Ozempic Lawsuits: Gastroparesis, NAION and the MDL Explained

Search “Ozempic lawsuit” and almost every result is a law firm trying to sign you up. This page is not that. It explains what the lawsuits actually allege, where the cases stand as of September 2026, and what the underlying science does and does not show, so you can read the ads with better judgment.

Nothing here is legal advice or medical advice.

What is an MDL, and why does it matter here?

When thousands of people sue the same company over the same product in federal courts across the country, the Judicial Panel on Multidistrict Litigation can consolidate the cases before a single judge for pretrial work. That is a multidistrict litigation, or MDL.

An MDL is not a class action. Each case stays separate and keeps its own facts. The judge handles shared questions once instead of thousands of times: what documents get produced, which expert opinions the jury may hear, and whether entire categories of claims survive. A handful of representative cases, called bellwethers, get tried first to show both sides how juries react.

Two GLP-1 MDLs now exist, both in the Eastern District of Pennsylvania, both before Judge Karen S. Marston.

MDL 3094: the gastrointestinal injury cases

Formally, In re: Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RAs) Products Liability Litigation. The JPML centralized it in February 2024 and it was reassigned to Judge Marston in June 2024 [2][10].

Size. As of the JPML’s September 1, 2026 statistics, 4,022 actions were pending, out of 4,056 filed to date [1].

Defendants. Novo Nordisk (Ozempic, Wegovy, Rybelsus) and Eli Lilly (Mounjaro, Trulicity). This is worth noting: the litigation covers the whole GLP-1 class, not only semaglutide [2].

Injuries alleged. Gastroparesis, meaning severely delayed stomach emptying, sometimes called stomach paralysis; ileus, where the intestine stops moving contents along; intestinal obstruction; severe persistent vomiting; and gallbladder injury [2][10].

Core claim. Failure to warn. Plaintiffs allege the manufacturers knew of these risks and did not put adequate warnings on the US label in time.

The manufacturers’ defenses. Three big ones. That the injuries are multifactorial, since obesity and diabetes both independently cause slowed stomach emptying. That plaintiffs’ expert opinions on causation are not scientifically reliable. And federal preemption, the argument that FDA-approved labeling forecloses state-law failure-to-warn claims.

Where does the gastroparesis case stand?

Judge Marston chose to resolve shared, case-killing questions before picking any trial cases. That is why there is still no bellwether trial two and a half years in.

The sequence [2][9][10]:

• August 15, 2025: the single most consequential evidentiary ruling in the docket so far. After an evidentiary hearing in May 2025 and argument in July, Judge Marston issued a 78-page memorandum resolving what the court called Cross-Cutting Issue No. 1: whether gastroparesis can reliably be diagnosed without objective testing. She held that any plaintiff claiming gastroparesis “must show that their diagnosis is based on a properly performed gastric emptying study (scintigraphy, breath test, or WMC),” and excluded the opinions of the plaintiffs’ diagnostic experts [14].
• April 28, 2026: deadline for Daubert motions, the challenges to expert reliability.
• April 30, 2026: summary judgment briefing filed, covering warnings adequacy and federal preemption.
• July 2026: summary judgment briefing completed.
• September 14 to 18, 2026: the Rule 702 hearing on expert admissibility. No ruling had issued as of September 14, 2026.

That September hearing is the hinge, and it was under way as this page was last verified. General causation means whether these drugs are capable of causing gastroparesis at all. If the court excludes the plaintiffs’ general causation experts, thousands of claims fall at once. If those experts survive, the litigation moves toward bellwether selection, with trials anticipated late 2026 or into 2027, though no trial date had been confirmed as of mid-September 2026 [2][10].

No settlement had been announced in either MDL as of September 2026 [10].

What does the science say about gastroparesis and semaglutide?

Both sides have real material to work with, which is precisely why the fight is close.

For the plaintiffs. Semaglutide slows gastric emptying. That is not contested; it is in the Clinical Pharmacology section of every label and is part of how the drug works. The label also says outright that semaglutide “is not recommended in patients with severe gastroparesis” [6]. Ileus, intestinal obstruction, severe constipation and fecal impaction all appear in the postmarketing section, with ileus added to the Ozempic label in September 2023 after FDA Adverse Event Reporting System reports [12].

The most-cited study is a 2023 JAMA research letter. Comparing new users of semaglutide or liraglutide for weight loss against new users of bupropion-naltrexone in a US claims database, it reported, per 1,000 person-years [5]:

Outcome	Semaglutide	Bupropion-naltrexone
Gastroparesis	9.1	3.1
Pancreatitis	4.6	1.0
Biliary disease	11.7	12.6

Adjusted hazard ratios for GLP-1 agonists versus the comparator were 3.67 for gastroparesis (95% CI 1.15 to 11.90), 9.09 for pancreatitis (1.25 to 66.00) and 4.22 for bowel obstruction (1.02 to 17.40). Biliary disease was not significantly increased [5].

