What is the recommended dose of Ozempic (semaglutide) for type 2 diabetes and weight management?

Ozempic (Semaglutide) Dosing for Type 2 Diabetes and Weight Management

For type 2 diabetes, Ozempic (semaglutide) should be initiated at 0.25 mg once weekly for 4 weeks, then increased to 0.5 mg once weekly, with further titration to 1 mg weekly after at least 4 weeks if additional glycemic control is needed, and up to 2 mg weekly in patients requiring further glycemic improvement. 1, 2

Initial Dosing and Titration Schedule

• Starting dose: 0.25 mg subcutaneously once weekly for 4 weeks (initiation dose only, not effective for glycemic control)
• First maintenance dose: 0.5 mg once weekly after 4 weeks
• Dose escalation:
  • Increase to 1 mg once weekly after at least 4 weeks on 0.5 mg if additional glycemic control is needed
  • Further increase to 2 mg once weekly may be considered after at least 4 weeks on 1 mg dose if additional glycemic control is needed 3

Administration Guidelines

• Administer subcutaneously in the abdomen, thigh, or upper arm
• Inject 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 after the missed dose; if more than 5 days have elapsed, skip the missed dose and administer the next dose on the regularly scheduled day

Efficacy Data

Semaglutide demonstrates significant dose-dependent reductions in:

• HbA1c:

  • 0.5 mg: -1.2% to -1.4% reduction from baseline 1, 4
  • 1.0 mg: -1.5% to -1.6% reduction from baseline 1, 4
  • 2.0 mg: -2.2% reduction from baseline (vs -1.9% with 1.0 mg) 3

• Body weight:

  • 0.5 mg: -3.5 to -3.8 kg reduction from baseline 1, 5
  • 1.0 mg: -4.5 to -6.0 kg reduction from baseline 1, 5
  • 2.0 mg: -6.9 kg reduction from baseline (vs -6.0 kg with 1.0 mg) 3

Special Populations

• Renal impairment: No dose adjustment required, including for patients with advanced kidney disease 6
• Hepatic impairment: Use caution in patients with severe hepatic impairment
• Elderly: No dose adjustment required based on age

Monitoring and Assessment

• Evaluate glycemic response and weight loss after 3 months on the maximum tolerated dose
• Consider discontinuation if inadequate glycemic response (<5% weight loss) after 3 months on maximum dose 2
• Monitor for gastrointestinal side effects, which typically improve over time

Common Side Effects

• Gastrointestinal: Nausea (20-24%), vomiting, diarrhea, abdominal pain 1, 4
• Other: Injection site reactions, elevated heart rate

Important Safety Considerations

• Black box warning: Risk of thyroid C-cell tumors in rodents (human relevance unknown) 1
• Contraindications: Personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2
• Cautions:
  • Risk of pancreatitis (discontinue if suspected)
  • Risk of hypoglycemia when used with insulin or sulfonylureas
  • Potential risk of acute kidney injury when initiating or increasing dose
  • May cause cholelithiasis and gallstone-related complications 2

Weight Management Specific Dosing

For patients specifically using semaglutide for weight management in the context of type 2 diabetes, the FDA-approved dose is:

• For injectable semaglutide (Wegovy): up to 2.4 mg once weekly 2
• For patients with obesity and type 2 diabetes: consider higher doses (1.0 mg or 2.0 mg) of Ozempic for optimal weight and glycemic outcomes 2, 3

Remember that clinical response varies between individuals, and dose adjustments should be made based on efficacy and tolerability.