Recommended Dosing Regimen for Ozempic (Semaglutide) for Weight Loss
For weight loss, Ozempic (semaglutide) should be initiated at 0.25 mg subcutaneously once weekly for 4 weeks, then increased to 0.5 mg weekly for 4 weeks, followed by 1.0 mg weekly, with potential titration up to 2.4 mg weekly as tolerated for maximum weight loss benefits. 1
Initial Dosing and Titration Schedule
The recommended titration schedule for semaglutide for weight loss is:
- Week 1-4: 0.25 mg subcutaneously once weekly
- Week 5-8: 0.5 mg subcutaneously once weekly
- Week 9 and beyond: 1.0 mg subcutaneously once weekly
- Further titration to 1.7 mg and then 2.4 mg weekly may be considered at 4-week intervals if additional weight loss is desired and the medication is well-tolerated 1
This gradual titration approach is essential to minimize gastrointestinal side effects, which are the most common adverse events with semaglutide 1.
Dosing Considerations
Efficacy at Different Doses
- The 2.4 mg weekly dose (approved for weight management under brand name Wegovy) provides greater weight loss than the 1.0 mg dose
- Clinical trials show that semaglutide 2.4 mg weekly can achieve 9.6% weight reduction from baseline compared to 7.0% with 1.0 mg weekly 1
- For patients with type 2 diabetes, the 1.0 mg dose is typically sufficient for glycemic control, but higher doses may provide additional weight loss benefits 2
Renal Function Considerations
- No dose adjustment is required for patients with mild, moderate, or severe renal impairment 1
- Semaglutide can be used without dose adjustment in patients with eGFR as low as 15 mL/min/1.73 m² 1
Administration Guidelines
- Administer subcutaneously once weekly on the same day each week
- Can be administered at any time of day, with or without meals 1
- Injection sites include abdomen, thigh, or upper arm
- If a dose is missed and it has been:
- Less than 5 days since the missed dose: administer as soon as possible
- More than 5 days: skip the missed dose and administer the next dose on the regularly scheduled day
Monitoring and Dose Adjustments
- Assess efficacy and safety at least monthly for the first 3 months and at least quarterly thereafter 1
- Early responders (>5% weight loss after 3 months) typically have better long-term outcomes 1
- If <5% weight loss is achieved after 3 months at the maximum tolerated dose, consider discontinuation or alternative treatment options 1
- Monitor for gastrointestinal side effects, which typically improve with continued use
Important Safety Considerations
- Most common adverse effects: nausea, vomiting, diarrhea, abdominal pain, and constipation 1
- Discontinue if pancreatitis is suspected 1
- Use caution in patients with history of:
- Medullary thyroid carcinoma (contraindicated)
- Multiple endocrine neoplasia syndrome type 2 (contraindicated)
- Significant gastroparesis
- Prior gastric surgery including bariatric procedures 1
Clinical Pearls
Gastrointestinal side effects can be minimized by:
- Following the recommended slow titration schedule
- Eating smaller meals
- Avoiding high-fat foods during initial titration
Weight management pharmacotherapy should be continued beyond reaching weight loss goals to maintain the health benefits, as sudden discontinuation often results in weight regain 1
For patients undergoing procedures requiring general anesthesia, consider the potential for delayed gastric emptying, which may affect the absorption of oral medications 1
Average weight loss with semaglutide ranges from 5-9% over 6 months at the 1.0 mg dose, with potentially greater weight loss at higher doses and with longer treatment duration 1, 3