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Are Ozempic and Mounjaro safe for your kidneys?

GLP Guidebook teamUpdated 5 Oct 202615 sourcesWritten from published sources
The short answer

The US labels for Ozempic (semaglutide) and Mounjaro (tirzepatide) give one kidney warning. Dehydration from vomiting or diarrhoea can cause sudden kidney injury. In FLOW (people with diabetic kidney disease), major kidney events or kidney and heart deaths hit 18.7% on semaglutide 1 mg vs 23.2% on placebo. Pooled tirzepatide trials showed no clear rise in kidney injury.

Before you go further
  • GLP‑1 medicines are prescription-only in India, not sold over the counter.14
  • A government statement on 1 Apr 2026 said only endocrinologists, internal-medicine specialists and cardiologists can prescribe them.14
  • Who should be careful, kidney disease included, is in Guide 4: Should I consider a GLP‑1?
  • Nothing here says these medicines are right for any one person.

How can a GLP‑1 medicine harm the kidneys?

The labelled risk comes from losing fluid, because vomiting, diarrhoea or nausea can dry you out and suddenly damage the kidneys.1,2

Doctors call this acute kidney injury. The Ozempic and Mounjaro US labels report cases since launch, some needing dialysis, mostly in dehydrated people.1,2 The EU Ozempic label says this happens "in rare cases", but its side-effect table gives it no frequency band.4

The US labels advise kidney checks for people with these stomach effects, especially when starting or raising the dose.1,2 Stomach side effects are covered in Mounjaro side effects: what the trials and the label say and Guide 5: Side effects and risks.

Get help now: call 112 if you can't keep fluids down, or you are peeing much less than usual, very thirsty, or confused or sleepy. These can be signs of kidney injury.13 The Ozempic label says to tell your doctor right away if vomiting or diarrhoea won't stop.1

What did the FLOW trial find in people with kidney disease?

Semaglutide cut serious kidney outcomes and kidney or heart deaths by about 4 to 5 people in every 100, over a median of 3.4 years.1,7

FLOW gave 3,533 adults with type 2 diabetes and chronic kidney disease semaglutide 1 mg weekly or a placebo (dummy injection).7 It had 17 sites in India.8

The main outcome was kidney failure, a drop of half or more in kidney function, or death from kidney, heart or blood-vessel causes.9 It happened in 331 people (18.7%) on semaglutide vs 410 (23.2%) on placebo.1 Long-term dialysis or a transplant: 4.9% vs 5.7%, a difference the trial could not confirm.1 Novo Nordisk, the maker, funded the trial.7

The US approved semaglutide for this use on 28 Jan 2025, at 1 mg weekly.1,10 In India, a CDSCO expert committee recommended it on 17 Jul 2025 and asked for an Indian follow-up safety study.11 We found no public Indian label with the final wording.

RisksThe risks, in brief
  • Stopping because of side effects was similar in FLOW: 13.2% on semaglutide, against 11.9% on a dummy injection. But stopping because of stomach problems was four times higher: 4.5% against 1.1%.9
  • Sudden kidney injury was no more common in FLOW: serious cases in 124 people on semaglutide and 123 on the dummy injection, about 7% each.8
  • Pancreatitis: severe stomach pain that won't go away, sometimes to the back.1
  • Not for people with a personal or family history of medullary thyroid cancer or MEN 2, says the US label; tell your doctor if this applies.1
Full detail in Guide 5: Side effects and risks →

Is Mounjaro (tirzepatide) safe for the kidneys?

Pooled trials found no clear rise in sudden kidney injury on tirzepatide, but the cases were few and the pooled results covered only 26 to 72 weeks.15

A 2025 review pooled 15 trials of tirzepatide 5–15 mg for diabetes or weight (14,471 people).15 Sudden kidney injury hit 8 of 2,965 people on tirzepatide vs 2 of 1,301 on placebo, too few to tell apart from chance.15 Albumin in the urine, an early sign of kidney damage, fell more on 10 mg and 15 mg than on placebo. The authors found no harmful effect on kidney filtering (eGFR), but rated most of this evidence low or very low certainty.15 The US Zepbound (tirzepatide for weight) label reports kidney injury in 0.5% vs 0.2% on placebo.3

In SURPASS-4, which ran up to 104 weeks, eGFR fell 1.4 points a year on tirzepatide vs 3.6 on insulin glargine.12 But most people started with near-normal kidneys (average eGFR 81), everyone knew which drug they took, the analysis wasn't planned in advance, and 5 of the 9 authors worked for Lilly.12 The US Mounjaro label lists no kidney use.2

Does the dose change if your kidneys are weak?

