Ozempic (semaglutide) is a GLP-1 receptor agonist widely prescribed in the UK for type 2 diabetes management. Whilst gastrointestinal side effects are well-documented, some patients report experiencing shortness of breath during treatment. This symptom is not listed among Ozempic's common adverse effects in UK regulatory guidance, yet understanding potential indirect mechanisms and when to seek medical attention remains crucial. This article examines the relationship between Ozempic and respiratory symptoms, explores possible contributing factors, and provides guidance on appropriate management and when medical review is necessary.

Understanding Ozempic and Its Common Side Effects

Ozempic (semaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist licensed in the UK for the treatment of type 2 diabetes mellitus. The medication works by mimicking the action of the naturally occurring hormone GLP-1, which stimulates insulin secretion in response to elevated blood glucose levels, suppresses glucagon release, and slows gastric emptying. These combined mechanisms help improve glycaemic control and often result in weight reduction as a secondary benefit.

The Medicines and Healthcare products Regulatory Agency (MHRA) has approved Ozempic for subcutaneous administration once weekly. Treatment starts with 0.25 mg weekly for 4 weeks as an initiation dose only (not for glycaemic maintenance), then increases to 0.5 mg weekly. The dose can be further increased to 1 mg weekly and up to 2 mg weekly if needed for optimal glycaemic control, depending on individual response and tolerability.

The most commonly reported adverse effects of Ozempic are gastrointestinal in nature, affecting a significant proportion of users. These include nausea, vomiting, diarrhoea, abdominal pain, and constipation, which typically occur during dose initiation or escalation and often diminish over time as the body adjusts to the medication. Other documented side effects include injection site reactions, fatigue, dizziness, and changes in appetite.

More serious adverse effects that require monitoring include:

• Pancreatitis (treatment should be discontinued immediately if suspected)

• Gallbladder disease (cholelithiasis and cholecystitis)

• Diabetic retinopathy complications (particularly with rapid HbA1c reduction in patients with pre-existing retinopathy)

• Acute kidney injury (secondary to dehydration from gastrointestinal side effects)

• Increased heart rate

• Hypoglycaemia (particularly when used with insulin or sulphonylureas)

Understanding the expected side effect profile helps patients distinguish between typical medication responses and symptoms that may warrant further medical evaluation. This knowledge is particularly important when experiencing unexpected symptoms such as respiratory difficulties, which require careful assessment to determine their relationship to the medication.

Can Ozempic Cause Shortness of Breath?

Shortness of breath, medically termed dyspnoea, is not listed among the common or frequent adverse effects of Ozempic in the UK Summary of Product Characteristics (SmPC) available on the electronic medicines compendium (emc). The clinical trials that led to Ozempic's approval did not identify respiratory symptoms as a significant concern directly attributable to semaglutide therapy. However, this does not entirely exclude the possibility of respiratory symptoms occurring in individual patients, and there is no official link established between Ozempic and shortness of breath as a direct pharmacological effect.

That said, several indirect mechanisms could potentially contribute to breathing difficulties in patients taking Ozempic:

• The medication's effect on gastric emptying and its association with gastrointestinal side effects may lead to bloating, abdominal distension, or gastro-oesophageal reflux, which can occasionally create a sensation of breathlessness or chest tightness.

• GLP-1 receptor agonists can increase heart rate, which some patients might experience as a sensation similar to breathlessness or palpitations.

• Allergic reactions, whilst rare, represent another consideration. Hypersensitivity reactions to semaglutide or its excipients could manifest with respiratory symptoms including shortness of breath, wheezing, or throat tightness, often accompanied by other allergic signs such as rash, itching, or facial swelling. Such reactions require immediate medical attention and discontinuation of the medication.

• Diabetic ketoacidosis (DKA) is a rare but serious risk, particularly if insulin doses have been rapidly reduced when starting Ozempic. The MHRA has issued a Drug Safety Update highlighting this risk. DKA can present with deep, rapid breathing (Kussmaul respiration) alongside abdominal pain, vomiting, and dehydration.

It is crucial to recognise that patients with type 2 diabetes often have multiple comorbidities, including cardiovascular disease, which independently increase the risk of dyspnoea. Therefore, when a patient taking Ozempic experiences shortness of breath, a thorough clinical assessment is necessary to determine whether the symptom relates to the medication, an underlying condition, or an entirely separate medical issue requiring investigation.

When to Seek Medical Attention for Breathing Difficulties

Patients experiencing shortness of breath whilst taking Ozempic should understand when this symptom constitutes a medical emergency requiring immediate attention versus when it may be appropriate to arrange a routine GP appointment. Certain warning signs indicate potentially serious conditions that demand urgent evaluation, and recognising these red flags is essential for patient safety.

Immediate medical attention through 999 or attendance at an emergency department is warranted if:

• Shortness of breath is accompanied by chest pain or pressure, particularly if radiating to the arm, jaw, or back, as this may indicate acute coronary syndrome

• Sudden onset of severe breathlessness with sharp chest pain, especially if associated with coughing up blood or unilateral leg swelling, could suggest pulmonary embolism

• Difficulty speaking in complete sentences due to breathlessness

• Blue discolouration of the lips or face (cyanosis)

• Confusion or altered consciousness

• Signs of severe allergic reaction such as facial swelling, throat tightness, or widespread rash developing rapidly after injection (stop Ozempic immediately)

• Severe abdominal pain with vomiting, fever and breathlessness (stop Ozempic if pancreatitis is suspected)

• Symptoms of diabetic ketoacidosis: excessive thirst, frequent urination, nausea, abdominal pain, rapid deep breathing, fruity-smelling breath, confusion (check ketones if possible)

Patients should contact their GP or NHS 111 within 24 hours if they experience new or worsening shortness of breath that is persistent but not immediately life-threatening, particularly if accompanied by fever, productive cough, leg swelling, or palpitations. Breathlessness that progressively worsens over days, interferes with normal daily activities, or causes significant anxiety also warrants prompt medical review. Additionally, if respiratory symptoms develop shortly after starting Ozempic or increasing the dose, this temporal relationship should be discussed with a healthcare professional.

