What is the recommended dosing for Ozempic (semaglutide)?

Recommended Dosing for Ozempic (Semaglutide)

The recommended dosing for Ozempic (semaglutide) is to start with 0.25 mg subcutaneously once weekly for 4 weeks, then increase to 0.5 mg once weekly, with further titration to 1 mg once weekly if additional glycemic control is needed after at least 4 weeks on the 0.5 mg dose. 1

Dosing Schedule

The FDA-approved dosing schedule for Ozempic (semaglutide) is as follows:

1. Initiation phase: 0.25 mg subcutaneously once weekly for 4 weeks

   • Note: This initial dose is for treatment initiation only and is not effective for glycemic control

2. First therapeutic dose: After 4 weeks, increase to 0.5 mg once weekly

3. Dose titration: If additional glycemic control is needed after at least 4 weeks on the 0.5 mg dose, the dosage may be increased to 1 mg once weekly

   • The maximum FDA-approved dose for glycemic control is 1 mg once weekly 1

Administration Guidelines

• Administer Ozempic once weekly, on the same day each week
• Can be administered at any time of day, with or without meals
• The day of weekly administration can be changed if necessary, as long as the time between two doses is at least 2 days (>48 hours)
• If a dose is missed, administer Ozempic as soon as possible within 5 days after the missed dose
• If more than 5 days have passed, skip the missed dose and administer the next dose on the regularly scheduled day 1

Injection Technique

• Administer subcutaneously to the abdomen, thigh, or upper arm
• Use a different injection site each week when injecting in the same body region
• When using with insulin, administer as separate injections and never mix the products
• Visually inspect Ozempic before use - it should appear clear and colorless 1

Special Considerations

Renal Function

• No dosage adjustment is required for patients with renal impairment 2
• Unlike some other GLP-1 RAs, semaglutide can be used in patients with eGFR >15 ml/min per 1.73 m² 2

Cautions

• Hypoglycemia risk is increased when used with insulin, sulfonylureas, or glinides 2
• May delay gastric emptying; use caution in patients with gastroparesis 2
• Care should be taken in patients with prior gastric surgery, including bariatric surgery 2
• Diabetic retinopathy complications have been reported with semaglutide, although it's unclear if this is a direct effect of the drug 2

Contraindications

• Personal or family history of medullary thyroid cancer
• Personal or family history of Multiple Endocrine Neoplasia type 2 (MEN2)
• History of serious hypersensitivity reaction to semaglutide
• Pregnancy or breastfeeding 2

Common Adverse Effects to Monitor

• Gastrointestinal effects: nausea (44%), diarrhea (32%), constipation (23%), vomiting (25%) 2
• Other potential effects: headache, weakness, dizziness
• Weight loss (which may be beneficial in many patients with type 2 diabetes)
• Injection site reactions 2

Clinical Pearls

• Slow titration is key to minimizing gastrointestinal side effects
• Semaglutide has demonstrated superior glycemic control compared to many other diabetes medications, with mean HbA1c reductions of 1.45-1.55% at therapeutic doses 3
• Beyond glycemic control, semaglutide offers cardiovascular benefits and significant weight reduction (3.47-5.17 kg) 4
• Recent evidence suggests that the 0.5 mg and 1 mg doses may have similar effectiveness in real-world practice, with comparable reductions in HbA1c and weight 5

By following this dosing schedule and monitoring for potential adverse effects, Ozempic can be effectively used to improve glycemic control while providing additional benefits of weight reduction and cardiovascular risk reduction in appropriate patients.