None of the five labels we checked lowers the dose for weak kidneys, but one advises against use when kidney function is very low.1,2,4,5,6

LabelWhat it says about weak kidneys
Ozempic, USNo dose change, including kidney failure.1
Mounjaro, USNo dose change, including end-stage disease. Check kidneys in people with kidney disease who have severe stomach side effects, when starting or raising the dose.2
Ozempic, EUNo dose change for mild to severe disease. Little experience in end-stage disease.4
Wegovy, EUNot recommended below an eGFR of 30, or in end-stage disease.5
Mounjaro, EUNo dose change. Little experience in severe or end-stage disease, so use with caution.6

Wegovy is the higher-dose semaglutide brand for weight loss. An eGFR below 30 is severe kidney disease.5

Read the full picture

Related questions

Is Ozempic safe? What is tirzepatide? Is Ozempic available in India? Is Mounjaro safe for people with heart disease?
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Sources

  1. Novo Nordisk. Ozempic (semaglutide) injection, US prescribing information and Medication Guide, revised 05/2026. US label, not the Indian one: we found no public Indian label. Sections 1, 2.2, 4, 5.2, 5.6, 6.1, 8.6, 14.3 (Table 10). novo-pi.com
  2. Eli Lilly. Mounjaro (tirzepatide) US prescribing information, revised 08/2026. US label. Sections 1, 5.5, 8.6. pi.lilly.com
  3. Eli Lilly. Zepbound (tirzepatide) US prescribing information, revised 08/2026. US label. Section 6.1 (acute kidney injury, pool of Studies 1 and 2). accessdata.fda.gov
  4. European Medicines Agency. Ozempic: summary of product characteristics. EU label. Sections 4.2, 4.4, 4.8. ema.europa.eu
  5. European Medicines Agency. Wegovy: summary of product characteristics. EU label. Sections 4.1, 4.2. ema.europa.eu
  6. European Medicines Agency. Mounjaro: summary of product characteristics. EU label. Sections 4.2, 4.4. ema.europa.eu
  7. Perkovic V et al. Effects of semaglutide on chronic kidney disease in patients with type 2 diabetes (FLOW). N Engl J Med 2024;391:109-121. doi:10.1056/NEJMoa2403347 · PMID 38785209
  8. ClinicalTrials.gov. FLOW (NCT03819153), posted results (serious adverse events) and study locations, including 17 sites in India. clinicaltrials.gov
  9. RxFiles Academic Detailing (University of Saskatchewan). FLOW trial summary, Sept 2025, reproduces the safety table (Table 3) and primary-outcome definition of the NEJM paper. rxfiles.ca
  10. National Kidney Foundation (US). FDA approves Ozempic for type 2 diabetes and chronic kidney disease, 20 Feb 2025. kidney.org
  11. CDSCO. Recommendations of the SEC (Endocrinology & Metabolism), meeting of 17 Jul 2025, item 3 (semaglutide injection, Novo Nordisk India). CDSCO reuses this file name for each new meeting; file as of 5 Oct 2026. cdsco.gov.in · archived copy
  12. Heerspink HJL et al. Effects of tirzepatide versus insulin glargine on kidney outcomes in type 2 diabetes in the SURPASS-4 trial: post-hoc analysis. Lancet Diabetes Endocrinol 2022;10:774-785. doi:10.1016/S2213-8587(22)00243-1 · PMID 36152639
  13. NHS. Acute kidney injury (page last reviewed 11 Mar 2026). UK source. nhs.uk
  14. PIB Research. GLP-1 drugs: use, risks, and regulation. Government backgrounder, 1 Apr 2026. static.pib.gov.in
  15. Kamrul-Hasan A et al. Renal effects and safety of tirzepatide in subjects with and without diabetes: a systematic review and meta-analysis. World J Diabetes 2025;16(2):101282. Results, Table 1, Limitations. PMC11718474 · PMID 39959269

Last checked 5 Oct 2026 · Next review due 5 Oct 2027 · Report an error

How this answer was made. Written by the GLP Guidebook team from the sources above. It's general information, not medical advice. Talk to a qualified doctor before starting, stopping or changing any medicine. How we write