s so important to see a clinician that is specialized in this area versus getting semaglutide online or at medspas,” Simonetti told Health. “They are not taking into account the other health problems a person may have.”

She added that compounded drugs often use semaglutide salts, which are a different active ingredient than what is in the FDA-approved drugs.

A recent report detailed three compounded semaglutide overdoses. Toxicologists at the Utah Poison Control Center in Salt Lake City found that two of the three people took 10 times the amount of semaglutide than the dose indicated.

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What Happens If You Overdose on Semaglutide

Overdosing on semaglutide can result in a few serious side effects.

In the short term, taking too much semaglutide can cause severe dehydration due to vomiting and diarrhea.

This can cause acute kidney failure that is usually reversible if a person gets proper care and hydration, said Simonetti.

But, prolonged dehydration can cause irreversible kidney damage.

In this case, Kraftson emphasized the need to get proper medical care immediately. If you cannot keep down food or liquids, you’ll likely need to get fluids through an IV.

In rare cases, a person who has overdosed may have extremely low blood sugar, which can be life-threatening, Brown explained.

Since semaglutide has a long half-life—the amount of time it takes for the drug to leave a person’s system—it usually takes more than a week for symptoms to go away, Simonetti said.

Another concern Simonetti has is muscle loss. When a person loses weight, it isn’t just fat they’re losing, they also lose muscle mass. This can be particularly dangerous for older patients who may already struggle to maintain muscle mass.

It also becomes easier to fracture bones, she said.

“There are all those issues that come along with getting medication without going to a provider that knows how to prescribe the medication,” she said.

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