Ozempic (semaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist licensed in the UK for treating type 2 diabetes mellitus in adults. Whilst its primary role is improving blood glucose control, emerging research has explored whether Ozempic lowers uric acid levels—a question of interest to patients with gout or hyperuricaemia. Current evidence suggests a modest uric acid-lowering effect may occur, though findings remain inconsistent and the mechanism is not fully understood. Ozempic is not licensed or recommended for managing elevated uric acid. Patients requiring urate control should continue dedicated therapies such as allopurinol, alongside appropriate lifestyle measures and regular monitoring by their GP.

What Is Ozempic and How Does It Work?

Ozempic (semaglutide) is a prescription medicine licensed in the UK for the treatment of type 2 diabetes mellitus in adults. It belongs to a class of drugs known as glucagon-like peptide-1 (GLP-1) receptor agonists. Ozempic is administered as a once-weekly subcutaneous injection and is available in pre-filled pens.

The primary mechanism of action involves mimicking the naturally occurring hormone GLP-1, which is released by the intestine in response to food intake. By binding to GLP-1 receptors in the pancreas, Ozempic stimulates insulin secretion in a glucose-dependent manner—meaning it works primarily when blood glucose levels are elevated. Additionally, semaglutide suppresses glucagon release, a hormone that raises blood sugar, and slows gastric emptying, which helps to moderate post-meal glucose spikes.

Beyond glycaemic control, Ozempic can lead to weight loss by reducing appetite and increasing feelings of satiety, although it is not licensed for weight management in the UK (Wegovy is the licensed semaglutide product for weight management). This effect is mediated through actions on appetite-regulating centres in the brain. Clinical trials have demonstrated that semaglutide can lead to significant reductions in HbA1c (a marker of long-term blood glucose control) and body weight.

Ozempic is typically initiated at 0.25 mg once weekly for 4 weeks as a starting dose to improve gastrointestinal tolerability. This is not an effective dose for glycaemic control. After 4 weeks, the dose should be increased to 0.5 mg once weekly, with further increases to 1 mg or 2 mg weekly if needed for glycaemic control. Common side effects include nausea, vomiting, and diarrhoea. The risk of hypoglycaemia is increased when Ozempic is used in combination with insulin or sulfonylureas, and dose reductions of these medications may be necessary.

Patients should receive appropriate counselling on injection technique and be monitored regularly by their healthcare team to assess treatment response and tolerability.

The Link Between Ozempic and Uric Acid Levels

Uric acid is a waste product formed from the breakdown of purines, substances found naturally in the body and in certain foods. Elevated uric acid levels (hyperuricaemia) can lead to the formation of urate crystals in joints, causing gout, or in the kidneys, potentially resulting in kidney stones. The relationship between GLP-1 receptor agonists like Ozempic and uric acid levels has been the subject of emerging research, though the Ozempic Summary of Product Characteristics (SmPC) does not list an established effect on serum urate levels.

Some clinical studies have suggested that GLP-1 receptor agonists may have a modest uric acid-lowering effect. The hypothesised mechanisms include increased renal excretion of uric acid and potential effects on purine metabolism, though these require further investigation. Weight loss associated with semaglutide therapy may also contribute indirectly, as obesity is a known risk factor for hyperuricaemia. However, the magnitude of any uric acid reduction appears to be relatively small and may not be clinically significant for all patients.

It is important to note that current evidence is limited and inconsistent. While some observational data and post-hoc analyses of clinical trials have reported reductions in serum uric acid among patients treated with GLP-1 agonists, these findings have not been consistently replicated across all studies. Furthermore, Ozempic is not licensed or recommended by NICE for the specific indication of lowering uric acid or treating gout.

Patients with pre-existing gout or hyperuricaemia should not assume that starting Ozempic will adequately control their uric acid levels. Dedicated urate-lowering therapy (such as allopurinol or febuxostat) remains the mainstay of treatment for patients requiring pharmacological management of hyperuricaemia, in line with NICE guidance on gout management.

Managing Uric Acid Levels While Taking Ozempic

For patients prescribed Ozempic who have concerns about uric acid levels—whether due to a history of gout, kidney stones, or elevated serum uric acid—a comprehensive management approach is essential. This should combine lifestyle modifications, appropriate monitoring, and, where necessary, specific urate-lowering medications.

