From the Guidelines
Semaglutide dosing should start with 0.25 mg once weekly for the first month, then increase to 0.5 mg weekly for the second month, 1 mg weekly for the third month, 1.7 mg weekly for the fourth month, and finally 2.4 mg weekly for maintenance for weight management, and 0.25 mg weekly for four weeks as an introductory dose, then increase to 0.5 mg weekly, with a maximum recommended dose of 1 mg weekly for type 2 diabetes, as recommended by the most recent guidelines 1.
Key Considerations
- The dosing schedule is designed to minimize gastrointestinal side effects, which are common when starting GLP-1 receptor agonists.
- Semaglutide works by mimicking GLP-1, a hormone that regulates blood sugar and appetite.
- Patients should inject semaglutide subcutaneously in the abdomen, thigh, or upper arm on the same day each week, and can change the day if needed as long as the last dose was administered at least 48 hours prior.
Dosing Details
- For weight management (Wegovy): 0.25 mg weekly for the first month, then increase to 0.5 mg weekly for the second month, 1 mg weekly for the third month, 1.7 mg weekly for the fourth month, and finally 2.4 mg weekly for maintenance.
- For type 2 diabetes (Ozempic): 0.25 mg weekly for four weeks as an introductory dose, then increase to 0.5 mg weekly, with a maximum recommended dose of 1 mg weekly.
Important Notes
- The gradual titration schedule is essential to reduce the risk of nausea, vomiting, and diarrhea.
- Semaglutide has been shown to be effective in reducing cardiovascular risk and improving glycemic control in patients with type 2 diabetes, as noted in previous studies 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 mean duration of type 2 diabetes was 13 years, and the mean BMI was 32 kg/m2. Table 7. Results at Week 30 in a Trial of OZEMPIC in Adult Patients with Type 2 Diabetes Mellitus in Combination with Basal Insulin with or without Metformin Placebo OZEMPIC 0. 5 mg OZEMPIC 1 mg Intent-to-Treat (ITT) Population (N)a 133 132 131 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 (0. 5 mg or 1 mg) once weekly or placebo for a minimum observation time of 2 years.
The recommended dose of Semaglutide is 0.5 mg or 1 mg once weekly 2.
- The 0.5 mg dose is mentioned in the context of a trial where patients received OZEMPIC 0.5 mg once weekly.
- The 1 mg dose is also mentioned as part of the same trial, where patients received OZEMPIC 1 mg once weekly.
From the Research
Semaglutide Dose Information
- The recommended dose of oral semaglutide is to be taken on an empty stomach upon waking with a sip (≤120 mL) of plain water and at least 30 minutes before the first food, beverage, or other oral medications of the day 3.
- The incidence of gastrointestinal adverse effects increased with semaglutide dose 4.
- A study characterized the dose-dependent effects of semaglutide (up to 16 mg/week) in people with type 2 diabetes and overweight or obesity, and found that higher semaglutide doses provide modest additional glucose-lowering effect, with additional weight loss, at the expense of more adverse events and treatment discontinuations 5.
- Subcutaneous semaglutide achieved significantly greater reductions in HbA1c compared to oral semaglutide, with low heterogeneity 6.
- Switching from liraglutide or dulaglutide to semaglutide in patients with type 2 diabetes mellitus resulted in further reductions in HbA1c and weight, with a small number of gastrointestinal side effects occurring 7.
Dose Administration
- Oral semaglutide should be taken as directed, with a sip of plain water and at least 30 minutes before the first food, beverage, or other oral medications of the day 3.
- Subcutaneous semaglutide can be administered once weekly, with doses escalated every 4 weeks, followed by a maintenance period 5.
Adverse Effects
- The most common adverse effects of oral semaglutide are gastrointestinal, typically nausea, diarrhea, and vomiting 3.
- Treatment-emergent adverse events and treatment discontinuations due to adverse events, primarily gastrointestinal, were more frequent in the semaglutide 8 and 16 mg groups than in the 2 mg group 5.
- Patients receiving oral semaglutide had a significantly higher risk of treatment discontinuation due to side effects compared to those receiving subcutaneous semaglutide 6.