Table of Contents
Introduction: Understanding the Concern
Semaglutide is a medication that has become more common in recent years. It is used to treat type 2 diabetes and help with weight loss in people who are overweight or obese. Semaglutide is sold under brand names such as Ozempic, Wegovy, and Rybelsus. As more people use this medication, questions have come up about its possible side effects. One concern that some patients and healthcare providers have is about yellowing of the eyes.
Yellow eyes, also known as scleral icterus, can be a sign that something is wrong inside the body. This symptom often means that there may be a problem with the liver. The liver is a vital organ that helps break down food, remove toxins, and process medicines. When the liver is not working well, a yellow substance called bilirubin can build up in the body. This can make the white part of the eyes look yellow.
Since yellow eyes can be a sign of liver trouble, it is important to ask whether semaglutide might cause liver damage or make liver problems worse. Some people who take semaglutide have noticed changes in how they feel. They may wonder if the medicine could be linked to yellow eyes or other signs of liver problems. These concerns are not only seen in social media discussions but are also reflected in online searches and questions asked in medical settings.
The goal of this article is to look closely at the link between semaglutide and yellow eyes. It will explore what yellow eyes mean, how semaglutide works, and whether this medicine can affect the liver. It will also explain what the current research says about liver-related side effects. While many medicines can have unwanted effects, not all symptoms are caused by the drug itself. That is why it is important to understand both the science and the facts before drawing conclusions.
Semaglutide belongs to a group of drugs called GLP-1 receptor agonists. These medicines work by mimicking a natural hormone in the body that helps control blood sugar and appetite. For people with type 2 diabetes, semaglutide helps lower blood sugar levels. For those trying to lose weight, it helps reduce hunger and slows down how fast food leaves the stomach. These effects have made semaglutide very popular and widely prescribed.
Even though semaglutide helps many people manage their health, it can also come with side effects. Some are mild, like nausea or constipation, and others may be more serious. One side effect that has received attention is the possibility of liver problems. If the liver is affected, it may show up as fatigue, dark urine, or yellowing of the eyes or skin. While these symptoms are rare, they can be signs of liver injury and need to be taken seriously.
There are reports of people who have developed yellow eyes while taking semaglutide. However, just because a person has this symptom while on the drug does not mean the drug caused it. There could be other causes, such as pre-existing liver disease, another medication, or even an infection like hepatitis. To understand if semaglutide can directly lead to yellow eyes, medical experts look at data from clinical trials, case reports, and safety monitoring systems.
Doctors and scientists also pay close attention to how the body processes semaglutide. The way the drug is broken down and removed from the body could affect the liver. If the liver has to work too hard to handle the medication, there could be a risk of injury. On the other hand, some studies suggest that semaglutide might actually help people with certain liver conditions like fatty liver disease. This makes the question more complex and worth exploring in detail.
Because the eyes can give important clues about liver health, yellowing of the eyes should never be ignored. Whether or not semaglutide is the cause, it is a sign that the body needs to be checked. Understanding the possible connection between semaglutide and liver health can help patients and healthcare professionals make better decisions. It also helps make sure that early signs of a serious problem are not missed. The rest of the article will look deeper into this important issue and review the facts available from science and medicine.
What Are Yellow Eyes and Why Do They Happen?
Yellow eyes are a sign that something may be wrong inside the body. When the white part of the eyes turns yellow, it usually means there is too much of a substance called bilirubin in the blood. This yellowing is called scleral icterus, and it is often linked to a problem with the liver, gallbladder, or bile ducts.
What Is Bilirubin?
Bilirubin is a yellow pigment that is made when the body breaks down old red blood cells. Red blood cells live for about 120 days. When they get old, the body removes them from the bloodstream. As part of this process, a substance called heme is broken down into biliverdin, and then into bilirubin.
Bilirubin travels in the blood to the liver. The liver changes it into a form that can leave the body. It gets mixed into bile, a fluid that helps digest fats. Bile then moves into the small intestine and exits the body in the stool. A small amount of bilirubin also leaves through urine.
When everything is working well, the body keeps bilirubin levels low. But if something goes wrong with how bilirubin is made, processed, or removed, it can build up. When too much bilirubin is in the blood, it starts to collect in tissues—especially in the eyes and skin—causing them to turn yellow. This is known as jaundice.
Why Do the Eyes Turn Yellow First?
The whites of the eyes, also called sclerae, are often the first place where yellowing appears. The sclera is thin and does not have much color of its own. This makes it easier to see the yellow pigment when bilirubin levels go up. Even a small rise in bilirubin may cause a noticeable change in eye color. That is why yellow eyes can be an early warning sign before other symptoms start.
Common Causes of Yellow Eyes
Many health problems can lead to yellowing of the eyes. Most of them are related to the liver, blood, or bile system.
- Liver Problems
The liver plays a major role in clearing bilirubin from the body. When the liver is damaged or inflamed, it may not process bilirubin correctly. This can happen with:
- Hepatitis (inflammation of the liver caused by a virus, alcohol, or certain medications)
- Cirrhosis (scarring of the liver from long-term damage)
- Fatty liver disease (extra fat stored in liver cells)
In these conditions, bilirubin builds up in the bloodstream and leads to jaundice.
- Blocked Bile Ducts
Bile ducts are small tubes that carry bile from the liver and gallbladder to the small intestine. If these ducts are blocked, bile cannot flow properly. Bilirubin gets trapped in the liver and leaks into the blood. Blockages may be caused by:
- Gallstones
- Tumors
- Swelling from infection
A blocked bile duct can quickly lead to yellow eyes and skin, dark urine, pale stools, and belly pain.
