From the Guidelines
The recommended initial dose of semaglutide for a patient is 0.25 mg once weekly by subcutaneous injection for the first 4 weeks, regardless of their previous medication, such as zepound 10mg. This low starting dose helps minimize gastrointestinal side effects such as nausea, vomiting, and diarrhea, as recommended by the 2022 clinical practice guideline on pharmacological interventions for adults with obesity 1. The dose titration schedule for semaglutide is as follows:
- 0.25 mg weekly for the first 4 weeks
- 0.5 mg weekly for the next 4 weeks
- 1.0 mg weekly for the next 4 weeks
- 1.7 mg weekly for the next 4 weeks
- 2.4 mg weekly as the maintenance dose after 16 weeks This gradual dose titration is recommended to minimize the risk of gastrointestinal adverse effects, as stated in the guideline 1. Additionally, the Mayo Clinic Proceedings study in 2022 also supports this dosing regimen for semaglutide, highlighting its importance in glucose lowering and weight management 1. It is essential to note that clinical judgment is recommended for adjusting the titration schedule as needed for an individual patient’s response, tolerance, and adverse effects 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION • Start at 0.25 mg once weekly. After 4 weeks, increase the dose to 0.5 mg once weekly. If after at least 4 weeks additional glycemic control is needed, increase to 1 mg once weekly (2.1). The recommended initial dose of semaglutide is 0.25 mg once weekly. The dose should be increased to 0.5 mg once weekly after 4 weeks, and if additional glycemic control is needed, it can be further increased to 1 mg once weekly after at least 4 more weeks 2.
From the Research
Initial Dose and Titration Schedule for Semaglutide
The recommended initial dose and titration schedule for semaglutide can vary depending on the specific patient population and the formulation of the medication.
- For patients with obesity, the initial dose of semaglutide is typically 0.25 mg per week, with a gradual increase to 2.4 mg per week over the course of 4-8 weeks 3.
- In clinical trials, semaglutide has been initiated at a dose of 0.05 mg per day and incrementally escalated every 4 weeks to doses of 0.1 mg, 0.2 mg, 0.3 mg, or 0.4 mg per day 4.
- For patients transitioning from another GLP-1 receptor agonist, such as zepound (liraglutide), the initial dose of semaglutide may be individualized based on the patient's previous dose and response to treatment.
Dose Titration
The dose of semaglutide should be titrated gradually to minimize the risk of gastrointestinal side effects, such as nausea and diarrhea.
- In clinical trials, the dose of semaglutide was escalated every 4 weeks, with a maximum dose of 2.4 mg per week 3.
- The dose titration schedule may need to be adjusted based on the patient's individual response to treatment and the presence of any adverse effects.
Considerations for Patients on Zepound (Liraglutide)
For patients transitioning from zepound (liraglutide) to semaglutide, the initial dose of semaglutide may be individualized based on the patient's previous dose and response to treatment.
- There is limited information available on the specific dose conversion from zepound (liraglutide) to semaglutide, and the decision to transition a patient from one medication to another should be made on a case-by-case basis, taking into account the patient's individual needs and medical history 5.