Calls to poison control centers involving semaglutide — the drug sold as Ozempic for type 2 diabetes and Wegovy for weight management — soared more than five times after the FDA approved it for obesity in 2021, rising from approximately 1,500 calls per year to more than 8,000 by 2023. And the leading cause was not an accidental overdose or a dangerous drug interaction. It was two entirely preventable mistakes: patients injecting the drug daily instead of weekly, and patients starting at the maximum dose instead of gradually stepping up as the prescribing instructions require.
A study published in the Journal of Medical Toxicology documents the full trajectory of this surge and concludes that most of these cases could have been prevented with better patient education at the point of prescribing.
Why This Matters
Semaglutide is now among the most-prescribed branded injectable medications in the United States. The drug has expanded far beyond endocrinology specialists to primary care offices, telehealth platforms, and compounding pharmacies. Millions of Americans are now self-administering a weekly injectable medication — many of them for the first time in their lives — with variable levels of instruction.
The population most at risk right now is changing. Medicare began covering semaglutide for cardiovascular risk reduction in 2024, and coverage for obesity indications has been expanding. That means a rapidly growing number of seniors are initiating GLP-1 therapy — often with fewer digital health resources, potentially greater difficulty reading fine-print dosing instructions, and more vulnerability to gastrointestinal side effects from accidental overdosing.
The researchers are direct: the majority of these 8,000 annual calls were preventable. Their recommendation is not a new drug warning label. It is better patient education.
What We Know So Far
The study, published online February 3, 2026, was conducted by researchers at the University of Texas at San Antonio (UTSA) and the South Texas Poison Center. The team analyzed every reported GLP-1 receptor agonist exposure logged in a national poison center database from 2012 through 2023.
Authors are Jordan G. Miller and Robert Miller (listed as joint first authors), and Dr. Shawn M. Varney and Dr. David Han (joint supervising authors), affiliated with UTSA's College of AI, Cyber and Computing and the South Texas Poison Center, Department of Emergency Medicine, Long School of Medicine at UT San Antonio.
Key findings:
- Before Wegovy's 2021 FDA approval for chronic weight management, semaglutide-related poison control calls were approximately 1,500 per year .
- After the approval, calls rose sharply and reached more than 8,000 per year by 2023 — a greater than five-fold increase.
- Semaglutide alone accounted for 64% of all GLP-1 receptor agonist poison control contacts during the study period — far outpacing other drugs in the class.
- The most common call category was unintentional therapeutic errors — patients using the drug incorrectly, not patients attempting misuse or intentional overdose.
- The two most common errors were injecting semaglutide daily instead of weekly and starting immediately at the maximum dose instead of following the required gradual titration schedule .
- The proportion of callers referred to a healthcare facility increased from 23% to 33.5% over the study period — meaning a growing share of errors were serious enough to require in-person evaluation.
- The majority of cases produced only mild gastrointestinal symptoms, primarily nausea and vomiting.
The Two Errors Every Semaglutide Patient Must Understand
The study's findings center on two specific, recurring mistakes. Both are preventable. Both reflect a mismatch between what prescribing instructions say and what patients actually understand or remember when they are home with their medication.
Error 1: Injecting semaglutide daily instead of weekly.
Ozempic and Wegovy are designed to be injected once per week, on the same day each week. Unlike oral medications, which create their own rhythm through daily habits, a weekly injection requires a patient to actively track a seven-day cycle. The pen does not send a reminder. Weeks blur. Some patients assume — particularly if they are accustomed to insulin or other daily injectables — that the medication should be taken every day.
Taking semaglutide daily instead of weekly means receiving seven times the intended weekly dose within a single week. The primary result is severe gastrointestinal distress: prolonged nausea, vomiting, and diarrhea that can result in dehydration significant enough to require IV fluids and clinical observation.
Error 2: Starting at the maximum dose instead of titrating up slowly.