- Blood Disorders
Sometimes the problem starts before bilirubin even gets to the liver. Certain blood conditions can break down red blood cells too quickly. This leads to extra bilirubin being produced. The liver cannot keep up, and bilirubin builds up in the blood. These conditions include:
- Hemolytic anemia
- Sickle cell disease
- Thalassemia
In these cases, the liver is working normally, but the system is overwhelmed.
- Medication Side Effects or Toxins
Some medications or chemicals can damage the liver or affect how bilirubin is processed. This is known as drug-induced liver injury. Symptoms like yellow eyes may appear suddenly. Medications, supplements, or toxins may be the cause if liver test results change after starting a new drug.
Other Symptoms That May Appear With Yellow Eyes
Yellow eyes are often a sign that something else is happening in the body. People with this symptom may also notice:
- Yellow skin (jaundice)
- Dark-colored urine
- Pale or gray stools
- Tiredness or weakness
- Itching
- Pain in the upper right side of the belly
These symptoms help doctors find the cause and decide what tests to run.
Yellowing of the eyes is not a disease by itself. It is a sign that bilirubin levels are too high, which often points to a problem in the liver, bile ducts, or blood cells. It can be caused by infections, blockages, blood disorders, or liver damage. The eyes are usually the first place this change is seen. Identifying the cause early is important so the right treatment can begin.
What Is Semaglutide and How Does It Work in the Body?
Semaglutide is a medication used to help people with type 2 diabetes and obesity. It belongs to a group of drugs called GLP-1 receptor agonists. GLP-1 stands for glucagon-like peptide-1, which is a natural hormone in the body. This hormone helps control blood sugar and appetite.
Semaglutide is made to act like the body’s own GLP-1, but it stays in the body much longer. This makes it helpful for long-term control of blood sugar and weight. It is available under brand names such as Ozempic and Wegovy. Ozempic is mainly used for type 2 diabetes, while Wegovy is used for weight loss.
How Semaglutide Works in the Body
Semaglutide works by copying the actions of the GLP-1 hormone. GLP-1 is released in the gut after eating. It sends signals to the brain and other organs to help manage digestion, hunger, and blood sugar.
Here are the main ways semaglutide works:
- It helps the pancreas release more insulin
After eating, blood sugar levels rise. Semaglutide helps the pancreas make more insulin only when blood sugar is high. Insulin is a hormone that moves sugar from the blood into the body’s cells to be used as energy. By helping the body make more insulin, semaglutide lowers blood sugar levels in a safe way. - It lowers the amount of glucagon
Glucagon is another hormone made by the pancreas. It tells the liver to release stored sugar into the blood. Semaglutide lowers the amount of glucagon the body makes. This helps stop extra sugar from entering the blood when it’s not needed. - It slows down how fast the stomach empties
Semaglutide makes food stay in the stomach longer. This slows digestion and helps prevent sharp increases in blood sugar after meals. It also makes people feel full sooner and for longer, which helps reduce how much they eat. - It acts on the brain to reduce hunger
Semaglutide sends signals to areas of the brain that control appetite. People taking the drug often feel less hungry. This helps them eat less and lose weight over time.
FDA-Approved Uses
Semaglutide has been approved by the U.S. Food and Drug Administration (FDA) for two main purposes:
- Type 2 Diabetes (as Ozempic)
For adults with type 2 diabetes, semaglutide helps lower blood sugar and reduce the risk of heart problems like heart attacks and strokes. It is used along with diet and exercise. - Obesity and Overweight (as Wegovy)
For adults with obesity, or those who are overweight with weight-related health problems, semaglutide helps with weight loss. It is used along with a reduced-calorie diet and increased physical activity.
Semaglutide is not used to treat type 1 diabetes or diabetic ketoacidosis. It is also not a substitute for insulin.
How the Body Processes Semaglutide
After being injected under the skin (usually once a week), semaglutide slowly enters the bloodstream. It is not broken down by the stomach like pills because it is given as an injection. Once in the blood, semaglutide travels throughout the body.
The liver and kidneys help remove semaglutide from the body. This is why the liver is important in the process. Any problems with liver function might change how the drug is handled. The drug stays in the body for a long time, so it only needs to be taken once a week.
Semaglutide is a drug that helps control blood sugar and appetite. It works by acting like the body’s own GLP-1 hormone. It helps the pancreas release more insulin, lowers glucagon, slows down stomach emptying, and reduces hunger. These effects make it useful for treating type 2 diabetes and obesity. Because semaglutide interacts with the liver and other organs, understanding how it works is important when considering side effects such as yellow eyes or liver issues.
Are Yellow Eyes Listed as a Known Side Effect of Semaglutide?
Semaglutide is a medicine that helps people with type 2 diabetes and obesity. It is sold under brand names like Ozempic, Wegovy, and Rybelsus. While many people benefit from semaglutide, some worry about its side effects. One question that often comes up is whether semaglutide can cause yellowing of the eyes, also called scleral icterus. This is often a sign of a liver problem. To understand the risks, it is important to look at what is known from official drug information, clinical trials, and safety reports.
Official Prescribing Information
Every prescription drug in the United States comes with a document called the prescribing information or drug label. This includes a list of possible side effects that were seen during clinical trials. It also explains serious warnings, common reactions, and rare but severe problems.
For semaglutide, the U.S. Food and Drug Administration (FDA) has approved several forms of the drug. These include:
- Ozempic (used for type 2 diabetes)
- Wegovy (used for weight loss in people with obesity or overweight)
- Rybelsus (oral form used for type 2 diabetes)
None of the FDA-approved labels for semaglutide specifically list “yellow eyes” or “jaundice” as a reported side effect. Jaundice is the medical term for yellowing of the skin or eyes caused by a build-up of a substance called bilirubin. However, just because it is not listed does not mean the risk is zero.
