Dr. Ahmed Stopping and restarting Ozempic is not uncommon because of multiple reasons, the main being the unavailability of Ozempic.
Other reasons to stop Ozempic may be intolerable side effects, cost savings, not being as effective as per expectations, and giving it a break as weight loss goals are achieved.
Restarting Ozempic has not been studied, especially when deciding on its dose. This is important because people may jump to 1 mg right away after giving it a break for 3 to 6 months, which can be awful.
Stopping and Restarting Ozempic Injections: What Dose Should I Start Off?
Guidelines are not available to answer this question clearly. Generally, restarting Ozempic after stopping it depends on multiple factors. These are discussed one by one here.
- How long have you been off Ozempic?
- What was the last dose you were on when you stopped Ozempic?
- Why did you stop Ozempic?
How long have you been off Ozempic? What dose you were on previously?
As mentioned, there are no guidelines provided by Novo Nordisk when you miss more than one dose.
What to do in such situations, especially stopping Ozempic and restarting after 2 months or more.
Here a doctor has to use his clinical judgment considering the number of doses missed, what dose the patient was on when they stopped Ozempic, and whether they had any side effects or not.
Here are some guidelines prepared after evaluating people’s data and responses from social media.
These guidelines provide a rough idea and may be used until guidelines from randomized controlled clinical trials are available.
If you missed fewer than 4 doses (Less than 4 weeks): |
If you have missed fewer than three doses of Ozempic, you should restart with the last dose you were on.
This is generally equivalent to a gap of 2 to 4 weeks of Ozempic.
Stopping and restarting Ozempic after 3 months: |
If you have been off for more than 3 months, you should restart using 0.25 mg per week for 4 weeks followed by 0.5 mg per week for 4 weeks, and then 1 mg.
Stopped Ozempic for more than 4 weeks but less than 3 months: |
If you have stopped Ozempic for more than 4 weeks but less than 3 months, and you were on 0.5 mg when you stopped, you should restart at a dose of 0.25 mg per week for 4 weeks and then 0.5 mg.
If you have stopped Ozempic for more than 4 weeks but less than 3 months, and you were on a 1 mg dose weekly, when you stopped, ideally, you should restart at a dose of 0.25 mg per week for 4 weeks and then 0.5 mg.
However, you may restart at a dose of 0.5 mg weekly if you had no side effects previously.
Alternatively, a safer option is to restart at a dose of 0.25 mg weekly for 2 weeks and then increase the dose after 2 weeks (instead of 4 weeks) to 1 mg after 4 weeks.
Stopped Ozempic and restarting Ozempic after 6 months: |
If you have stopped Ozempic for a duration of more than 6 months, you should restart at a dose of 0.25 mg per week for 4 weeks and then 0.5 mg.
Follow the recommended dosing guidelines as if starting it for the first time.
Here is a summary of the dosing guidelines:
How long have you been off Ozempic? | Previous Dose | How to restart Ozempic? |
| Missed Fewer Than 4 Doses (< 4 weeks) | Any | Restart the same dose |
| Restarting after stopping Ozempic for more than 12 weeks (>3 months) | Any | Restart at a dose of 0.25 mg per week |
| Restarting after stopping Ozempic for 4 to 12 weeks | 0.5 mg | Restart at a dose of 0.25 mg per week |
| 1 mg | Ideally, if there is no urgency, you should restart at a dose of 0.25 mg weekly and then increase the dose. However, you may restart at a dose of 0.5 mg if there were no side effects previously. One best option is to start at a dose of 0.25 mg weekly and increase the dose to 0.5 mg after 2 weeks (instead of 4 weeks) and then to 1 mg after 4 weeks. |
Why Did You Stop Ozempic?
If you stopped Ozempic due to a major side effect or contraindication, it is better not to restart it and consult your healthcare provider.
If you Stopped Ozempic due to minor side effects, you should restart it at a low dose and gradually titrate it upwards.
If you Stopped Ozempic due to cost issues, you may restart it following the doses mentioned in the table above.
Stopping and Restarting Ozempic after Surgery:
Your surgeon will put you on insulin before a major surgery and ask you to stop all kinds of medications.
You may be asked to restart your previous medications soon after a minor surgery or after 2 or more weeks after a major surgery.
Regarding Ozempic, you may restart Ozempic at the same dose after your surgery once you are allowed to do so.
However, if you have had a major surgery involving the stomach, intestines, pancreas, or liver, your surgeon may ask you to hold Ozmepic for a month or more until you start tolerating oral diet and medications.
In addition, gastrointestinal surgeries are usually associated with marked weight loss, and restarting Ozempic may not be a good choice.
However, where indicated, it’s better to start with the lowest dose of 0.25 mg weekly and then titrate it as per tolerance.
Will Stopping Ozempic Result in Withdrawal Symptoms?
Withdrawal symptoms are commonly associated with drugs that cause dependence. Hence, sudden or rapid discontinuation may cause side effects.
The term withdrawal is not used when we discontinue Ozempic, as it does not cause dependence.
However, some of the effects of Ozempic may rapidly reverse when you stop it.
One common symptom is that your appetite comes back. You may develop cravings for food and alcohol which sometimes may be very intense.
It’s awful to regain the lost weight so rapidly especially after all those months and years of effort.
Another major setback is dysglycemia. Your blood glucose may go wary. You should always consult your doctor so that you may switch to another diabetes medicine.
Safer options for diabetics include:
- Switching from Ozempic to another formulation of Semaglutide such as Rybelsus
- Switching to the more potent twincretin, Mounjaro (Tirzepatide)
- Switching to another GLP-1 analog such as Liraglutide or Dulaglutide
- Switching to metformin if not already taking or adding an SGLT2 inhibitor like Jardiance and Farxiga
- Switching to a combination of metformin, SGLT2 inhibitor, and a basal insulin
- Switching to Xultophy (Liraglutide + Degludec)
- Switching to twice or thrice daily insulin
Will You Regain Weight After Stopping Ozempic?
Yes. if you lose weight using Ozempic, you will regain it when you stop it. Weight gain is fairly rapid in people who are not exercising and eating all the time.
Your cravings will return when you stop Ozempic. This will further release the brakes on your weight gain.
Weight gain of more than the baseline has been reported by people who stopped Ozempic.
People have regained weight rapidly. Some people mentioned they regained about 10 lbs within the first month after stopping it.
How to not gain weight after stopping Ozempic?
People who stop Ozempic and do not regain weight usually follow a strict low-calorie diet and exercise.
Other options may include:
- Switching to Mounjaro (Tirzepatide)
- Switching to Victoza or Saxenda
- Take Orlistat (Xenical) or Phentermine, Qsymia, and Contrave while sticking to a low-calorie diet and exercise routine.
Taking Ozempic after Stopping it just because it stopped working?
Some people start to lose weight initially, then there is a plateau phase where the weight neither increases nor decreases.
Although not recommended by the manufacturer, some people stop Ozempic for a few months and then restart it with the hope that it will start working again and let them lose weight.
This is not true, in fact when you stop using it, you will end up gaining weight again.
In addition, you will have to restart at a low dose which will take you a lot of time to get back to the last dose you were on.
If Ozempic stops working, try combining it with other weight loss drugs such as Qsymia (Topiramate-Phentermine), Orlistat, or Contrave (Naltrexone-Bupropion).
Alternatively, you may add natural supplements such as Berberine weight loss tea to your diet. Some people have found it helpful, especially when used with Ozempic.
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