The FDA-approved prescribing instructions for both Ozempic and Wegovy require patients to begin at a low starting dose and increase it gradually over several weeks — a process called titration. This is not optional. The titration schedule exists specifically to allow the body to adjust to the drug's effects on gastric motility. Patients who begin immediately at the full maintenance dose are far more likely to experience severe nausea, vomiting, and gastrointestinal distress.
As researchers at UTSA noted via ScienceDaily: "We need to better educate the public because how this drug behaves in our body and its long-term safety are not yet fully understood."
Where the Risk Is Highest
The study period runs through 2023, which predates the most recent wave of Medicare coverage expansion and the widespread adoption of GLP-1 drugs through telehealth prescribers. Based on available evidence, the error risk is highest in the following settings:
Compounded semaglutide patients. As reported by Dr. Stephanie Lambson and cited by the American College of Medical Toxicology, compounded semaglutide vials — obtained through compounding pharmacies or wellness clinics — require patients to draw their own dose using a syringe, rather than using the pre-calibrated pen provided with FDA-approved Ozempic or Wegovy. This creates conditions for significant dosing errors, including ten-fold overdoses reported in prior case series.
First-time injectable medication users. Patients who have never self-administered an injectable medication before are less familiar with dosing mechanics, more likely to misread dose strength labeling, and more vulnerable to the psychological pressure of wanting to start treatment at full strength.
Seniors newly starting GLP-1 therapy. Older adults who are newer to injectable medications may have difficulty reading fine-print labeling, navigating digital dosing trackers, or distinguishing between pens of different dose strengths. The expansion of Medicare coverage for semaglutide has meaningfully expanded this population.
Telehealth-initiated prescriptions. Patients who receive prescriptions through telehealth platforms — particularly those prescribing compounded semaglutide — may receive less in-person counseling on titration schedules and weekly dosing than those seen in an endocrinology or primary care office.
What Doctors and Experts Say
Dr. David Han, a co-supervising author of the study and an emergency medicine and toxicology physician at UT San Antonio, emphasized that the poison control surge is a signal about patient education, not drug toxicity.
"When the GLP-1 drugs are being sold to diabetic patients, that's a completely different story versus when the drug is used for weight management," Han told researchers, according to Mirage News. "So, we had to quantify this evidence to show that it stemmed from the FDA approval and how to contain the risk."
He added that the next step is better public education — and that the long-term safety of the drug for millions of new users remains an active area of research.
Dr. Stephanie Lambson, quoted by ACMT, noted that compounded vial-based products introduce particular risk because they lack the auto-calibrated pen mechanism of the branded products: "It's up to the patients to draw out the correct amount of medication to administer to themselves, and this is where we've seen a lot of the errors."
What the Evidence Shows and What It Does Not
MedicalDaily Evidence Check
- Study type: Retrospective analysis of national poison center database records (2012–2023)
- Participants: All reported GLP-1 receptor agonist exposures in national poison center data
- Published in: Journal of Medical Toxicology (2026), Volume 22, pages 275–285 ( DOI: 10.1007/s13181-026-01121-z )
- What it found: Poison control calls involving semaglutide surged more than five-fold after FDA weight-loss approval; 64% of GLP-1 calls involved semaglutide; most were unintentional dosing errors, not intentional misuse
- What it did not prove: The study cannot assess outcomes beyond poison control contact — it does not track hospitalizations, deaths, or longer-term adverse events; it does not establish how many patients on semaglutide never contacted poison control despite making similar errors
- What readers should know: Most cases were mild; the increase reflects the vast expansion of the patient population combined with a specific, preventable pattern of dosing errors; the drug itself is not inherently dangerous at recommended doses
Who Faces the Greatest Risk?
