What is the recommended dosage and treatment plan for using Ozempic (semaglutide) for weight loss?

Recommended Dosage and Treatment Plan for Ozempic (Semaglutide) for Weight Loss

For weight loss in adults with obesity or overweight with weight-related complications, semaglutide (Ozempic) should be started at 0.25 mg subcutaneously once weekly for 4 weeks, then increased to 0.5 mg weekly, with further titration to 2.4 mg weekly as the target maintenance dose for maximum weight loss efficacy. 1, 2

Dosing Schedule and Titration

The FDA-approved dosing schedule for semaglutide for weight management follows a specific titration protocol:

1. Initial dose: 0.25 mg subcutaneously once weekly for 4 weeks

   • This initial dose is for tolerability and is not effective for weight control 1

2. Titration schedule:

   • Week 5-8: Increase to 0.5 mg once weekly
   • Week 9-12: Increase to 1.0 mg once weekly (if additional weight loss is needed)
   • Week 13-16: Increase to 1.7 mg once weekly
   • Week 17 onward: Maintenance dose of 2.4 mg once weekly 2

Administration Guidelines

• Administer subcutaneously to the abdomen, thigh, or upper arm
• Use a different injection site each week when injecting in the same body region
• Administer on the same day each week, at any time of day, with or without meals
• If a dose is missed, administer as soon as possible within 5 days; if more than 5 days have passed, skip the missed dose and resume regular schedule 1

Expected Outcomes

The STEP clinical trials demonstrated significant weight loss with semaglutide 2.4 mg:

• Mean weight loss of 14.9% from baseline after 68 weeks (compared to 2.4% with placebo) 3
• 86.4% of participants achieved ≥5% weight loss
• 69.1% achieved ≥10% weight loss
• 50.5% achieved ≥15% weight loss 4

Monitoring and Follow-up

• Assess efficacy and safety monthly for the first 3 months, then at least quarterly thereafter 2
• Early response (>5% weight loss after 3 months) predicts better long-term outcomes
• Continue medication if achieving sufficient early weight loss unless clinical circumstances suggest otherwise 2

Common Side Effects and Management

Gastrointestinal side effects are most common:

• Nausea (44%)
• Diarrhea (32%)
• Vomiting (25%)
• Constipation (23%) 2

These side effects are typically transient, mild-to-moderate in severity, and subside with time. The gradual dose titration helps minimize these effects 3.

Important Precautions

• Black box warning: Risk of thyroid C-cell tumors in rodents (human relevance not determined)
• Contraindications: Personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 1
• Use caution in patients with kidney disease due to potential risk of acute kidney injury
• May cause gallbladder-related complications
• Monitor for potential consequences of delayed absorption of oral medications 2

Duration of Treatment

• Long-term use is necessary for maintaining weight loss
• Studies show significant weight regain after discontinuation
• Weight management pharmacotherapy should be continued beyond reaching weight loss goals to maintain health benefits 2

Treatment Algorithm for Optimal Results

1. Confirm eligibility: BMI ≥30 kg/m² or ≥27 kg/m² with weight-related comorbidities
2. Screen for contraindications: Thyroid cancer history, pregnancy, severe gastrointestinal disease
3. Initiate treatment: Follow titration schedule as outlined above
4. Combine with lifestyle modifications: Reduced-calorie diet and increased physical activity
5. Monitor response: If <5% weight loss after 12 weeks at maximum tolerated dose, consider discontinuation
6. Long-term maintenance: Continue treatment indefinitely for those who respond well

Clinical Pearls

• Semaglutide has demonstrated superior weight loss compared to other GLP-1 receptor agonists
• The 2.4 mg weekly dose for weight management is higher than doses used for diabetes management
• Patients should be counseled about the need for long-term treatment
• Real-world effectiveness shows maintained weight loss at 24 months with continued treatment 5
• Hydration should be monitored if taking insulin or sulfonylurea medications 2

By following this evidence-based dosing and treatment plan, patients can achieve clinically meaningful weight loss with semaglutide, leading to improvements in cardiometabolic risk factors and quality of life.