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As more people take the injectable weight-loss medication Wegovy, they should be aware of concerning reports of overdoses. That drug, more generally called semaglutide, can have unpleasant gastrointestinal side effects at prescribed doses. But if people take too much semaglutide, the adverse effects can be severe and even require hospitalization. The Food and Drug Administration recently alerted health care providers, pharmacies, and the public about the dangers of overdoses from semaglutide, which is also prescribed under the name Ozempic to treat diabetes. Scientific American spoke to experts about how people using semaglutide and similar weight-loss medications can stay safe.

How can people overdose on semaglutide?

These incidents often happen when people are required to portion their own doses of the medication. Novo Nordisk, the company that produces semaglutide, provides injectable forms of the medication in disposable injector pens with preportioned doses. But many people are reportedly receiving such medication through a different (and usually cheaper) source: compounding pharmacies. These facilities are allowed to replicate and dispense patented medications that are in shortage.* Such drugs include semaglutide, which has been listed as “in shortage” by the FDA since 2022.

Compounding pharmacies typically dispense these drugs in vials with accompanying syringes, leaving the patient to draw up their own dose as prescribed by their doctor. “You have to know conversions, and you have to know how much to draw up,” says Janice Jin Hwang, an endocrinologist at University of North Carolina at Chapel Hill.

These conversions can be complicated. Doses are sometimes prescribed in milligrams but dispensed in syringes that are marked in milliliters—and these may be ambiguously referred to as “units.” Additionally, the syringes people receive can be far larger than the intended dose, potentially leading to a much higher one. According to the FDA, some individuals injected anywhere from five to 20 times the prescribed dose.

These wonky conversions have even confused doctors. The FDA overdose alert cited two cases in which doctors prescribed patients an incorrect dose. (Doses can vary among people and throughout the course of treatment. Regimens should be determined at the discretion of a health care provider.)

“You really have to know exactly what you’re doing. Otherwise, it’s really, really easy to make mistakes,” Hwang says.

What happens when people take too much of these medications?

Taking too much semaglutide can cause severe gastrointestinal symptoms, such as nausea, vomiting, and abdominal pain. People who have experienced dosing errors have also reported fainting, headaches, migraines, dehydration, gallstones and acute pancreatitis, or inflammation of the pancreas, which can be life-threatening. (These drugs are known to carry a risk of pancreatitis and gallbladder disease.) Many of these people sought out medical care or were hospitalized.

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