Lifestyle measures play a crucial role in managing uric acid levels. Patients are advised to:

• Maintain adequate hydration by drinking plenty of water throughout the day, which helps the kidneys excrete uric acid more effectively

• Limit intake of purine-rich foods such as red meat, organ meats, certain seafood (anchovies, sardines, mussels), and high-fructose corn syrup

• Moderate alcohol consumption, particularly beer and spirits, as alcohol can increase uric acid production and reduce its excretion

• Achieve and maintain a healthy weight through balanced nutrition and regular physical activity, as obesity is strongly associated with hyperuricaemia

• Avoid rapid weight loss, which can paradoxically trigger acute gout attacks by temporarily raising uric acid levels

Monitoring is important for patients with known hyperuricaemia or gout. Your GP may arrange periodic blood tests to check serum uric acid levels based on your gout management needs rather than specifically due to Ozempic therapy. According to NICE guidance (NG219), the target serum urate level is typically below 360 micromol/L, or below 300 micromol/L in people with severe gout or tophi.

If you are already taking urate-lowering therapy such as allopurinol or febuxostat, you should continue this medication as prescribed unless advised otherwise by your doctor. When starting or increasing urate-lowering therapy, your doctor may prescribe prophylactic medication (such as colchicine or an NSAID) to prevent gout flares. Note that febuxostat carries additional cautions for people with established cardiovascular disease. There is no known interaction between Ozempic and urate-lowering agents.

It is worth noting that the gastrointestinal side effects of Ozempic—particularly nausea and vomiting—can occasionally lead to dehydration, which may theoretically increase uric acid concentration. Ensuring adequate fluid intake is therefore particularly important during the dose-escalation phase of treatment.

If you experience side effects from Ozempic, report them to your healthcare professional or directly to the MHRA through the Yellow Card Scheme (yellowcard.mhra.gov.uk).

When to Speak to Your GP About Uric Acid and Ozempic

Patients taking Ozempic should be aware of situations that warrant discussion with their GP or diabetes care team regarding uric acid levels and related concerns. Proactive communication ensures that any potential issues are identified and managed appropriately.

You should contact your GP if you:

• Develop sudden, severe joint pain, particularly if accompanied by swelling, warmth, and redness—these are hallmark symptoms of an acute gout attack

• Have a history of gout and notice an increase in the frequency or severity of flares after starting Ozempic

• Experience symptoms of kidney stones, such as severe flank or abdominal pain, blood in the urine, or difficulty passing urine

• Are concerned about elevated uric acid levels identified in recent blood tests, especially if you have risk factors such as a family history of gout, chronic kidney disease, or are taking diuretics (which can raise uric acid levels)

• Notice persistent nausea, vomiting, or diarrhoea while on Ozempic, as these may lead to dehydration and potentially affect uric acid levels

Seek urgent medical attention if you experience severe joint pain with fever or systemic illness (which could indicate septic arthritis rather than gout) or if you are unable to pass urine with severe flank pain (which might suggest an obstructive kidney stone).

Your GP may arrange blood tests to measure serum uric acid, renal function (creatinine and estimated glomerular filtration rate), and other relevant parameters. If hyperuricaemia is confirmed and deemed clinically significant, your doctor will discuss whether urate-lowering therapy is indicated, taking into account NICE guidance on the management of gout.

It is important to emphasise that Ozempic should not be stopped without medical advice. If you have concerns about side effects or interactions with other conditions, discuss these with your healthcare team rather than discontinuing treatment independently. Your GP can assess whether any adjustments to your diabetes management or additional treatments for uric acid control are needed.

For patients with complex medical histories—such as those with advanced chronic kidney disease, heart failure, or multiple comorbidities—management decisions may require input from specialist services. According to NICE guidance, referral to a specialist may be appropriate for people with refractory gout despite urate-lowering therapy, those with tophi, where there is diagnostic uncertainty, or in the presence of significant kidney disease. Your GP will coordinate appropriate referrals if necessary to ensure comprehensive, individualised care.

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