Ozempic (Semaglutide) Titration Dosing Schedule
The standard Ozempic (semaglutide) titration schedule starts with 0.25 mg once weekly for 4 weeks, then increases to 0.5 mg once weekly for at least 4 weeks, followed by potential increases to 1.0 mg once weekly and up to 2.4 mg once weekly for maximum efficacy, with each dose increase separated by at least 4 weeks to minimize gastrointestinal side effects.
Standard Titration Schedule
The recommended titration schedule for Ozempic (semaglutide) is as follows:
| Weeks | Dose |
|---|---|
| 1-4 | 0.25 mg once weekly |
| 5-8 | 0.5 mg once weekly |
| 9+ (if needed) | 1.0 mg once weekly |
| If further titration needed | 1.7 mg once weekly |
| Maximum dose | 2.4 mg once weekly |
Rationale for Gradual Titration
- Gastrointestinal tolerability: The gradual titration minimizes common side effects including nausea, vomiting, diarrhea, and constipation 1
- Adaptation period: Allows the body to adjust to the medication's effects on gastric emptying
- Optimal efficacy: Each dose increase should be maintained for at least 4 weeks before considering further increases 1
Clinical Considerations During Titration
Monitoring During Titration
- Assess weight loss response at each dose level
- Monitor for gastrointestinal side effects (nausea, vomiting, diarrhea)
- For patients with diabetes: monitor blood glucose levels closely
Management of Side Effects
- For nausea/vomiting: Consider ondansetron 4-8mg as needed or metoclopramide 5-10mg before meals 1
- For diarrhea: Loperamide 2mg after each loose stool (maximum 8mg/day) may be used 1
- For constipation: Increase fluid intake, dietary fiber, or use osmotic laxatives 1
Dietary Recommendations During Titration
- Smaller, more frequent meals
- Avoid high-fat foods
- Maintain adequate hydration (2-3 liters daily)
- Avoid carbonated beverages and alcohol 1
Special Populations
Patients with Renal Impairment
- No dose adjustment is required for patients with renal impairment
- Use caution when initiating or increasing doses due to potential risk of acute kidney injury 1
Patients on Insulin or Sulfonylureas
- Consider reducing insulin or sulfonylurea doses by 10-20% when initiating Ozempic to prevent hypoglycemia 1
Maintenance Dosing
After reaching the target dose (typically 1.0 mg once weekly for diabetes or 2.4 mg once weekly for weight management), continue at that dose for maintenance therapy.
Contraindications
Ozempic is contraindicated in:
- Patients with personal or family history of medullary thyroid carcinoma
- Patients with Multiple Endocrine Neoplasia syndrome type 2
- Pregnancy and breastfeeding 1
Important Warnings
- Risk of gallbladder disease including cholelithiasis and cholecystitis 1
- Rapid improvement in glycemic control may worsen existing diabetic retinopathy 1
- Increased risk of pulmonary aspiration under anesthesia (important for perioperative planning) 1
Following this structured titration approach maximizes the benefits of Ozempic while minimizing adverse effects, leading to better treatment adherence and outcomes.