Ozempic (semaglutide) is a GLP-1 receptor agonist licensed in the UK for treating type 2 diabetes mellitus. Whilst gout flare-ups are not listed as a recognised adverse effect in the Summary of Product Characteristics, some patients have reported joint symptoms during treatment. Understanding the potential indirect link between Ozempic-induced weight loss and gout risk is important for patients with pre-existing hyperuricaemia or a history of gout. This article examines the evidence, explores mechanisms behind weight loss-related gout flare-ups, and provides practical guidance on managing gout risk whilst benefiting from Ozempic therapy.

Understanding Ozempic and How It Works

Ozempic (semaglutide) is a prescription medication licensed in the UK for the treatment of type 2 diabetes mellitus. It belongs to a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists, which work by mimicking the action of a naturally occurring hormone that regulates blood sugar levels and appetite.

The mechanism of action of Ozempic involves several key processes:

• Stimulating insulin secretion from the pancreas in response to elevated blood glucose levels

• Suppressing glucagon release, which reduces glucose production by the liver

• Slowing gastric emptying, which helps control post-meal blood sugar spikes

• Reducing appetite through effects on brain centres that regulate hunger

Ozempic is administered as a once-weekly subcutaneous injection, typically starting at 0.25 mg and gradually increasing to maintenance doses of 0.5 mg, 1 mg, or 2 mg, depending on individual response and tolerability. The MHRA has approved Ozempic specifically for improving glycaemic control in adults with type 2 diabetes, either as monotherapy or in combination with other glucose-lowering medications.

Beyond its glucose-lowering effects, Ozempic can lead to weight loss in many patients. At diabetes treatment doses, this weight loss is typically more modest than the substantial reductions seen with higher doses of semaglutide (Wegovy 2.4 mg) that is specifically licensed for weight management. It's important to note that Ozempic and Wegovy are distinct products with different licensed indications in the UK, despite containing the same active ingredient.

Patients should be aware of important safety considerations, including rare but serious risks such as pancreatitis (seek medical help for severe, persistent abdominal pain), gallbladder problems, and potential effects on diabetic retinopathy, particularly with rapid improvement in blood glucose control.

The Link Between Ozempic and Gout Flare-Ups

There is no established direct pharmacological link between Ozempic and gout flare-ups based on current clinical evidence. Gout is not listed as a recognised adverse effect in the Summary of Product Characteristics (SmPC) for semaglutide, and the drug's mechanism of action does not directly influence uric acid metabolism or crystal formation in joints.

However, there have been anecdotal reports of gout flare-ups in some patients taking Ozempic. It is important to distinguish between direct causation and indirect effects that may occur as a consequence of the medication's primary actions, particularly its effect on weight loss.

The most common adverse effects of Ozempic according to the SmPC include:

• Gastrointestinal symptoms such as nausea, vomiting, diarrhoea, and constipation

• Injection site reactions

• Hypoglycaemia (particularly when used with insulin or sulphonylureas)

Whilst gout is not among these recognised side effects, the weight loss induced by Ozempic may create metabolic conditions that temporarily increase the risk of gout flare-ups in susceptible individuals. This represents an indirect association rather than a direct drug effect, and is consistent with NICE guidance (NG219) which recognises that rapid weight loss can trigger gout attacks.

Patients with a pre-existing history of gout or elevated uric acid levels (hyperuricaemia) may be at higher risk of experiencing flare-ups during treatment with Ozempic, particularly during the initial months when weight loss occurs. Healthcare professionals should be aware of this potential indirect association when prescribing semaglutide to patients with known gout or risk factors for the condition.

What Causes Gout Flare-Ups During Weight Loss

Gout is a form of inflammatory arthritis caused by the deposition of monosodium urate crystals in joints and surrounding tissues. These crystals form when uric acid levels in the blood become elevated (hyperuricaemia), leading to painful, swollen joints—most commonly affecting the big toe, but also ankles, knees, and other joints.

Rapid weight loss, regardless of the method used to achieve it, is a well-recognised trigger for acute gout flare-ups. This phenomenon occurs through several metabolic mechanisms:

• Increased breakdown of purines: When the body metabolises fat and muscle tissue during weight loss, purines (compounds found in body tissues) are broken down, producing uric acid as a by-product

• Ketone body production: Rapid weight loss, particularly with very low-calorie diets, leads to ketone production, which competes with uric acid for excretion by the kidneys

• Reduced renal clearance: Ketones and other metabolic by-products can temporarily impair the kidneys' ability to excrete uric acid efficiently

• Dehydration: Weight loss programmes may involve reduced fluid intake or increased fluid loss, concentrating uric acid in the blood

The rate of weight loss appears to be a critical factor. Losing weight too quickly—typically more than 0.5-1 kg per week—may increase the risk of gout flare-ups. NHS and NICE (NG219) guidance advise avoiding crash dieting and fasting in people with gout for this reason.

