By now, we’ve all heard about the wildly popular prescription injectable drugs like Ozempic and Wegovy that are helping people lose loads of pounds quickly. Perhaps you’ve seen friends successfully slim down. Or you’ve noticed Hollywood celebs, like Sharon Osbourne, looking a bit scary-thin. But amid all the buzz and success stories is a growing list of side effects for these prescriptions. One that keeps popping up: muscle pain. So we decided to ask top doctors — experts on the front lines of the obesity battle prescribing these medications— can Ozempic cause muscle pain? Their answers may surprise you.
How Ozempic works
To understand the muscle connection, it’s important to remember how these drugs work. A quick refresher: Ozempic and Wegovy (another popular weight-loss injectable) both have the same active ingredient: semaglutide. It comes as a solution that gets injected into the body and works by stimulating the release of insulin to help balance blood sugar. Semaglutide also slows digestion, making you feel full for a longer period of time. The medication is referred to as a GLP-1–stimulating drug because it works like the glucagon-like peptide hormones the gut releases naturally to reduce appetite. All of these mechanisms translate into weight loss.
The side effects of prescription weight-loss shots
The FDA, along with researchers and patients, have noted various side effects, ranging from mild to severe, associated with using these injectable drugs. Some of them are…
- Nausea, abdominal pain, constipation, heartburn, diarrhea or vomiting
- Rash, itching, swelling
- Difficulty breathing or swallowing
- Vision changes, fainting or dizziness
- Rapid heartbeat
- Pain at the injection site
- Loss of buccal (facial) fat, also known as “Ozempic face” (Click through Sharon Osbourne before and after)
- Your blood sugar may drop too low if you take this drug with other blood sugar-lowering medications
- You may regain some or all of the weight when you stop taking the drug
In addition, some semaglutide users have developed rare, but serious kidney or gallbladder problems. People who have a history of thyroid cancer or pancreatitis (inflammation of the pancreas) should not take semaglutide.
Can Ozempic cause muscle pain?
The FDA doesn’t identify muscle pain as a side effect of taking semaglutide. “Ozempic, at this time, has no mechanism of action directly on skeletal muscle,” says Gabrielle Lyon, DO, an osteopathic doctor and author of Forever Strong. She adds, “Muscle pain is subjective. We would need to have a better understanding if this is due to a lack of exercise or something else.”
Still, some users of the weight-loss drug report muscle pain. So what’s going on? One explanation could be muscle pain at the injection site, similar to what we feel after getting a flu shot. Plus, a cascade of body and hormonal changes that accompany rapid weight loss can lead to fatigue, aches and pains. Internist and board-certified physician Melina Jampolis, MD, co-founder of Ahara, a personalized nutrition company, says some of those symptoms could be due to the fact that “women often undereat significantly on this drug.”
The bigger concern: Ozempic and muscle loss
While there is no research currently linking Ozempic to muscle pain, there is real concern about the drug’s connection to lost muscle mass. A 2021 clinical trial on semaglutide found that about 40% of the weight people lost came from lean mass, including muscle tissue. That’s worse than the results compared with other rapid weight-loss approaches like fad diets and gastric bypass. “It’s important to remember that anyone losing weight — no matter what the method — loses muscle mass,” says ob/gyn Kathleen Jordan, MD, Chief Medical Officer at Midi Health, a virtual care clinic focused on women’s health. She adds, “Faster weight loss, which we find with bariatric surgery or these highly effective medications, can contribute to a greater reduction in muscle.”
What doctors say about Ozempic and muscle loss
“It’s not the Ozempic that is directly causing muscle loss. When patients aren’t eating enough protein or exercising to preserve their muscle, muscle loss is a very real risk,” says Charlie Seltzer, MD, a preventive medicine expert and a certified strength and conditioning specialist.
