A 67-year-old diabetic patient injected his entire monthly semaglutide supply at once during a dysphoric mood episode, resulting in multiorgan failure, hypoglycemia, liver dysfunction, and duodenal ulcers.
4x overdose causing multiorgan failureSelf-injection of an entire monthly semaglutide supply (4 times the weekly dose) led to multiorgan failure, hypoglycemia, liver dysfunction, and duodenal ulcers — the first detailed report of such overdose consequences.
What the researchers found
A patient on weekly 1 mg semaglutide for one year self-injected his entire monthly prescription at once (approximately 4 times the recommended dose) during a period of dysphoria. He presented 14 days later with multiorgan failure, hypoglycemia, cholestatic liver dysfunction, two duodenal ulcers, and a two-week history of weakness, appetite loss, epigastric pain, severe diarrhea, melena, and syncope.
The authors characterize this as possible suicide-related behavior based on six criteria: the patient's prior treatment experience, ability to self-inject, awareness that a single injection is limited to the weekly dose, the intentional injection of multiple doses exceeding the monthly supply, the safety of the pen delivery system, and self-reported dysphoria before the event. The patient's clinical status improved gradually, including ulcer healing by discharge.
Why it matters
As semaglutide prescriptions surge worldwide for both diabetes and weight loss, understanding potential psychiatric side effects and overdose consequences becomes increasingly important. This case highlights two concerns: the potential link between GLP-1 drugs and mood changes that could lead to self-harm, and the serious medical consequences of semaglutide overdose — a scenario that may become more common as these drugs become more widely available.
How the study worked
This is a single-patient case report describing the clinical presentation, diagnostic workup, treatment course, and outcome of a semaglutide overdose. The authors retrospectively assessed the circumstances of the overdose, including the patient's mental state, and conducted a clinical review of the link between GLP-1 receptor agonists and suicidal behavior.
What this study cannot tell us
This is a single case report, which is the weakest form of clinical evidence and cannot establish causation between semaglutide and suicidal behavior. The patient's mood state before the overdose was assessed retrospectively and may be subject to recall bias. Pre-existing psychiatric conditions are not fully characterized. Whether the multiorgan failure was entirely caused by the semaglutide overdose or involved other factors is uncertain. One case cannot distinguish between drug-induced mood changes and coincidental depression.
How to read the evidence
This is a single case report, providing the lowest level of clinical evidence. While it documents a rare and important clinical scenario, it cannot establish causation between semaglutide and suicidal behavior, and the conclusions are limited to hypothesis generation.
When this study was published
Published in 2025, this case report is timely given the explosive growth in semaglutide prescriptions and ongoing regulatory discussions about GLP-1 RA psychiatric safety.
The bigger picture
There has been ongoing regulatory scrutiny of a potential link between GLP-1 receptor agonists and suicidal ideation or behavior. While large-scale studies have not established a causal link, case reports like this contribute to pharmacovigilance efforts. As millions more patients are prescribed these drugs, even rare psychiatric side effects could affect a significant number of people, making mental health screening particularly important.
Questions still open
- Should mental health screening become standard before and during semaglutide treatment?
- What are the pharmacokinetics of semaglutide at supratherapeutic doses and the expected timeline of toxicity?
- Is the monthly pre-filled pen design a safety risk factor for intentional overdose compared to other delivery methods?
Common questions
What happens if someone takes too much semaglutide?
Can semaglutide affect mood or mental health?
Read the original research
Semaglutide Overdose in a Diabetic Patient: Suicidal Behavior and Multiorgan Failure.
The American journal of case reports, 26, e947682
Citation
Zamir, Doron; Ovadia, Yaniv S; Ben-Bassat, Ofer; Zamir, Mariana; Malnick, Stephen D H. (2025). Semaglutide Overdose in a Diabetic Patient: Suicidal Behavior and Multiorgan Failure.. The American journal of case reports, 26, e947682. https://doi.org/10.12659/AJCR.947682