Side Effects Seen in Clinical Trials
Before semaglutide was approved, it was tested in thousands of people during large clinical trials. These trials looked at both common and rare side effects. According to the data from these studies, the most common side effects of semaglutide are:
- Nausea
- Vomiting
- Diarrhea
- Constipation
- Stomach pain
- Headache
- Low blood sugar (when used with other diabetes drugs)
Some people in the studies also showed small increases in liver enzymes like ALT (alanine aminotransferase) and AST (aspartate aminotransferase). These enzymes are chemicals that the liver makes. When they go up, it sometimes means the liver is under stress or inflamed. However, most of these increases were mild and went back to normal without stopping the medicine.
Warnings About Serious Liver Problems
Although semaglutide is not known for causing liver failure or major liver damage, its labels do include some general safety warnings. For example, Ozempic has a warning about pancreatitis, a painful condition of the pancreas that is located near the liver. Pancreatitis itself can sometimes raise liver enzymes. There is also a caution about gallbladder disease, such as gallstones, which can block bile ducts and lead to jaundice.
Even though liver failure is not a known effect, doctors are told to use caution when giving semaglutide to patients with severe liver problems. People with cirrhosis or chronic hepatitis may already have abnormal liver function. For them, any added stress on the liver may increase the risk of complications.
Post-Marketing Safety Reports
Once a drug is approved and sold to the public, safety experts continue to track side effects. These reports are collected in databases like the FDA Adverse Event Reporting System (FAERS). Healthcare providers and patients can report any problems they believe are linked to a medicine.
A review of FAERS reports shows that a very small number of people have reported jaundice or liver injury while taking semaglutide. However, these are only reports. They do not prove that semaglutide caused the problem. Many of these patients were also taking other medications or had health issues that could affect the liver. Also, the reports may not include full details like lab tests or medical history.
To date, yellow eyes are not a common or expected side effect of semaglutide. They are not listed on the drug labels, and clinical trials did not find a strong link between semaglutide and liver failure or jaundice. However, some people have reported liver-related problems after starting the medication. While these cases are rare, they show the need to be alert to signs of liver stress, especially in people with other risk factors.
Semaglutide appears to be safe for the liver in most people. But yellowing of the eyes should always be taken seriously. If this symptom appears, it may point to a deeper issue with the liver, the gallbladder, or another part of the body. A doctor should evaluate it right away.
Can Semaglutide Affect Liver Function?
Semaglutide is a medicine used to treat type 2 diabetes and obesity. It works by copying a natural hormone in the body called GLP-1 (glucagon-like peptide-1). This hormone helps control blood sugar and appetite. Since semaglutide affects different parts of the body, people may wonder if it can also impact the liver. The liver plays a major role in breaking down and removing substances from the body, including medicines. Any drug that changes how the liver works or adds extra stress to it can sometimes lead to problems.
To understand how semaglutide might affect the liver, it helps to look at how the medicine is handled inside the body. Semaglutide is injected under the skin and then enters the bloodstream. From there, it travels through the body and eventually reaches the liver. Unlike some medicines that are broken down mainly by the liver, semaglutide is removed more slowly. A part of it is cleared by enzymes in the blood and other tissues, while the rest is filtered out by the liver and kidneys over time. This means the liver does help process semaglutide, though it is not the main organ responsible for removing it.
Studies have looked at whether semaglutide causes liver damage. In large clinical trials, researchers measured liver enzymes such as ALT (alanine aminotransferase) and AST (aspartate aminotransferase) in people taking the medicine. These enzymes are found in liver cells. When the liver is stressed or injured, the enzymes can leak into the blood, which causes their levels to rise. A small rise may not mean anything serious, but very high levels could be a sign of liver damage.
Most people in the trials did not show big changes in liver enzyme levels. For many, the levels stayed the same or even improved. In some cases, semaglutide helped lower ALT and AST, especially in people who had obesity or type 2 diabetes. These people often have a condition called non-alcoholic fatty liver disease (NAFLD), where fat builds up in the liver and causes inflammation. Some researchers believe that semaglutide might help reduce fat in the liver, which could protect it from damage.
A few people in the studies did have increases in liver enzymes. These increases were usually mild and went back to normal over time. Serious liver problems, such as liver failure or hepatitis, were very rare and not clearly linked to semaglutide. In many of those rare cases, there were other possible reasons, such as alcohol use, other medications, or existing liver disease. So far, there is no strong proof that semaglutide directly causes liver damage in healthy people.
There is also interest in whether semaglutide can help treat fatty liver disease. Some smaller studies have shown that it might lower liver fat and improve liver tests in people with NAFLD. One reason could be weight loss. Semaglutide helps people lose weight, and losing weight often helps the liver work better. Another reason might be that semaglutide reduces inflammation in the body, including the liver.
Even though the results look hopeful, more research is needed. Larger and longer studies will help show if semaglutide really protects the liver or just improves liver test results in the short term.
It is important to remember that everyone reacts to medicines in different ways. While semaglutide does not seem to harm the liver in most people, there may be rare cases where it plays a role, especially if someone already has liver disease or is taking other medications that affect the liver. Doctors may check liver tests before starting semaglutide in people with known liver problems, just to be safe.
Semaglutide is not known to directly cause liver damage in most people. In fact, it may improve liver health in some cases by helping with weight loss and lowering blood sugar. However, liver function should still be watched carefully in patients who have other risk factors or who show signs of liver trouble, such as yellowing of the eyes or skin, dark urine, or upper right belly pain.
Have There Been Documented Cases of Jaundice or Liver Injury from Semaglutide?
Doctors and researchers have looked at how semaglutide affects the liver. So far, the reports of liver problems like jaundice (yellowing of the eyes or skin) are very rare. Still, some people taking semaglutide have reported these symptoms. It is important to look closely at these cases and understand what may have caused them.
Jaundice and the Liver
Jaundice is a condition that causes the skin and the whites of the eyes to turn yellow. This happens when there is too much bilirubin in the blood. Bilirubin is a yellow substance made when the body breaks down red blood cells. The liver usually removes bilirubin from the blood. If the liver is not working well, bilirubin can build up and cause yellowing of the eyes and skin.
Jaundice is not a disease on its own. It is a sign that something may be wrong with the liver or bile ducts. It can also be caused by certain medications that affect liver function.
What the Case Reports Show
Some case reports have described patients who developed liver problems after taking semaglutide. These problems included elevated liver enzymes, dark urine, and yellowing of the skin or eyes. In a few cases, doctors suspected that semaglutide may have caused these issues. However, the number of these reports is small compared to the large number of people using the drug.
A review of data from the U.S. Food and Drug Administration’s Adverse Event Reporting System (FAERS) shows that liver-related side effects have been reported. These include increased liver enzymes, hepatitis, and jaundice. Still, these events were uncommon. Most people taking semaglutide do not report liver problems.
How Common Are These Cases?
Liver problems related to semaglutide are not common. In clinical trials that tested the safety of semaglutide, serious liver damage was not seen in large numbers. Most patients did not experience liver-related side effects. Mild increases in liver enzymes were sometimes noted, but these were often temporary and went away on their own.
There are no large studies that show semaglutide directly causes jaundice or severe liver injury in healthy people. The few reported cases could be due to other causes or conditions that the person already had before taking the drug.
Possible Reasons for Liver Injury
Some people taking semaglutide may also have other health problems, such as obesity, type 2 diabetes, or fatty liver disease. These conditions can already put stress on the liver. In such cases, it can be hard to tell whether semaglutide or another factor caused the liver problem.
Other medications taken along with semaglutide can also affect the liver. Some over-the-counter drugs, herbal supplements, and alcohol may interact with semaglutide or worsen liver function. These outside factors make it difficult to know the exact cause of liver damage in patients with jaundice.
Why It’s Hard to Prove Semaglutide Caused the Liver Problem
Just because someone develops liver problems after starting semaglutide does not mean the drug caused it. This is called “causality.” Proving causality requires ruling out all other possible causes. Doctors use special tools, such as the RUCAM (Roussel Uclaf Causality Assessment Method), to study whether a drug is likely to have caused liver damage. Even then, it is often not possible to be 100% sure.
Many of the case reports about semaglutide and liver injury do not have complete medical information. Some reports are based on patient complaints without lab results or liver scans. This makes it hard to draw clear conclusions.
So far, the evidence does not show a strong link between semaglutide and liver injury or jaundice. A few cases have been reported, but they are rare and not confirmed by strong proof. Most patients taking semaglutide do not experience liver problems. Still, people should be aware of the signs of liver trouble, such as yellow eyes, dark urine, or upper stomach pain. If these symptoms occur, a doctor should be contacted right away to check liver function and rule out serious issues.
What Should Patients and Clinicians Watch For? Early Signs of Liver Dysfunction
Yellow eyes are often an early warning sign that something might be wrong with the liver. The white part of the eye turns yellow when there is a buildup of a substance called bilirubin in the blood. Bilirubin is made when the body breaks down old red blood cells. Normally, the liver filters out bilirubin and helps remove it through stool. But if the liver is not working well, bilirubin can build up and cause yellowing of the eyes and skin. This yellowing is called jaundice, and it can be a signal of liver trouble.
Even though semaglutide (a medicine used to treat type 2 diabetes and help with weight loss) is not commonly known to cause liver damage, it is still important to know what early liver problems can look like. Recognizing the signs early can help prevent more serious issues. Some of the signs may be mild at first, but they can get worse if ignored.
Common Early Signs of Liver Problems
- Yellowing of the Eyes or Skin (Jaundice): This is often the most visible sign. It may start in the eyes and then appear on the skin. The yellow color happens because of extra bilirubin in the body.
- Dark-Colored Urine: When bilirubin builds up in the blood, it may leave the body through the urine. This can make the urine appear dark brown or tea-colored.
- Pale or Clay-Colored Stool: Healthy liver function helps give stool its normal brown color. If the liver or bile ducts are not working right, stool may look very light or even gray.
- Fatigue or Weakness: Feeling very tired all the time can be a sign of liver stress. The body uses a lot of energy when it is trying to deal with liver problems.
- Pain or Discomfort in the Upper Right Abdomen: The liver sits on the right side of the body under the ribs. A person may feel dull pain, pressure, or fullness in this area if the liver is inflamed or enlarged.
- Nausea or Vomiting: These symptoms can happen when the liver is not clearing toxins well. They can also be linked to general digestive changes.
- Loss of Appetite or Unplanned Weight Loss: People with liver problems may not feel hungry. This can lead to eating less and losing weight without trying.
- Swelling in the Abdomen or Legs: This may occur in more advanced liver conditions. The abdomen may fill with fluid, a condition called ascites.
These signs do not always mean the liver is damaged by semaglutide. They can be caused by many health problems. But anyone taking semaglutide or any other medicine should report these symptoms to a healthcare provider. A proper evaluation can help find the cause and start the right treatment.
Monitoring Liver Health
Liver problems can sometimes be found before symptoms appear. Doctors may do blood tests to check for signs of liver stress or damage. These tests are called liver function tests (LFTs) and include measurements such as:
- ALT (alanine aminotransferase): This enzyme rises when liver cells are injured.
- AST (aspartate aminotransferase): Like ALT, this enzyme shows liver cell damage.
- ALP (alkaline phosphatase): High levels may point to problems in the bile ducts.
- Bilirubin: A direct measure of how well the liver is clearing waste.
- Albumin and INR: These check how well the liver is making important proteins.
Doctors may order these tests before starting semaglutide, especially for people who already have liver conditions. If a person taking semaglutide develops symptoms like yellow eyes, these tests can help find out what is happening.
When to Seek Medical Attention
Some people may not think yellow eyes or tiredness are serious. But these signs can be very important. It is best to talk to a healthcare provider right away if any of the following appear:
- The eyes or skin turn yellow
- Urine becomes dark for more than a day
- Stools become pale or gray
- Ongoing nausea or vomiting
- Sudden or serious fatigue
- Pain near the liver (right upper belly)
Waiting too long can allow a mild liver issue to become serious. In some rare cases, drug-induced liver injury can lead to liver failure, which is life-threatening. Early testing and treatment can help avoid these outcomes.
Knowing the signs of liver dysfunction and getting help early can make a big difference in keeping the liver healthy. Even though semaglutide is usually safe for the liver, being alert to changes in the body is a smart part of using any medication.
Who May Be at Higher Risk for Liver-Related Side Effects While Using Semaglutide?
Not every person who takes semaglutide will experience liver-related side effects. Most people tolerate the medication well. However, some groups may be at higher risk of liver problems, which could show up as yellowing of the eyes or skin. These people need closer medical monitoring while using semaglutide.
People With Pre-existing Liver Disease
People who already have liver disease may be more likely to develop problems when taking semaglutide. This includes those with conditions such as:
- Non-alcoholic fatty liver disease (NAFLD)
- Non-alcoholic steatohepatitis (NASH)
- Hepatitis B or C
- Cirrhosis
In these conditions, the liver is already inflamed, scarred, or not working properly. Semaglutide is not known to directly damage the liver in most people, but in someone whose liver is already under stress, any additional pressure on the liver could make symptoms worse. The yellowing of the eyes may be an early sign of liver strain in these cases.
People Taking Multiple Medications (Polypharmacy)
Taking many medications at the same time—known as polypharmacy—can increase the risk of side effects, especially those involving the liver. The liver processes most drugs in the body. If it becomes overwhelmed or if certain drugs interact, this may lead to drug-induced liver injury (DILI).
For example, a person taking semaglutide along with drugs that are known to affect the liver—like statins, acetaminophen, or certain antibiotics—may be at higher risk. This is especially true if these drugs are not spaced out or if dosages are too high. Even over-the-counter medicines and herbal supplements can contribute to liver problems.
Some drug combinations may not be harmful on their own but could cause problems when taken with semaglutide. Monitoring liver function in these individuals is often recommended.
People Who Drink Alcohol Regularly
Alcohol is another major factor that can harm the liver. Drinking alcohol while using semaglutide may increase the chance of liver-related side effects. Alcohol is broken down by the liver, just like medications. If both semaglutide and alcohol are present, the liver may struggle to manage both.
In some cases, heavy or long-term alcohol use can cause liver inflammation or fat buildup, which can make semaglutide less safe. Even moderate drinking might increase the risk if the person already has liver disease or is on other medications. Yellow eyes, dark urine, or tiredness could be early signs of alcohol-related liver injury.
People With Obesity or Metabolic Syndrome
Obesity is one of the most common reasons semaglutide is prescribed. However, obesity itself is a known risk factor for liver disease, especially fatty liver. People with metabolic syndrome—a group of conditions that includes high blood sugar, high cholesterol, high blood pressure, and abdominal fat—are also at risk.
In these individuals, the liver often stores too much fat, which can lead to inflammation and scarring over time. When semaglutide is added to this already stressed system, even if it helps with weight loss and blood sugar, some temporary effects on the liver may occur. These effects usually improve as weight goes down and health markers improve, but yellowing of the eyes should not be ignored if it appears.
People With Kidney Problems
While semaglutide mainly affects the digestive system and pancreas, the kidneys and liver work together to process and clear waste from the body. People with kidney disease may also have some liver issues or may be more sensitive to side effects. When the kidneys are not working well, medications can stay in the body longer and put more pressure on the liver.
In rare cases, dehydration from semaglutide (which may cause vomiting or diarrhea) can lead to kidney stress, and this in turn may indirectly affect the liver. Monitoring both kidney and liver function in people with known kidney problems is important.
Dose-related Considerations
Semaglutide is started at a low dose and increased slowly. This method helps reduce side effects, especially those related to the stomach. For some people, higher doses may put more strain on the liver, especially if other risk factors are present. Those who experience signs such as yellow eyes, stomach pain, or fatigue after a dose increase should contact a healthcare provider.
Doctors may adjust the dose more slowly or stop the drug if liver-related symptoms appear. Lower doses may still offer benefits while reducing the risk of serious side effects.
People with liver disease, those who take many medications, regular alcohol drinkers, people with obesity or metabolic syndrome, and those with kidney problems may be at greater risk for liver-related side effects when using semaglutide. Careful monitoring and early attention to warning signs like yellowing of the eyes are important to keep treatment safe and effective.
Could Yellow Eyes Be Caused by Something Other Than Semaglutide?
Yellow eyes, also known as scleral icterus, usually happen when there is a buildup of a substance called bilirubin in the blood. Bilirubin is a yellow pigment made when the body breaks down old red blood cells. The liver helps remove bilirubin from the blood. If the liver is not working well, or if something is blocking the flow of bile, bilirubin levels can rise. When this happens, the eyes and skin may turn yellow. While some people may worry that semaglutide is the cause of yellow eyes, many other health problems or medications may be responsible. Understanding these other possible causes is important.