“There are many health benefits of GLP-1 medications, so the loss of lean muscle mass does not deter me from prescribing,” says Shauna Levy, MD, medical director of Tulane Hospital’s Bariatric and Weight Loss Center. “But I do think it is incredibly important to warn patients of this possibility and emphasize the important of exercise, particularly strength training and not just cardio, to preserve their muscle strength and mass.”
Muscle changes can be dangerous for older adults
Muscle loss can be particularly problematic for people over 50 since it becomes harder and harder to regain muscle as you age. “There’s a generalized decline in muscle strength and mass as people age, and it really tends to accelerate later in life,” confirms Jeremy Walston, MD, co-director of the Biology of Healthy Aging program at Johns Hopkins. The loss of muscle with age is called sarcopenia. “Patients with metabolic disorders like diabetes and obesity have higher rates of sarcopenia,” says ob/gyn Mary Jacobson, MD, Chief Medical Officer of Hello Alpha, a telemedicine company for women. (Click to read how protein coffee can help fight sarcopenia.)
Muscle loss is most common in women
Women are at an increased risk of muscle loss with weight-loss medications. “Right after menopause, there’s a rapid decline drop off in muscle mass,” says Dr. Walston. Men don’t see this rapid drop off because testosterone tends to protect skeletal muscle. As a gerontologist, Dr. Walston sees women suffer from weak shoulders and upper arms, a popular site for Ozempic injections. He says, “For many people as they age, the rotator cuff muscles get weakened, and there’s a lot of very thin fascia layers there that can rip quite easily.” He adds, “that’s a muscle group women especially should try to strengthen.”
How to use Ozempic to *improve* muscle health
The FDA recommends using these weight-loss drugs with proper diet and exercise. When done correctly, some experts believe muscle tissue and strength is improved, not weakened. New York City weight-loss doctor Sue Decotiis, MD, says, “Semaglutides enhance fat burning and even building of muscle and bone. Those who are losing muscle are not receiving the proper care, which includes being weighed at least every two weeks with a body composition scale. None of my patients have lost muscle.”
Dr. Jordan says, “At Midi, we counsel our patients on GLP-1 medications to aim for a high protein intake and do plenty of strength-training exercise. Those interventions can go a long way toward preserving muscle while losing weight, which comes with so many powerful health benefits — including a lower risk of diabetes, heart disease and cancer.” She adds, “The goal here is health, and overall, these drugs are helping with that.”
Tips to help protect muscle during weight loss
Fortunately, simple strategies can prevent muscle loss. Here, three of the proven methods:
- Eat adequate protein. Getting enough protein, around 30 grams per meal, can provide the amino acids — or building blocks — needed to support and build healthy muscle tissue. Click to read how high-protein foods help women lose weight.
- Don’t save protein for dinner. Packing more protein into every meal is vital for staying strong and warding off. Indeed, in a small study in the journal Frontiers in Nutrition researchers found that volunteers over age 70 ate less protein than younger subjects and consumed most of their protein during dinner. Increasing protein intake and spreading it throughout the day nourishes existing muscle to prevent muscle loss, which is vital for staying active. Click to learn how adding protein to your breakfast can help you lose weight.
- Consider supplements. Vitamin D is essential for muscle-building. In fact, a review of studies published in the journal Calcified Tissue International and Musculoskeletal Research found that subjects who didn’t get enough vitamin D were 70% more likely to suffer from age-related loss of muscle strength than those with healthy D. levels. Experts advise supplementing with 2,000 IU of vitamin D a day. Click through to learn more about the link between vitamin D and fatigue.
- Move your muscles. Weight training and resistance training are best for protecting lean muscle mass and building strength. But you may also want to consider Tai Chi. Research shows the easy, gentle movements, which are similar to yoga, are effective at building muscle and reducing the risk of falls as we age. Plus, Heather Moday, MD, director of the Moday Center in Philadelphia, adds, “its gentleness helps reduce inflammation to combat the soreness that other exercises may cause.” To give Tai Chi a try, check out this video from YouTuber TaiFlow:
This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.
For more on weight-loss injectables: