From the Guidelines
Semaglutide dosing should be initiated at 0.25 mg once weekly and gradually titrated to minimize gastrointestinal side effects, with a maintenance dose of 0.5 mg or 1 mg weekly for type 2 diabetes, and up to 2.4 mg weekly for weight management, as recommended by the most recent guidelines 1.
Key Considerations for Semaglutide Dosing
- The dosing schedule for semaglutide varies depending on the indication, with a gradual titration approach recommended to reduce the risk of gastrointestinal side effects 1.
- For type 2 diabetes, the initial dose is 0.25 mg once weekly for 4 weeks, followed by an increase to 0.5 mg weekly, and if necessary, to 1 mg weekly after at least 4 weeks 1.
- For weight management, the dosing schedule is more aggressive, with an initial dose of 0.25 mg once weekly for the first month, followed by increases to 0.5 mg, 1 mg, 1.7 mg, and finally 2.4 mg weekly 1.
Administration and Missed Doses
- Semaglutide should be administered subcutaneously in the abdomen, thigh, or upper arm on the same day each week, with or without meals 1.
- If a dose is missed, it should be administered within 5 days of the scheduled dose; if more than 5 days have passed, the missed dose should be skipped and the regular schedule resumed 1.
Monitoring and Contraindications
- Patients on semaglutide should be monitored for gastrointestinal side effects, such as nausea, vomiting, and diarrhea, as well as hypoglycemia, especially when used in combination with other glucose-lowering medications 1.
- Semaglutide is contraindicated in patients with a history of serious hypersensitivity reaction to the medication, as well as in patients with severe renal impairment or end-stage renal failure 1.
From the FDA Drug Label
The mean changes from baseline to week 30 were -3.2 kg, -4.7 kg and 0.9 kg in the OZEMPIC 0.5 mg, OZEMPIC 1 mg, and insulin glargine arms, respectively. Patients had a mean age of 59 years and 56% were men. The primary endpoint, MACE, was the time to first occurrence of a three-part composite outcome which included cardiovascular death, non-fatal myocardial infarction and non-fatal stroke OZEMPIC significantly reduced the occurrence of MACE. The estimated hazard ratio for time to first MACE was 0.74 (95% CI: 0.58,0. 95).
The dosing for semaglutide is 0.5 mg or 1 mg once weekly 2.
From the Research
Dosing for Semaglutide
- The dosing for semaglutide varies depending on the specific treatment goal and patient population.
- For patients with type 2 diabetes, once-weekly semaglutide 2.0 mg has been shown to be effective in reducing HbA1c levels and body weight, with a similar safety profile to the 1.0 mg dose 3.
- In the treatment of overweight or obesity, once-weekly subcutaneous semaglutide 2.4 mg has been associated with significant weight loss and improvements in cardiometabolic risk factors 4, 5.
- Oral semaglutide has also been approved for the treatment of type 2 diabetes, with a recommended dosing regimen of taking the medication on an empty stomach upon waking with a sip of plain water and at least 30 minutes before the first food, beverage, or other oral medications of the day 6.
Specific Dosing Regimens
- Once-weekly semaglutide 2.0 mg has been compared to 1.0 mg in patients with type 2 diabetes, with the higher dose showing greater reductions in HbA1c and body weight 3.
- Once-weekly semaglutide 2.4 mg has been evaluated in the Semaglutide Treatment Effect in People with obesity (STEP) clinical trial programme, with significant weight loss and improvements in cardiometabolic risk factors observed 4, 5.
- The safety profile of semaglutide has been consistent across trials, with gastrointestinal adverse events being the most commonly reported 3, 7, 5.
Patient Counseling
- Pharmacists play an important role in counseling patients prescribed oral semaglutide on optimal dosing, expected therapeutic response, and strategies to mitigate potential gastrointestinal adverse events 6.
- Patients should be advised to take oral semaglutide on an empty stomach upon waking with a sip of plain water and at least 30 minutes before the first food, beverage, or other oral medications of the day 6.