Does Ozempic cause muscle and joint pain? Ozempic (semaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist licensed in the UK for treating type 2 diabetes mellitus. Whilst musculoskeletal pain is not listed as a recognised adverse effect in official UK product information, some patients have reported such symptoms during treatment. Understanding the potential indirect mechanisms—including weight loss, changes in body composition, and dehydration—can help clinicians and patients distinguish between medication-related effects and coincidental musculoskeletal conditions. This article examines the evidence, explores possible contributing factors, and provides guidance on assessment and management of muscle and joint pain during Ozempic therapy.

Does Ozempic Cause Muscle and Joint Pain?

Ozempic (semaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist licensed in the UK for the treatment of type 2 diabetes mellitus. A higher dose formulation of semaglutide (Wegovy) is licensed for weight management, but Ozempic itself is not approved for this purpose in the UK.

There is no official, direct causal link established between Ozempic and muscle or joint pain. According to the Medicines and Healthcare products Regulatory Agency (MHRA) approved Summary of Product Characteristics (SmPC), musculoskeletal pain is not listed amongst the recognised adverse effects of Ozempic. The major clinical trials in the SUSTAIN programme did not identify muscle or joint pain as statistically significant adverse events compared to placebo or comparators.

Whilst the official documentation does not establish a link, some patients have reported musculoskeletal symptoms during treatment through spontaneous reporting systems such as the MHRA Yellow Card scheme. However, it's important to note that such reports cannot establish causality or frequency of these symptoms.

It is important to distinguish between pain directly caused by the medication and pain that may arise indirectly through physiological changes associated with treatment—such as weight loss, altered body composition, or changes in physical activity levels. Additionally, musculoskeletal symptoms may coincide with Ozempic use but stem from unrelated conditions, including osteoarthritis, fibromyalgia, or other rheumatological disorders. A thorough clinical assessment is essential to determine the underlying cause of any pain and to guide appropriate management strategies.

Why Muscle and Joint Pain May Occur with Ozempic

Several indirect mechanisms may hypothetically explain why some patients report muscle and joint pain whilst taking Ozempic, even in the absence of a direct pharmacological link.

Weight loss is one potential contributing factor. Semaglutide promotes weight reduction by suppressing appetite and slowing gastric emptying. Whilst weight loss is generally beneficial for metabolic health, changes in body mass can alter biomechanics and place different stresses on joints and supporting musculature. Individuals who lose weight may experience temporary discomfort as the musculoskeletal system adapts to a new load distribution.

Changes in body composition may occur during treatment. Studies of semaglutide for weight management (STEP trials) have shown that some weight loss includes lean tissue. Maintaining adequate protein intake and resistance exercise during weight loss is important to preserve muscle mass and joint stability. This is especially relevant in older adults or those with pre-existing sarcopenia.

Gastrointestinal side effects, such as nausea, vomiting, and reduced appetite, are common with Ozempic and may lead to dehydration or electrolyte imbalances. The Ozempic SmPC includes warnings about the risk of dehydration and potential acute kidney injury with significant gastrointestinal losses. Dehydration can contribute to muscle cramps and generalised musculoskeletal discomfort. Additionally, inadequate nutrition may impair tissue repair and recovery.

Increased physical activity is often encouraged alongside GLP-1 receptor agonist therapy. Patients who suddenly increase exercise intensity or duration without adequate conditioning may experience delayed-onset muscle soreness (DOMS) or joint strain, which can be mistakenly attributed to the medication itself. These potential mechanisms remain hypothetical and require further research to establish their clinical relevance.

How Common Is Musculoskeletal Pain with Ozempic?

Musculoskeletal pain is not classified as a recognised adverse effect of Ozempic in the UK product information. The pivotal SUSTAIN clinical trial programme, which evaluated semaglutide in thousands of patients with type 2 diabetes, did not identify muscle or joint pain as a statistically significant adverse event compared to placebo or active comparators.

The true incidence of musculoskeletal symptoms during Ozempic treatment is difficult to quantify. Spontaneous reports through systems like the MHRA Yellow Card scheme cannot establish frequency or definitively confirm causality. Additionally, musculoskeletal complaints are prevalent in the general population—particularly among individuals with obesity, diabetes, and advancing age—making it challenging to determine whether such symptoms are medication-related.