It is worth noting that long-term weight loss is actually beneficial for gout management, as obesity is a significant risk factor for hyperuricaemia and recurrent gout attacks. The challenge lies in managing the transition period when metabolic changes are most pronounced.

Managing Gout Risk While Taking Ozempic

For patients taking Ozempic who are concerned about gout or have a history of the condition, several practical strategies can help minimise the risk of flare-ups whilst still benefiting from the medication's therapeutic effects.

Hydration is important. Patients should be advised to:

• Maintain adequate hydration (for most adults, around 6-8 drinks per day), adjusting for individual needs and comorbidities

• Seek specific advice from a healthcare professional if you have kidney disease or heart failure

• Avoid excessive alcohol consumption, particularly beer and spirits, which can raise uric acid levels

• Limit sugary drinks containing fructose, which has been linked to increased uric acid production

Dietary modifications can support uric acid management:

• Reduce intake of purine-rich foods such as red meat, organ meats, certain seafood (anchovies, sardines, mussels), and yeast extracts

• Increase consumption of low-fat dairy products, which may have a protective effect against gout

• Some evidence suggests cherries or cherry juice may help reduce uric acid levels, though this should not replace medical therapy

• Maintain a balanced diet with plenty of vegetables and fruits

Medication considerations should be discussed with a GP or specialist:

• Patients with recurrent gout may benefit from urate-lowering therapy (ULT), with allopurinol as the first-line treatment according to NICE guidance (NG219)

• Febuxostat may be considered if allopurinol is not tolerated or contraindicated, though the MHRA advises caution in patients with pre-existing major cardiovascular disease

• The target uric acid level for gout management is typically below 360 μmol/L (or below 300 μmol/L in severe gout or with tophi)

• When starting or increasing ULT, flare prophylaxis with colchicine (500 micrograms once or twice daily) is typically recommended for up to 6 months

Monitoring is essential. Patients should have serum uric acid levels checked before starting Ozempic if they have a gout history, with periodic monitoring during treatment.

Finally, patients should be counselled about realistic weight loss expectations and the importance of gradual, sustainable changes rather than viewing rapid weight loss as the primary goal.

When to Seek Medical Advice About Gout Symptoms

Patients taking Ozempic should be aware of the characteristic symptoms of gout and understand when medical attention is necessary. Early recognition and treatment can prevent prolonged discomfort and potential joint damage.

Seek same-day medical advice if you experience:

• Sudden, severe pain in a joint, particularly the big toe, ankle, or knee, often developing overnight

• Visible swelling, redness, and warmth over the affected joint

• Extreme tenderness making it difficult to bear weight or tolerate even light touch (such as bedsheets)

• Fever or feeling generally unwell accompanying joint symptoms, which may indicate infection (septic arthritis) requiring urgent assessment (contact NHS 111, an urgent treatment centre, or A&E)

Contact your GP promptly if:

• You have a known history of gout and experience symptoms suggestive of a flare-up

• Joint symptoms are moderate but persistent and affecting daily activities

• You have recurrent episodes of joint pain since starting Ozempic

• You are uncertain whether symptoms represent gout or another condition

Arrange a routine appointment to discuss:

• Preventive strategies if you have a history of gout before starting Ozempic

• Uric acid monitoring if you are at higher risk (family history, previous gout, kidney disease)

• Medication adjustments if you experience frequent flare-ups despite preventive measures

It is important to note that acute gout attacks should not necessarily lead to discontinuation of Ozempic. With appropriate management—including anti-inflammatory medications (NSAIDs, colchicine, or corticosteroids) for acute attacks and potentially urate-lowering therapy for prevention—most patients can continue treatment safely.

Do not stop Ozempic without consulting your prescriber, as this may affect your diabetes control. Instead, work with your healthcare team to develop a comprehensive management plan that addresses both your diabetes treatment and gout risk. Your GP may refer you to a rheumatologist for specialist input if gout becomes difficult to control or if there is diagnostic uncertainty.

If you suspect you've experienced a side effect from Ozempic, you can report this through the MHRA Yellow Card scheme, which helps monitor the safety of medicines in the UK.

Frequently Asked Questions