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The Ozempic prescribing information explicitly states: "Patients using oral medications that require threshold concentrations for efficacy should be monitored particularly closely during the first 4 weeks of semaglutide therapy." [3] Patients should be counseled on three practical points: take levothyroxine and other narrow-window drugs before other medications in the morning, keep injection day consistent but do not assume interaction risk disappears on non-injection days, and report any unusual symptoms (breakthrough bleeding on OC, fatigue suggesting hypothyroidism, unusual bruising suggesting INR shift) promptly

Others underdose for weeks and wonder why nothing is happening

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