The Side Effects of Missing an Ozempic Dose

There may come a time when you miss a dose of your weekly injectable GLP-1 drug. Here’s what experts want you to know about skipping a semaglutide (Ozempic, Wegovy) or tirzepatide (Mounjaro, Zepbound) dose, including potential side effects, risks, and how to get back on track.

What Happens if You Miss an Ozempic Dose

If you miss a dose of your weight loss or type 2 diabetes GLP-1 medication, you may not feel any differently right away, says Cecilia Low Wang, MD, a professor of medicine and director of the Glucose Management Team at the University of Colorado Hospital in Aurora.

“Ozempic is a long-acting medication, so one may not immediately notice anything from missing or delaying a dose that is due,” Dr. Low Wang says.

Because the drug lingers in the body for so long, “skipping a dose occasionally does not cause severe side effects,” says Tatiana Figueredo-Dietes, MD, an obesity medicine physician at NYC Health + Hospitals, Bellevue. “But not following the correct dosing schedule makes the medication not work as effectively.”

Eventually people who have missed a dose might “feel the effects of the medication wearing off,” Low Wang says. For those using Ozempic for appetite suppression and weight loss, food noise may worsen as the medication wears off after a missed dose, Low Wang says, and people who use the drug for glucose control may see their blood sugar rise. She says that people who are on a higher dose may feel a more significant difference after missing an Ozempic injection than those on a lower dose.

“Seven or eight days after their last dose,” says Dr. Figueredo-Dietes, “patients can expect to feel hungrier.”

Missing two or more GLP-1 doses allows your body to begin returning to its natural state. To resume your GLP-1 treatment safely, you may need to restart at a starter dose and work your way back up to the dosage you had previously used.

The Risks of Skipping an Ozempic Dose

If you’ve ever been tempted to skip or delay a GLP-1 dose in advance of a special occasion, such as a vacation or large holiday meal, experts warn that one missed dose is not likely to have a big effect on your hunger or gastrointestinal fitness.

Dr. Saunders says when her patients have tried to indulge in big meals after skipping a dose, they often learn that overeating can still provoke punishing side effects: “Eating heavy foods or large portions while on semaglutide or tirzepatide can lead to heartburn, nausea, and vomiting. Sometimes people feel fine while they’re eating and even afterwards for a while, but then they vomit out of nowhere several hours later,” she says.

Andrew Kraftson, MD, the director of the weight navigation program at Michigan Medicine in Ann Arbor, agrees that skipping a single dose is unlikely to quickly alleviate any gastrointestinal side effects. “Individuals should still be counseled to chew very thoroughly, eat slowly, and moderate their portions to avoid getting into trouble,” he says.

Sean Hashmi, MD, the regional director of clinical nutrition and weight management for Kaiser Permanente Southern California and a medical reviewer for Everyday Health, says that delaying or skipping a single dose of your medication is medically harmless in the short term — but he still cautions against doing it.

Dr. Hashmi says that the biggest risk of missing a dose is potentially breaking the good habits people build on GLP-1 drugs. “This concept that we can stop this medicine to do something that we know isn’t good for us, it sets us up for failure in the long run,” he says. 

Altering dose timing by a day or two, however, may be a viable option. Many people experience their worst digestive issues during the first day or two after their weekly injection, and have learned to delay their shot on days when vomiting or diarrhea would be particularly inconvenient, such as during job interviews, air travel, or holiday parties. Dr. Kraftson calls these short delays “totally reasonable.”

What to Do if You Miss Your Dose

If you only missed one injection of your GLP-1 medication, you can probably resume your previous dosing schedule without much issue, says Low Wang. The U.S. Food and Drug Administration (FDA) provides specific instructions:

• Semaglutide (Ozempic, Wegovy) users are advised to take a missed dose “as soon as possible within five days after the missed dose.” If more than five days have passed, users should skip the week’s dose entirely and resume their regularly scheduled injections.
• Semaglutide users should never administer two doses within 48 hours of each other.

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• Tirzepatide (Mounjaro, Zepbound) users are advised to take a missed dose “as soon as possible within four days (96 hours) after the missed dose.” If more than four days have passed, users should skip the week entirely and resume their regularly scheduled injections.
• Tirzepatide users should never administer two doses within 72 hours of each other.

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If you missed two or more weekly doses, however, it’s time to get in touch with your healthcare provider. They may write you a prescription for a smaller dosage, and ask you to slowly work your way back up. Going back to a high dose after a wait of several weeks could be more than your body is ready to handle, resulting in nausea, vomiting, constipation, and diarrhea, Figueredo-Dietes says.

Saunders takes a similarly cautious strategy with her patients: “When our patients are off medication for an extended period, we generally recommend starting back at the lowest dose and titrating up gradually.”

The more doses a person has missed, the more likely they are to have difficulty tolerating the medication when they restart it, and the more likely they are to have gastrointestinal side effects, Low Wang says.

The Takeaway

• Ozempic and related GLP-1 drugs stay in the body for more than one week, so missing or delaying one dose is unlikely to have significant immediate side effects.
• Eventually, the drug’s effects will begin to wear off, which should cause your hunger to return. People with type 2 diabetes should notice their blood sugar levels rising.
• If you’ve gone longer than a week or two without the medication, using the drug again can provoke serious gastrointestinal side effects. You may need help from your clinician to get safely back on track.

Additional reporting by Ross Wollen.