What is the typical dosing regimen for semaglutide (glucagon-like peptide-1 receptor agonist) for the treatment of type 2 diabetes or obesity?

From the Guidelines

Semaglutide dosing for type 2 diabetes or obesity typically starts at 0.25 mg weekly, with gradual dose titration to minimize gastrointestinal adverse effects, and the maintenance dose is 2.4 mg weekly for obesity treatment or 1 mg weekly for type 2 diabetes, as recommended by recent guidelines 1. The dosing regimen for semaglutide involves a gradual increase in dose to reduce the risk of gastrointestinal side effects.

• The initial dose is 0.25 mg weekly for the first 4 weeks.
• The dose is then increased to 0.5 mg weekly, followed by 1.0 mg weekly, and finally 1.7 mg weekly, with each dose increase occurring every 4 weeks.
• The maintenance dose for obesity treatment is 2.4 mg weekly, while for type 2 diabetes, the dose may be increased to 1 mg weekly if needed for glycemic control. Key considerations for semaglutide dosing include:
• Gradual dose titration to minimize gastrointestinal adverse effects
• Individualized dose adjustments based on patient response, tolerance, and adverse effects
• Monitoring for potential complications like pancreatitis and contraindications in patients with personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2. Recent studies, such as the one published in Gastroenterology in 2022 1, provide guidance on the optimal dosing regimen for semaglutide, prioritizing morbidity, mortality, and quality of life outcomes.

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). • Administer once weekly at any time of day, with or without meals (2.1). • If a dose is missed administer within 5 days of missed dose (2.1). • Inject subcutaneously in the abdomen, thigh, or upper arm (2.2).

The typical dosing regimen for semaglutide is to start at 0.25 mg once weekly, then increase the dose to 0.5 mg once weekly after 4 weeks. If additional glycemic control is needed after at least 4 weeks, the dose can be increased to 1 mg once weekly 2, 2.

• The medication should be administered once weekly at any time of day, with or without meals.
• If a dose is missed, it should be administered within 5 days of the missed dose.
• The injection should be administered subcutaneously in the abdomen, thigh, or upper arm.

From the Research

Semaglutide Dosing Regimens

The typical dosing regimen for semaglutide, a glucagon-like peptide-1 receptor agonist, varies depending on the indication, whether for the treatment of type 2 diabetes or obesity.

• For type 2 diabetes, semaglutide is administered via subcutaneous injection once weekly. The dosing can start at 0.5 mg once weekly and can be escalated to 1.0 mg once weekly for additional glycemic control, as seen in the SUSTAIN FORTE trial 3.
• A higher dose of semaglutide, 2.0 mg once weekly, has been shown to be effective for patients with type 2 diabetes who require more intensive treatment, offering superior HbA1c reduction and additional body weight loss compared to the 1.0 mg dose, with a similar safety profile 3.
• For the treatment of obesity, semaglutide is administered at a dose of 2.4 mg once weekly, which has been demonstrated to achieve a superior and clinically meaningful decrease in body weight compared to placebo, with significant improvements in cardiometabolic risk factors and patient-reported physical functioning 4, 5.
• The efficacy and safety of semaglutide 2.4 mg have also been compared to another GLP-1 analogue, liraglutide, in adults with overweight or obesity without diabetes, showing that semaglutide results in significantly greater weight loss at 68 weeks 6.
• Earlier phase 2 trials have explored the dose-ranging efficacy and safety of semaglutide for weight loss in patients with obesity, indicating that semaglutide is well-tolerated and shows clinically relevant weight loss compared to placebo at various doses 7.

Key Findings

• Semaglutide dosing for type 2 diabetes typically starts at 0.5 mg once weekly, with the option to escalate to 1.0 mg or even 2.0 mg once weekly for enhanced glycemic control.
• For obesity treatment, a dose of 2.4 mg once weekly has been established as effective for significant weight loss.
• Semaglutide has been shown to be superior to liraglutide in terms of weight loss in adults with overweight or obesity without diabetes.
• The safety profile of semaglutide is characterized by gastrointestinal adverse events, which are generally mild to moderate and transient.