Based on the study findings and clinical guidance from toxicologists:
- Patients using compounded semaglutide from vials rather than pre-filled pens
- Patients who did not receive explicit verbal counseling on the weekly dosing schedule at the time of prescription
- Patients managing multiple injectable medications who may confuse dosing intervals
- Adults over 65 newly initiating therapy through Medicare
- Patients using telehealth prescribers without in-office nursing education
- Anyone who does not clearly understand the titration schedule and assumes full-dose starts are appropriate
Symptoms and Warning Signs of a Dosing Error
The most common consequence of a semaglutide dosing error — particularly taking it too frequently or starting at too high a dose — is prolonged or severe gastrointestinal distress. Signs that may indicate a dosing error include:
- Severe nausea lasting more than 24 hours
- Persistent vomiting — particularly if it prevents keeping fluids down
- Diarrhea combined with inability to eat or drink
- Dizziness or lightheadedness, which may indicate dehydration
- Extreme fatigue or weakness
- Rapid heart rate in the context of dehydration symptoms
- Severe abdominal pain
If these symptoms develop after a semaglutide injection, do not wait them out at home. Contact the Poison Control Center at 1-800-222-1222 immediately for guidance, or seek medical evaluation. Severe dehydration from vomiting and diarrhea can escalate quickly, particularly in older adults.
What You Can Do Now
- Confirm your dosing schedule with your prescriber right now. Semaglutide (Ozempic and Wegovy) is a weekly injectable. It should be taken on the same day each week , not daily.
- Do not skip the titration schedule. Your prescriber or the medication guide should specify a starting dose and a step-up schedule. Do not begin at the maximum dose, even if you feel fine during the first week.
- Set a weekly reminder. Use a phone alarm, a calendar reminder, or a medication-tracking app to ensure you know exactly when your last dose was given and when the next is due.
- If you are using compounded semaglutide from a vial , confirm the exact dose in milligrams and the exact volume to draw with your prescribing provider before your first injection — and at every dose change.
- Contact your doctor before increasing your dose if you are unsure whether you have completed the recommended titration period.
- Save the Poison Control number in your phone: 1-800-222-1222 . It is free, confidential, and available 24 hours a day.
- Medicare beneficiaries newly starting GLP-1 therapy can ask their physician's office for a nursing or pharmacist counseling session, which may be covered under their plan.
Cost and Access: What Patients Should Know
FDA-approved Ozempic and Wegovy use pre-filled injection pens that are calibrated to deliver a specific dose automatically — reducing the margin for volume measurement error. Compounded semaglutide, which is drawn from a vial using a syringe, does not have this safeguard.
Many patients use compounded semaglutide because it is substantially cheaper than branded products. Before the FDA restricted the compounding of semaglutide products in 2025 due to a shortage resolution, compounded versions were widely available through telehealth platforms at a fraction of the cost of Ozempic or Wegovy.
America's Poison Centers offers free, 24-hour guidance on medication concerns at 1-800-222-1222. The service is confidential and does not require insurance.
For patients experiencing financial barriers to branded semaglutide, Novo Nordisk offers a patient assistance program that may reduce or eliminate out-of-pocket costs for eligible individuals.
What Happens Next
The study authors are calling for the findings to be incorporated into prescriber education and patient counseling standards — particularly for primary care offices and telehealth platforms that are now initiating the vast majority of new semaglutide prescriptions.
Future research should track whether the rate of poison control calls stabilizes, decreases, or continues to rise as Medicare coverage expands the patient base. Data through 2025 and 2026 — not yet available at publication — will be critical for understanding whether the error patterns identified here have been addressed by changes in prescribing practices.
MedicalDaily will follow any updates to FDA prescribing guidance, Medicare coverage rules, or clinical guidelines related to GLP-1 patient safety.
The Bottom Line
Poison control calls involving Ozempic and Wegovy surged more than five-fold in two years — not because the drug is acutely dangerous at the right dose, but because millions of patients made the same two mistakes: taking it daily instead of weekly, and starting at the maximum dose without titrating up gradually. Both errors are preventable with clear instructions at the point of prescribing.
If you or someone you care for is on semaglutide, confirm the dosing schedule today, set a weekly reminder, and save 1-800-222-1222 in your phone. If you are unsure what dose you should be taking or when you took your last injection, call your prescriber before your next scheduled dose.
