Starting Dose of Ozempic (Semaglutide) for Weight Loss
For weight loss, Ozempic (semaglutide) should be initiated at 0.25 mg subcutaneously once weekly for 4 weeks, followed by dose escalation according to a structured titration schedule. 1
Dosing Schedule for Weight Loss
The recommended dose progression for semaglutide when used for weight loss follows this schedule:
| Weeks | Dose |
|---|---|
| 1-4 | 0.25 mg once weekly |
| 5-8 | 0.5 mg once weekly |
| 9-12 | 1.0 mg once weekly |
| 13-16 | 1.7 mg once weekly |
| 17+ | 2.4 mg once weekly (maintenance dose) |
Important Considerations
- The initial 0.25 mg dose is intended for treatment initiation and is not effective for weight control on its own 1
- Gradual dose titration is essential to minimize gastrointestinal side effects, which are typically transient and mild-to-moderate in severity 2
- The maximum FDA-approved dose for weight loss is 2.4 mg once weekly (marketed as Wegovy), which has shown superior efficacy compared to lower doses 3
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 1
- 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 the regular schedule 1
Efficacy for Weight Loss
Clinical trials have demonstrated significant weight loss with semaglutide:
- At the 2.4 mg dose, mean weight loss at 68 weeks was 14.9% compared to 2.4% with placebo 3
- Long-term studies (104 weeks) showed sustained weight loss of 15.2% with semaglutide versus 2.6% with placebo 4
- The oral formulation of semaglutide (50 mg daily) has shown 15.1% weight reduction at 68 weeks 5
Monitoring and Follow-up
- Regular follow-up is recommended, with monthly visits for the first 3 months, then quarterly 2
- Monitor weight, blood pressure, and heart rate at each visit
- Assess for side effects, particularly gastrointestinal symptoms
- Laboratory monitoring should include baseline and periodic assessment of renal function 2
Common Side Effects and Management
- Most common side effects include nausea, vomiting, and diarrhea
- For nausea/vomiting: consider ondansetron 4-8mg as needed or metoclopramide 5-10mg before meals
- For diarrhea: loperamide 2mg after each loose stool (maximum 8mg/day)
- Dietary modifications: smaller, more frequent meals, avoiding high-fat foods, adequate hydration 2
Cautions and Contraindications
- Contraindicated during pregnancy and breastfeeding
- Use caution when combining with insulin or insulin secretagogues due to hypoglycemia risk
- May delay gastric emptying, potentially affecting absorption of oral medications requiring rapid onset of action 2
Important Clinical Considerations
- Long-term use is necessary to maintain weight loss; significant weight regain occurs after discontinuation 6
- Semaglutide has shown cardiovascular benefits in patients with overweight or obesity, with or without diabetes 6
- When discontinuing, a gradual dose reduction schedule should be implemented to minimize gastrointestinal rebound symptoms and reduce the rate of weight regain 2
By following this structured approach to initiating and titrating semaglutide for weight loss, you can maximize efficacy while minimizing side effects for your patients.