For the defense. That study included 5,411 patients in total, only 613 of them on semaglutide. Look at those confidence intervals: the pancreatitis interval runs from 1.25 to 66. That is compatible with a small effect or an enormous one. Claims databases also record diagnosis codes, not verified diagnoses, and people who take weight loss drugs differ systematically from people who do not.

There is also a separate March 2026 development the plaintiffs have seized on: on March 5, 2026 the FDA issued a warning letter to Novo Nordisk citing failures to report serious and unexpected adverse events within the required 15-day window, including three deaths, one a suicide, in patients taking semaglutide. The letter also cited a failure to develop written procedures for handling postmarketing adverse drug experiences, and followed an inspection and a long exchange of correspondence beginning in March 2025 [11][15]. That is a documented regulatory finding about reporting timeliness. It is not a finding that the drug caused any particular injury.

MDL 3163: the vision loss cases

The newer litigation. Formally, In re: Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RAs) Non-Arteritic Anterior Ischemic Optic Neuropathy Products Liability Litigation. The JPML created it on December 15, 2025 [3][4].

Size. 216 pending as of September 1, 2026 [1]. Much smaller than the GI docket, and growing.

Who is named. The transfer order describes claims arising from Novo Nordisk’s Ozempic, Wegovy and Saxenda and Eli Lilly’s Trulicity. Plaintiffs bring failure-to-warn, design-defect and breach-of-warranty claims [13].

Why separate? Not for the reason usually reported. Eli Lilly actually asked the panel to fold these cases into MDL 3094, and the JPML found there would be “substantial overlap” between the two litigations, noting that some plaintiffs allege both GI injuries and NAION and that the same defendants and largely the same counsel appear in both. That overlap is why it sent the cases to Judge Marston. It declined to merge the dockets on case-management grounds: a separate MDL lets her decide how much to coordinate them, makes tracking easier and keeps docketing orderly. The panel cited its own Taxotere precedent, where eye-injury claims got their own MDL before the judge already handling the hair-loss litigation [13].

Schedule so far. Leadership appointed March 3, 2026. A Science Day held June 2, 2026, where the judge heard non-adversarial scientific presentations from both sides on whether semaglutide-class drugs can cause NAION. Discovery and bellwether selection follow [3].

What is NAION, and what does the evidence show?

NAION stands for non-arteritic anterior ischemic optic neuropathy. It is sudden, usually painless loss of vision in one eye, caused by loss of blood supply to the front of the optic nerve. People often notice it on waking. It is usually permanent, and a meaningful share of patients eventually develop it in the second eye.

The evidence trail:

July 2024. Researchers at Massachusetts Eye and Ear published a matched cohort study in JAMA Ophthalmology reporting hazard ratios of 4.28 in people with type 2 diabetes prescribed semaglutide and 7.64 in people with overweight or obesity. It was a single referral center, which drew criticism, but it started everything.

June 6, 2025. The European Medicines Agency’s safety committee completed a full review of non-clinical data, clinical trials, postmarketing reports and published literature. It concluded NAION is a very rare side effect of semaglutide, affecting up to 1 in 10,000 people, and recommended adding it to the product information for Ozempic, Rybelsus and Wegovy. It found large epidemiological studies suggesting roughly a two-fold increase in relative risk in adults with type 2 diabetes [7]. The UK regulator followed, and the World Health Organization issued an alert later that month.

February 12, 2026. The largest study so far, published in JAMA Ophthalmology, emulated a randomized trial using records from 102,361 US veterans with type 2 diabetes who were already taking metformin, comparing 11,478 people who started semaglutide with 90,883 who started an SGLT2 inhibitor. Over up to 7.5 years there were 173 incident NAION events: 30 among semaglutide initiators and 143 among SGLT2 inhibitor initiators. That works out to 123 events per 100,000 person-years versus 67. Weighted cumulative risk was 0.29% with semaglutide versus 0.13% with the comparison class over a median 2.1 years, a hazard ratio of 2.33 (95% CI 1.54 to 3.54) and an absolute difference of 0.16 percentage points. The authors wrote that while the absolute incidence is low, counseling about this complication may be warranted [8].

Put in plain numbers, regulators frame the risk as roughly one extra NAION case per 10,000 people treated per year [7].

What the plaintiffs allege. That the manufacturer had information about NAION cases and did not warn US patients, particularly after European regulators acted in mid-2025. As of September 2026, the FDA had not required a NAION warning on the US semaglutide labels, even though the EU and UK product information carries one. That divergence is central to the litigation on both sides: plaintiffs say it shows the US warning is inadequate; defendants can point to FDA’s decision not to require one.

None of these allegations has been proven in court.

What are the state attorney general cases, and are they the same thing?

No, and they are easy to confuse.