Liver Diseases
Liver disease is one of the most common reasons why the eyes may turn yellow. Conditions such as hepatitis (inflammation of the liver), cirrhosis (scarring of the liver), or fatty liver disease can damage the liver. When the liver is damaged, it may not remove bilirubin properly. As a result, bilirubin builds up in the blood and causes yellow eyes. These conditions can be caused by viruses, alcohol use, obesity, or certain medications. People with known liver problems are more likely to have yellowing of the eyes, even without taking semaglutide.
Gallbladder and Bile Duct Problems
Another possible cause of yellow eyes is a blockage in the bile ducts. Bile is a fluid made by the liver that helps with digestion. It flows through small tubes called bile ducts into the intestine. If a stone, tumor, or swelling blocks the ducts, bile cannot flow normally. This can lead to a buildup of bilirubin in the body. Conditions such as gallstones or bile duct infections (called cholangitis) can lead to this kind of blockage. These problems may cause sudden yellowing of the eyes, along with pain in the upper right side of the abdomen, dark urine, pale stools, and fever.
Hemolysis (Breakdown of Red Blood Cells)
In some cases, yellow eyes can happen when too many red blood cells break down too quickly. This is known as hemolysis. When red blood cells are destroyed, they release large amounts of bilirubin. If the liver cannot clear the extra bilirubin fast enough, it builds up in the body. Hemolysis can be caused by blood disorders, infections, autoimmune diseases, or certain medications. Signs of hemolysis may include fatigue, dark urine, and a rapid heartbeat.
Drug-Induced Liver Injury (DILI)
Many different medications can cause liver injury. This is known as drug-induced liver injury or DILI. When the liver is damaged by a medicine, it may not work properly. This can lead to higher bilirubin levels and yellowing of the eyes. Some antibiotics, seizure medications, and over-the-counter pain relievers like acetaminophen can harm the liver if taken in large amounts or for a long time. Even herbal supplements can cause liver problems in some cases. People who are taking semaglutide may also be taking other drugs at the same time. If yellow eyes appear, another medicine could be the cause, rather than semaglutide itself.
Underlying Health Conditions
Some people who are prescribed semaglutide already have other health conditions that may affect the liver. For example, people with type 2 diabetes or obesity are at higher risk for non-alcoholic fatty liver disease (NAFLD). This condition causes fat to build up in the liver, which can lead to liver damage over time. If a person with NAFLD takes semaglutide and develops yellow eyes, the cause may be the liver disease and not the medication.
Importance of a Full Medical Check-Up
When yellow eyes appear, it is important to get a full medical check-up. A doctor can run blood tests to check liver enzymes, bilirubin levels, and other markers of liver health. Imaging tests like ultrasound or CT scan may be needed to look for gallstones, liver damage, or bile duct blockages. A full review of all medications, supplements, and medical history can help find the true cause. Semaglutide may not always be the reason for yellow eyes, especially if other risk factors are present.
Although semaglutide has raised some concerns about liver safety, yellow eyes can be caused by many other conditions. Liver disease, gallstones, hemolysis, and other medications are common causes. In many cases, the symptom may have nothing to do with semaglutide. A careful medical review is needed to find the exact cause and make the right treatment plan.
What Does the Current Research Say About Semaglutide’s Liver Safety Profile?
Semaglutide is a medicine used to help people manage type 2 diabetes and obesity. It belongs to a group of drugs called GLP-1 receptor agonists. These drugs work by helping the body control blood sugar, reduce hunger, and support weight loss. As with any medicine, it is important to understand how it affects the body, including the liver. The liver plays a major role in processing medicines, so researchers have studied how semaglutide interacts with it.
Several clinical trials have looked at how safe semaglutide is for the liver. Most of these studies have shown that semaglutide does not usually cause serious liver problems in most people. In fact, some studies suggest that semaglutide may actually help improve liver health, especially in people with fatty liver disease.
Fatty liver disease, also called non-alcoholic fatty liver disease (NAFLD), is common in people with obesity or type 2 diabetes. In this condition, fat builds up in the liver, which can lead to swelling, scarring, and even liver failure in serious cases. Some clinical trials found that semaglutide helped reduce liver fat in people with NAFLD. This means semaglutide might protect the liver in certain situations, though more research is needed to confirm this benefit.
For example, a study published in The Lancet in 2020 looked at people with type 2 diabetes and fatty liver. After taking semaglutide for several weeks, many of them had lower levels of liver fat. Liver enzyme tests also showed signs of improvement. These early results are promising, but scientists are still studying how long these effects last and how they work over time.
Even though many people tolerate semaglutide well, there have been a few reports of possible liver injury. In rare cases, patients taking semaglutide have developed symptoms such as yellowing of the eyes (also known as jaundice), dark urine, nausea, and upper right belly pain. These can be signs of liver problems. However, these side effects have been reported in only a small number of people. It is not always clear whether semaglutide caused these symptoms or if something else was the reason.
The U.S. Food and Drug Administration (FDA) collects safety data on drugs through a system called the FDA Adverse Event Reporting System (FAERS). According to this system, liver-related problems such as elevated liver enzymes and jaundice have been reported with semaglutide, but the number of cases is very low compared to how many people use the drug. This suggests that serious liver damage from semaglutide is rare.
In studies comparing semaglutide with other diabetes medicines, semaglutide did not lead to more liver problems than the other drugs. Some studies even showed fewer liver-related side effects with semaglutide. However, these studies mostly included people without severe liver disease, so more research is needed in people with advanced liver conditions.
Some scientists have asked if semaglutide might cause liver problems in people who already have liver disease. Since the liver helps break down many medicines, it is important to be cautious in these cases. In most studies, semaglutide did not seem to worsen liver function in people with mild to moderate liver disease. But it is still unclear how safe semaglutide is for people with cirrhosis or severe liver failure. These groups were often excluded from clinical trials, so doctors usually monitor them more closely if they use semaglutide.
