What is the recommended dose for Ozempic (semaglutide)?

Recommended Dosing for Ozempic (Semaglutide)

For Ozempic (semaglutide), the recommended dosing regimen starts at 0.25 mg once weekly for 4 weeks, then increases to 0.5 mg weekly, with further titration to 1.0 mg weekly as needed for glycemic control. 1

Initial Dosing and Titration Schedule

The proper titration schedule for subcutaneous semaglutide (Ozempic) is:

1. Starting dose: 0.25 mg once weekly for 4 weeks

   • This is an initiation dose to minimize gastrointestinal side effects
   • Not intended for glycemic control at this dose

2. First titration: 0.5 mg once weekly after 4 weeks

   • This is often an effective maintenance dose for many patients

3. Second titration: 1.0 mg once weekly if additional glycemic control is needed

   • Consider this dose after at least 4 weeks on the 0.5 mg dose
   • This is the maximum dose for type 2 diabetes treatment

4. Higher doses: For obesity management, doses up to 2.4 mg weekly may be used (marketed as Wegovy), but this is not the standard Ozempic dosing 1

Administration Considerations

• Administer subcutaneously in the abdomen, thigh, or upper arm
• Consistent day of the week administration is recommended
• Can be administered any time of day, with or without meals
• If a dose is missed, administer within 5 days after the missed dose

Dose Adjustments for Special Populations

• Renal impairment: No dose adjustment required, even with severe renal impairment 1
• Hepatic impairment: No dose adjustment required
• Elderly: No dose adjustment required based on age

Managing Missed Doses

If more than 2 consecutive doses are missed:

• If patient tolerated the medication well previously, consider resuming at the same dose
• If tolerance was an issue, consider lowering the next dose
• If 3 or more consecutive doses are missed, consider restarting the titration schedule 1

Potential Side Effects to Monitor

• Gastrointestinal effects: Nausea, vomiting, diarrhea (most common)
• Hypoglycemia risk: Increased when used with insulin or insulin secretagogues
• Delayed gastric emptying: May affect absorption of oral medications
• Diabetic retinopathy complications: Monitor in patients with existing retinopathy

Important Cautions and Contraindications

• Contraindicated in:

  • Personal or family history of medullary thyroid cancer
  • Multiple endocrine neoplasia syndrome type 2 (MEN2)
  • Pregnancy or breastfeeding
  • History of serious hypersensitivity to semaglutide

• Use with caution in:

  • Patients with gastroparesis
  • Patients with prior gastric surgery, including bariatric surgery
  • Concurrent use with other GLP-1 receptor agonists or DPP-4 inhibitors is not recommended 1

Clinical Pearls

• Gradual dose titration is critical to minimize GI side effects
• Some patients may achieve adequate response at submaximal doses
• The half-life of semaglutide is approximately 7 days, allowing for once-weekly dosing 2
• Steady state is reached in approximately 4-5 weeks 2
• For patients with type 2 diabetes who need additional glycemic control beyond the 1.0 mg dose, evidence shows that 2.0 mg can provide further HbA1c reduction (-0.23 percentage points additional reduction) 3