Alongside the personal injury MDLs, there is a separate legal front over compounded semaglutide, the copies made by pharmacies rather than by Novo Nordisk. After the FDA declared the semaglutide shortage resolved in February 2025 and a Texas federal court declined in April 2025 to freeze that decision, mass compounding lost its legal basis. What followed was a wave of enforcement:

• The FDA issued a wave of more than 40 warning letters to telehealth-based compounding pharmacies in late 2025, then announced 30 more to telehealth companies on March 3, 2026, then 25 more during the week of June 15, 2026, over marketing that implied compounded products were equivalent to FDA-approved medicines [16].
• As of May 21, 2026, the FDA reported receiving more than 1,700 adverse event reports associated with compounded semaglutide and tirzepatide, while noting that state-licensed pharmacies are not legally required to report, so the real number is likely higher.
• Novo Nordisk itself has filed a reported 130-plus civil suits across 40 states against compounders, med spas and telehealth platforms, including a February 2026 suit against Hims & Hers.
• State attorneys general have opened their own investigations. Connecticut settled with a med spa over compounded GLP-1 prescribing and announced that an international trade platform would stop selling research-grade GLP-1s into the United States. Attorneys general in California, Texas, New York, Massachusetts and other states have investigated direct-to-consumer telehealth weight-loss platforms on consumer protection and unauthorized-practice theories.
• A compounding pharmacy has pushed back: Strive Compounding Pharmacy sued both Eli Lilly and Novo Nordisk in January 2026 alleging antitrust violations through exclusive telehealth agreements. Those allegations are unproven.

None of this is the personal injury litigation. It is a fight about who may legally make and market semaglutide, not about whether semaglutide caused someone’s injury.

What should you make of the lawsuit ads?

A few things are worth knowing before you click one.

Settlement numbers circulating online are speculation. Figures like “$250,000 to $1 million per plaintiff” appear on law firm pages, but no settlement exists in either MDL and no bellwether has been tried [10]. Nobody knows what these cases are worth, including the lawyers advertising them.

Filing a case does not prove a case. More than 4,000 claims are pending. The number of pending cases reflects how many people filed, not how many will succeed.

The science is genuinely unsettled for gastroparesis and more settled for NAION. For NAION, three regulators have acted and the largest study found a roughly two-fold relative increase on a small absolute base. For gastroparesis, the strongest study is small with wide confidence intervals, which is exactly why the court is spending a year on expert admissibility.

Do not stop a prescribed medicine because of a lawsuit ad. Whether semaglutide is right for any individual, and whether a symptom is drug-related, is a conversation for a healthcare provider. If you think you have been injured, that is a separate conversation for a licensed attorney in your state.

What to watch next

• The ruling from the September 2026 Rule 702 hearing in MDL 3094. It determines whether the gastroparesis litigation proceeds or collapses.
• The summary judgment ruling on federal preemption and warnings adequacy, which could dispose of whole categories of claims regardless of the science.
• Whether the FDA adds a NAION warning to the US semaglutide labels. That single regulatory decision would reshape MDL 3163 in either direction.
• The first bellwether trial date in either docket.
• The JPML’s monthly case count, which is the only authoritative running tally.

Sources

1. Pending MDL Dockets by Actions Pending, as of September 1, 2026 — U.S. Judicial Panel on Multidistrict Litigation
2. MDL 3094 docket tracker — MDL Update
3. MDL 3163 docket tracker — MDL Update
4. NAION: New MDL for Ozempic and Other GLP-1 Drugs Linked to Vision Loss — Levin Papantonio
5. Risk of Gastrointestinal Adverse Events Associated With GLP-1 Receptor Agonists for Weight Loss — JAMA, October 5, 2023
6. OZEMPIC (semaglutide) injection label — DailyMed / Novo Nordisk, revised May 2026
7. PRAC concludes NAION is a very rare side effect of semaglutide medicines — European Medicines Agency, June 6, 2025
8. New-Onset NAION and Initiators of Semaglutide in US Veterans With Type 2 Diabetes — JAMA Ophthalmology, February 12, 2026
9. Link Between Gastroparesis and Ozempic To Be Reviewed by MDL Court in 2026 — AboutLawsuits.com
10. Ozempic Lawsuit: September 2026 Blindness and Gastroparesis Claims — Drugwatch
11. FDA issues warning letter to Novo Nordisk for improper reporting of GLP-1 adverse events — Healio, March 11, 2026
12. FDA Adds Intestinal Blockage Reports to Ozempic Labeling — MedPage Today, September 28, 2023
13. MDL No. 3163 Transfer Order, December 15, 2025 — U.S. Judicial Panel on Multidistrict Litigation
14. Docket, In re GLP-1 RAs Products Liability Litigation, No. 2:24-md-03094 (E.D. Pa.) — govinfo, for the August 15, 2025 gastric emptying study order
15. Warning Letter to Novo Nordisk Inc., MARCS-CMS 717576 — U.S. Food and Drug Administration, March 5, 2026
16. FDA Warns 30 Telehealth Companies Against Illegal Marketing of Compounded GLP-1s — U.S. Food and Drug Administration, March 3, 2026