Research is ongoing to understand more about semaglutide and the liver. Some studies are testing whether semaglutide can be used as a treatment for fatty liver disease, even in people who do not have diabetes. These studies could give more information about how semaglutide affects the liver in the long term.
The current research shows that semaglutide does not usually cause liver problems and may even help the liver in some people. Serious liver injury appears to be rare. However, because some cases of jaundice and liver changes have been reported, patients and healthcare providers should remain aware. Ongoing studies will help answer more questions about the liver safety of semaglutide, especially for people with existing liver conditions.
Should Liver Function Be Monitored During Semaglutide Therapy?
Semaglutide is a medication used to manage type 2 diabetes and obesity. It works by mimicking a natural hormone in the body called GLP-1, which helps control blood sugar and reduce appetite. While semaglutide is considered safe for most people, it may affect the liver in some cases. Because of this, doctors and patients often ask whether liver function should be checked while using this medicine.
Liver function refers to how well the liver performs its many important jobs, such as removing toxins, breaking down fats, and processing medicines. Liver function tests (LFTs) are blood tests that help show how healthy the liver is. These tests measure things like alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin, and alkaline phosphatase. When levels of these markers are high, it may mean the liver is irritated, inflamed, or injured.
Even though semaglutide is not commonly linked to liver damage, there are a few reasons why liver function might need to be checked while using this drug. One reason is that semaglutide is processed in the body in a way that may involve the liver, even if it is not mainly broken down by the liver like some other drugs. Because of this, it may cause small changes in liver enzyme levels in some people.
Another reason for monitoring is that people who are prescribed semaglutide often already have risk factors for liver problems. For example, people with type 2 diabetes or obesity are more likely to have non-alcoholic fatty liver disease (NAFLD). This condition causes fat to build up in the liver, which may lead to liver inflammation or scarring over time. If a person with NAFLD starts using semaglutide and develops symptoms like yellowing of the eyes or skin, it is important to know whether semaglutide played a role or if it was caused by their liver condition.
Some clinical studies have suggested that semaglutide may help improve liver health in people with NAFLD by reducing fat in the liver. However, more research is needed to know for sure. Even if semaglutide may help the liver in some cases, it is still important to be careful, especially when someone already has liver disease.
Doctors may recommend liver function testing before starting semaglutide to check for any hidden liver problems. This baseline test helps show whether the liver is already working properly. If the test shows abnormal liver enzyme levels, the doctor may decide to monitor the liver more closely after starting semaglutide. If the levels are very high, the doctor may wait to start semaglutide or choose a different treatment.
During treatment, liver function tests may be repeated if the person develops symptoms of liver trouble. These symptoms include yellowing of the eyes (a sign of high bilirubin), dark-colored urine, pain in the upper right side of the belly, or unusual tiredness. If blood tests show that liver enzymes are rising after starting semaglutide, the doctor may lower the dose, pause treatment, or stop it entirely depending on how severe the problem is.
In people who take many other medicines, especially those that affect the liver, careful monitoring becomes even more important. Some medications can increase the risk of liver damage when used together. Older adults may also be more sensitive to changes in liver function. Regular testing helps catch problems early and reduces the chance of serious complications.
For people with no liver problems and no symptoms, routine liver testing during semaglutide therapy is not always required. However, the decision should be made based on individual health conditions, medical history, and any changes noticed during treatment. When in doubt, a healthcare provider may suggest testing just to be safe.
Liver function testing can be a helpful tool during semaglutide therapy. It gives doctors information about how the liver is working and helps them make safer choices for their patients. Although liver problems with semaglutide are rare, keeping an eye on liver health ensures that any issues are found and treated early.
Conclusion: Is There a Real Link Between Semaglutide and Yellow Eyes?
Semaglutide is a medicine that helps manage type 2 diabetes and obesity. It works by mimicking a hormone called GLP-1, which affects blood sugar levels and appetite. While semaglutide has proven helpful for many people, some users have reported unusual symptoms. One of these symptoms is yellowing of the eyes, also known as scleral icterus. This yellow color often points to a buildup of bilirubin, a substance that comes from breaking down red blood cells. High levels of bilirubin can mean that the liver is not working well. Because of this, some have asked whether semaglutide can cause liver problems that lead to yellow eyes.
Yellow eyes are not a known or common side effect listed in the official drug information for semaglutide. The manufacturers of Ozempic and Wegovy, which are popular brand names for semaglutide, have not included jaundice or yellowing of the eyes as expected side effects. Clinical trials involving thousands of patients did not show a strong link between semaglutide and liver damage. However, like with any medicine, rare effects may not be seen until a drug is used by a much larger group of people over a longer time.
The liver plays a role in removing semaglutide from the body, although the drug is mostly broken down by enzymes and not stored in the liver. Some studies have shown small increases in liver enzymes like ALT and AST in people using semaglutide. These enzymes can go up for many reasons and do not always mean liver damage. In most cases, the changes were mild and went back to normal without treatment. There have not been strong reports of severe liver injury or liver failure directly caused by semaglutide in scientific journals or major safety databases. Still, there have been rare reports of people developing liver-related symptoms while using semaglutide. These include fatigue, dark urine, upper stomach pain, and yellow skin or eyes. It is not always clear if semaglutide caused these problems or if they were due to other conditions.
Doctors and researchers look at a group of cases called “drug-induced liver injury,” or DILI, to study liver side effects from medicine. This group includes people who show signs of liver damage soon after starting a drug, with no other clear cause. Some medicines are well known to cause DILI, but semaglutide has not been strongly linked to this problem. The data so far suggest that liver injury from semaglutide is very rare.