For patients with pre-existing respiratory or cardiac conditions, any change in baseline breathing patterns should be reported to their GP, as this may indicate deterioration of the underlying condition rather than a medication effect. Healthcare professionals can then conduct appropriate investigations, including physical examination, oxygen saturation monitoring, electrocardiography, chest radiography, or blood tests as clinically indicated, to establish the cause and guide management.

Managing Respiratory Symptoms While Taking Ozempic

If a patient experiences mild respiratory symptoms whilst taking Ozempic and serious causes have been excluded through appropriate medical assessment, several management strategies may help alleviate discomfort whilst continuing treatment. The approach depends on the underlying cause identified during clinical evaluation and should always be guided by healthcare professional advice rather than self-management alone.

For patients in whom gastrointestinal side effects are contributing to a sensation of breathlessness through bloating or reflux, dietary modifications may prove beneficial. Eating smaller, more frequent meals rather than large portions can reduce gastric distension and pressure on the diaphragm. Avoiding foods that trigger reflux, such as spicy dishes, caffeine, alcohol, and high-fat meals, particularly in the evening, may reduce nocturnal symptoms. Remaining upright for at least two to three hours after eating and elevating the head of the bed can further minimise reflux-related breathing difficulties. Some patients may benefit from over-the-counter antacids, though any additional medications should be discussed with a pharmacist or GP to ensure compatibility with existing treatments.

Ensuring adequate hydration is important to reduce the risk of acute kidney injury, particularly if gastrointestinal side effects are present. Gentle, progressive physical activity as tolerated can improve cardiovascular fitness and respiratory efficiency, though patients should start slowly and increase intensity gradually under medical guidance, particularly if they have been previously sedentary.

In cases where respiratory symptoms are suspected to relate to the medication itself, the prescribing clinician may consider temporarily adjusting the Ozempic dose to assess whether symptoms improve. Any dose reduction or re-escalation must be guided by the prescriber in accordance with the UK SmPC. Alternatively, switching to a different GLP-1 receptor agonist might be explored, though it's important to note that many side effects are class-related and may occur with alternative agents. Such decisions must be made collaboratively with the diabetes care team, considering the overall benefits of glycaemic control against the impact of side effects on quality of life.

Patients should maintain a symptom diary documenting when breathlessness occurs, its severity, associated activities, and any relieving or exacerbating factors. This information proves invaluable during medical consultations and helps identify patterns that may guide management decisions. If symptoms persist or worsen despite these measures, patients should seek further medical review as this may indicate an unrelated condition requiring different management.

Alternative Treatments and Speaking to Your GP

For patients who experience persistent or troublesome respiratory symptoms whilst taking Ozempic, or for whom the medication proves unsuitable for other reasons, numerous alternative treatment options exist for managing type 2 diabetes. The choice of alternative therapy depends on individual patient factors including renal function, cardiovascular risk profile, weight management goals, hypoglycaemia risk, and patient preferences, all of which should be discussed thoroughly with the GP or diabetes specialist team.

Other GLP-1 receptor agonists available in the UK include dulaglutide (Trulicity), liraglutide (Victoza), exenatide (Byetta, Bydureon), and tirzepatide (Mounjaro), which share similar mechanisms of action but differ in dosing frequency and pharmacokinetic profiles. It's worth noting that GLP-1 receptor agonists generally have similar gastrointestinal side-effect profiles, though individual tolerance can vary between agents.

Beyond this drug class, NICE guideline NG28 for type 2 diabetes management recommends various alternatives including:

• SGLT2 inhibitors such as dapagliflozin or empagliflozin, which offer cardiovascular and renal protective benefits

• DPP-4 inhibitors like sitagliptin, which have a favourable side effect profile

• Traditional agents including metformin, sulphonylureas, or insulin therapy, depending on disease progression and individual circumstances

When preparing to discuss concerns about Ozempic with your GP, it is helpful to document specific symptoms, their timing in relation to doses, their impact on daily activities, and any measures already attempted to manage them. Be prepared to discuss your diabetes control, including recent HbA1c results, blood glucose monitoring patterns, and any hypoglycaemic episodes. Your GP will also want to review other medical conditions, current medications, and treatment goals to ensure any alternative therapy aligns with your overall health needs.

The conversation should be collaborative, weighing the benefits of good glycaemic control against quality of life considerations. If Ozempic has been effective for diabetes management and weight reduction, your GP may wish to investigate respiratory symptoms thoroughly before discontinuing the medication, as the cause may be unrelated. Conversely, if symptoms significantly impair wellbeing, transitioning to an alternative treatment whilst maintaining diabetes control remains entirely appropriate. Remember that diabetes management is individualised, and finding the right treatment sometimes requires trying different options under medical supervision until the optimal balance of efficacy, tolerability, and safety is achieved.

It's important to note that Ozempic (semaglutide) is licensed specifically for type 2 diabetes treatment, while Wegovy (also semaglutide but at different doses) is licensed for weight management. Your healthcare team will ensure you receive the appropriate medication for your specific needs.

Frequently Asked Questions