Common adverse effects of Ozempic, as documented in the UK SmPC, include:

• Gastrointestinal symptoms: nausea, vomiting, diarrhoea, constipation, abdominal pain (very common, affecting more than 1 in 10 patients)

• Decreased appetite (very common)

• Hypoglycaemia: when used in combination with insulin or sulphonylureas

• Gallbladder disorders: including cholelithiasis and cholecystitis

• Fatigue

• Injection site reactions: such as bruising or pain

Whilst musculoskeletal pain is not formally listed, healthcare professionals should remain vigilant for patient reports and consider the broader context of treatment, including weight loss trajectory, nutritional status, and concurrent medical conditions. Suspected adverse reactions should be reported via the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk).

Managing Muscle and Joint Pain While Taking Ozempic

If muscle or joint pain develops during Ozempic therapy, a systematic approach to assessment and management is recommended. First, exclude other causes of musculoskeletal symptoms, including inflammatory arthritis, infection, trauma, or medication interactions. A thorough clinical history and examination are essential.

Optimise nutritional intake to support musculoskeletal health. Ensure adequate protein consumption to preserve lean muscle mass during weight loss. The British Dietetic Association recommends a balanced diet with sufficient protein, particularly during periods of weight loss. Consider referral to an NHS dietitian if nutritional deficiencies are suspected, especially for patients with complex needs or those with conditions such as renal disease where protein intake requires careful management.

Maintain hydration and monitor for electrolyte disturbances, especially if gastrointestinal side effects are prominent. The Ozempic SmPC warns about the risk of dehydration and potential acute kidney injury with significant vomiting or diarrhoea. Advise patients to drink adequate fluids and seek medical review if symptoms persist.

Encourage gradual, appropriate physical activity. Resistance training and weight-bearing exercise can help preserve muscle mass and improve joint stability. However, patients should be counselled to increase activity levels gradually to avoid overuse injuries. Physiotherapy referral may be beneficial for tailored exercise prescription and pain management strategies.

Symptomatic relief may be achieved with:

• Paracetamol (first-line analgesic for mild to moderate pain)

• Topical NSAIDs (e.g., ibuprofen gel) for localised joint pain, which may have fewer systemic effects than oral NSAIDs

• Heat or cold therapy for muscle soreness

Patients should be advised not to stop or adjust their Ozempic dose without consulting their healthcare provider. If pain is severe, persistent, or associated with other concerning features, further investigation may be warranted, including blood tests or imaging studies. In some cases, temporary dose adjustment may be considered in consultation with the prescribing clinician.

When to Seek Medical Advice About Pain Symptoms

Patients taking Ozempic should be advised to contact their GP or healthcare provider if they experience persistent, severe, or worsening musculoskeletal pain. Certain features warrant prompt medical evaluation:

• Severe muscle pain or weakness, particularly if accompanied by dark urine, which may indicate rhabdomyolysis (a rare but serious condition involving muscle breakdown)

• Joint swelling, redness, or warmth, which could suggest inflammatory arthritis or infection (septic arthritis)

• Pain that significantly impairs daily activities or does not respond to simple analgesia

• Systemic symptoms such as fever, unexplained weight loss (beyond expected therapeutic effect), or night sweats

• New or worsening pain following dose escalation, which may require dose adjustment or further investigation

• Sudden, severe pain in the right upper abdomen, possibly with fever or jaundice, which could indicate gallbladder disease (a recognised risk with GLP-1 receptor agonists)

Patients should also seek advice if they experience other concerning adverse effects of Ozempic, including:

• Persistent nausea or vomiting leading to dehydration or reduced fluid intake

• Symptoms of hypoglycaemia (tremor, sweating, confusion), particularly if taking Ozempic with insulin or sulphonylureas

• Severe abdominal pain, which may indicate pancreatitis (a known but uncommon risk with GLP-1 receptor agonists)

• Visual changes or signs of diabetic retinopathy progression

For urgent concerns outside of GP hours, patients should contact NHS 111. For severe symptoms such as extreme pain, breathing difficulties, or signs of serious dehydration, they should attend A&E or call 999.

NICE guidance (NG28) on the management of type 2 diabetes emphasises the importance of regular monitoring and patient education. Individuals prescribed Ozempic should have access to ongoing clinical review, with opportunities to discuss any adverse effects or concerns. Suspected adverse reactions should be reported through the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk).

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