Even though semaglutide is not known to directly harm the liver, it is still important to watch for warning signs. Yellow eyes are always a sign that something may be wrong with the liver or bile system. When this happens, doctors will run blood tests to check liver enzymes and bilirubin levels. Other causes like hepatitis, alcohol use, gallbladder disease, or reactions to other medicines will also be checked. People with pre-existing liver disease or heavy alcohol use may be at higher risk for liver problems in general, and any new symptoms in these people should be taken seriously.
Some early research has even suggested that GLP-1 receptor agonists like semaglutide may help people with fatty liver disease, which is common in people with obesity or type 2 diabetes. In small trials, semaglutide reduced liver fat and improved liver enzymes. However, these benefits need more study and do not mean the medicine is risk-free for the liver. Every person responds differently, and some may still experience side effects.
Healthcare providers do not routinely order liver tests for everyone on semaglutide unless the person has liver disease or develops symptoms. However, if yellow eyes, itching, or stomach pain appear, it is important to do further testing. Most cases of jaundice or yellow eyes are not caused by semaglutide, but it should not be ruled out without a careful review.
In summary, there is no strong proof that semaglutide causes yellow eyes or liver damage in most people. Yellow eyes are a serious sign that should not be ignored, but they are not a common side effect of this medicine. People who take semaglutide should be aware of the signs of liver trouble and talk to their healthcare provider if anything unusual happens. As with all new and widely used medicines, continued research and safety tracking will help uncover rare side effects and improve how patients are monitored and treated.
Research Citations
Ma, J., Mathur, K., Muldoon, J., Ghabril, M., Chalasani, N., & Vuppalanchi, R. (2022). Progressive cholestasis and biliary cirrhosis after initiating oral semaglutide: Report from the Drug‑Induced Liver Injury Network. ACG Case Reports Journal, 9(12), e00922. doi:10.14309/crj.0000000000000922
Enslin, S., Bartell, N., & Kaul, V. (2021). The first reported case of drug‑induced liver injury caused by semaglutide. The American Journal of Gastroenterology, 116(Suppl 1), S2727. doi:10.14309/ajg.000000000000S2727
Galeano Lovera, S. F., & Gnanapandithan, K. (2023). Semaglutide‑induced hepatotoxicity: A rare case of drug‑induced liver injury. American Journal of Gastroenterology, 118(10 Suppl), S2370. doi:10.14309/ajg.000000000000S2370
Alghamdi, K. M., Hifni, H. A., Almatrafi, M. J., … & [et al.]. (2024). Drug‑induced autoimmune‑like hepatitis and cholelithiasis associated with dulaglutide and semaglutide use in a young adult: A case report and review of literature. Journal of Population Therapeutics and Clinical Pharmacology, 31(1), 674–682.
National Institute of Diabetes and Digestive and Kidney Diseases. (2025). LiverTox: Clinical and research information on drug‑induced liver injury. Semaglutide. Retrieved from National Library of Medicine.
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Poltiyelova, E., Kotkes, D., Oletsky, R., & Partiula, B. (2025). A rare case of lisinopril‑induced liver injury in a patient with concurrent semaglutide use. Journal of Hospital Medicine, 18(4), 200–203.
Xie, Y., Choi, T., & Al‑Aly, Z. (2025). Mapping the effectiveness and risks of GLP‑1 receptor agonists. Nature Medicine, 31(1), 45–54. doi:10.1038/s41591-024-02567-3
Hemingway, A., Liu, Q., & Zhang, L. (2024). Hepatic and osteogenic effects of dulaglutide and semaglutide in an experimental CCl₄‑induced liver injury model in mice. Toxicology Letters, 385, 53–62. doi:10.1016/j.toxlet.2024.01.019
Duan, Z., Wei, K., Xue, Z., Li, L., Jin, J., Yang, S., Zhou, J., & Ma, S. (2025). Crowdsourcing‑based knowledge graph construction for drug side effects using large language models with an application on semaglutide. arXiv Preprint. arXiv:2504.04346
Questions and Answers: Semaglutide Yellow Eyes
Semaglutide is a medication used to treat type 2 diabetes and obesity. It mimics a natural hormone called GLP-1 to regulate blood sugar and appetite.
Yes, yellowing of the eyes can occur in rare cases as a sign of liver issues or pancreatitis, both of which are potential (though uncommon) side effects of semaglutide.
Yellow eyes usually indicate jaundice, which is caused by elevated bilirubin levels in the blood and can signal liver dysfunction.
Yes, you should stop taking the medication immediately and seek medical attention, as yellow eyes can be a sign of a serious reaction such as liver injury or pancreatitis.
It is rare. While gastrointestinal side effects are more common, liver-related symptoms like jaundice occur infrequently but require urgent evaluation.
Your doctor may order liver function tests (LFTs), a bilirubin test, and abdominal imaging to check for liver or pancreas issues.
Yes, semaglutide has been associated with cases of acute pancreatitis, which can potentially lead to liver enzyme abnormalities and jaundice.
Yes, symptoms may include dark urine, light-colored stools, nausea, abdominal pain, or fatigue—these warrant immediate medical attention.
People with pre-existing liver disease or a history of pancreatitis may be at higher risk and should be monitored closely while on semaglutide.
Discuss your full medical history with your doctor, including any liver conditions. Regular monitoring and blood tests can help catch issues early.
Dr. Melissa VanSickle
Dr. Melissa Vansickle, MD is a family medicine specialist in Onsted, MI and has over 24 years of experience in the medical field. She graduated from University of Michigan Medical School in 1998. She is affiliated with medical facilities Henry Ford Allegiance Health and Promedica Charles And Virginia Hickman Hospital. Her subspecialties include General Family Medicine, Urgent Care, Complementary and Integrative Medicine in Rural Health.