Suspected fake Ozempic causes hypoglycemia in 11 in Lebanon

Eleven people suffered bouts of dangerously low blood sugar in Lebanon this year, one of whom required hospitalization, after injecting suspected fake versions of Novo Nordisk’s diabetes drug Ozempic, according Lebanese health officials.

A director for the Lebanese Ministry of Public Health, Rita Karam, said officials suspected the drugs were fake after discovering the doses were different from the ones calibrated for authentic Ozempic injector pens.

Explosive demand for Ozempic and other drugs used for weight loss, including Eli Lilly’s Mounjaro and Novo’s Wegovy, is fueling a global surge in counterfeit versions, Reuters interviews with law enforcement, anti-counterfeiting and public health officials showed last month.

Counterfeit Ozempic has already been found in at least 17 countries, including the UK, Germany, Egypt and Russia. Several have issued warnings to pharmacies and consumers to be vigilant about counterfeits, since it is not clear what they actually contain.

Karam said the ministry had begun investigations into the 11 cases, but that the source and batch numbers of the drugs in question had not been identified in most, which made it hard to determine what the victims may have taken.

Three of the people who took the suspected fake Ozempic did so to control their diabetes, while four took it for weight management, Karam said. The other four injected the drug for an ‘unspecified indication.’

People with diabetes need to closely manage their blood sugar, which can be done with a variety of medicines including Ozempic. When blood sugar, or glucose level, gets too low they can suffer hypoglycemia, with symptoms that may include headaches or dizziness and can progress to a loss of consciousness or seizures.

Lebanon’s Ministry of Public Health issued two recalls related to Ozempic in January 2023, according to its website. No cases of potentially counterfeit Ozempic were reported in Lebanon in 2022, Karam said.

Novo Nordisk said it investigates and reports every counterfeit case it finds to local authorities, and that it has created a guide for health care providers in the Middle East to show how to spot fake drugs.

More than a quarter of Lebanese adults are obese, according to 2017 figures from the World Obesity Federation. Obesity has been closely linked with type 2 diabetes, by far the most common form of the disease.

Data from the International Diabetes Federation showed that almost 9 percent of adults in Lebanon had diabetes in 2021, compared to nearly 14 percent in the United States.

Karam said Ozempic is neither purchased nor provided by the Ministry of Public Health.

Wegovy, Novo Nordisk’s weight-loss drug with the same active ingredient — semaglutide — as Ozempic, was shown to help patients lose an average of 15 percent of their weight in a late-stage trial.

The scramble for supplies of the powerful pound-shedding molecule has led to shortages of Ozempic in several countries including Britain, Germany, Belgium and the United States.

A source familiar with anti-counterfeiting efforts told Reuters last month that markets where sales of fake weight-loss drugs were most prevalent included Lebanon and other countries in the Middle East.

Several people have been hospitalized in Austria for hypoglycemia after taking potentially fake versions of Ozempic. The health safety regulator there said the side effects indicated the product contained insulin instead of semaglutide.

Last month, Belgium’s drug regulator said it had seized counterfeit versions of Ozempic in which the injector pens were confirmed to contain insulin.