Warning signs on GLP-1 treatment: when to call your care team and when to go to the emergency room

Seek urgent care

In these cases, don’t wait for it to get better, and tell the staff which medication you take, by name: semaglutide (Ozempic, Wegovy, Rybelsus), tirzepatide (Mounjaro) or liraglutide (Saxenda, Victoza).

• Severe belly pain that doesn’t go away, which may spread to the back, with or without vomiting. Talk to your prescriber before your next dose.
• Swelling of the face, lips, tongue or throat, trouble breathing or swallowing, a very fast heartbeat, dizziness or fainting, or severe itching or rash across the body. Don’t take another dose before talking to your prescriber.
• Sudden loss of vision, or vision that gets worse quickly, even without pain. With semaglutide, it can be a very rare injury to the optic nerve, which may not be reversible; and sudden vision loss has other causes that are also urgent.
• Constipation with a swollen belly, together with no gas passing, vomiting or severe pain.
• Vomiting or diarrhea that won’t stop, not even water staying down, blood in the vomit or stool, or signs of severe dehydration: little or no urine, strong dizziness, confusion.
• Low blood sugar with confusion, fainting, a seizure or inability to swallow, or mild low blood sugar that doesn’t improve with sugar. Call your local emergency number; anyone nearby should give nothing by mouth.
• Thoughts of hurting yourself or of suicide. Get help right away, from a crisis line or your local emergency number, and keep someone close by.

Act now, then tell your care team

Here the first thing is what to do in the moment; letting your team know comes right after.

• Mild low blood sugar, with shakiness, sweating, hunger and a racing heart, while still alert enough to swallow: first, fast-acting sugar, 15 g (120 mL, or 4 oz, of juice or regular soda, not diet, or 1 tablespoon of sugar). With a glucose meter, check again in 15 minutes and repeat if it’s still below 70 mg/dL. Then let your care team know.
• An extra dose by mistake (a double dose, a repeated injection, a wrong measurement): call a poison control center or your prescriber right away, with the pen or the package in hand. With severe vomiting, signs of low blood sugar, another severe symptom or a much larger dose, it’s an emergency.

Contact your care team soon, without waiting for your appointment

These signs can’t wait for your next appointment, and some become emergencies if they get worse.

• Pain in the upper right side of the belly, fever, yellowing of the skin or eyes, pale stools. If the pain is severe and doesn’t go away, it’s an emergency.
• A lump or swelling in the neck, hoarseness that doesn’t go away, trouble swallowing. Sudden, severe shortness of breath is an emergency.
• Changes in vision, if you have type 2 diabetes. Sudden loss of vision is an emergency.
• Constipation for several days with a swollen belly and pain that isn’t severe, while gas still passes and there’s no vomiting. If severe pain or vomiting starts, or gas stops passing, it’s an emergency.
• A racing heart at rest that lasts a few minutes or keeps coming back. With chest pain, shortness of breath or fainting, it’s an emergency.
• Vomiting or diarrhea if you take a diuretic, blood pressure medicine or diabetes medicine: let your team know the same day, even without signs of dehydration.
• Pregnancy, or plans to get pregnant: talk to your prescriber soon. The time between stopping the medication and trying to conceive isn’t the same for semaglutide, tirzepatide and liraglutide, and the date is something to agree on with your prescriber.
• Surgery, an endoscopy or any procedure with anesthesia or sedation: tell the procedure team when you schedule it, not just on the day, because a slower stomach calls for care with anesthesia. Sometimes the team asks for a liquid-only diet in the 24 hours before; don’t stop treatment on your own.

What not to do

If you notice one of these signs, don’t treat it as “normal for treatment” and don’t wait for it to pass. And don’t change, skip or double your dose on your own: what to do with your treatment is your prescriber’s call, after you’ve been seen.