What is the maximum dose of Ozempic (semaglutide) for weight loss?

Maximum Dose of Ozempic (Semaglutide) for Weight Loss

The maximum dose of Ozempic (semaglutide) for weight loss is 2.4 mg administered subcutaneously once weekly. 1, 2

Dosing Protocol for Weight Loss

Semaglutide for weight management follows a specific titration schedule to minimize gastrointestinal side effects:

1. Initiation phase:

   • Start with 0.25 mg subcutaneously once weekly for 4 weeks 3
   • This initial dose is for titration only and not effective for weight control

2. Titration schedule:

   • Weeks 5-8: Increase to 0.5 mg weekly
   • Weeks 9-12: Increase to 1.0 mg weekly
   • Weeks 13-16: Increase to 1.7 mg weekly
   • Week 17 onward: Reach maintenance dose of 2.4 mg weekly 2

3. Administration details:

   • Inject subcutaneously in abdomen, thigh, or upper arm
   • Administer on the same day each week
   • Can be given with or without meals 3

Efficacy for Weight Loss

The 2.4 mg weekly dose has demonstrated superior efficacy for weight management:

• Produces mean weight reduction of 14.9% from baseline at 68 weeks (compared to 2.4% with placebo) 4
• Significantly more patients achieve clinically meaningful weight loss:
  • 86.4% achieve ≥5% weight loss
  • 69.1% achieve ≥10% weight loss
  • 50.5% achieve ≥15% weight loss 4

Monitoring and Continuation Criteria

• Evaluate efficacy at 12 weeks after reaching the maintenance dose
• Continue treatment only if patient achieves ≥5% weight loss from baseline 2
• If inadequate response (<5% weight loss), discontinue treatment as further improvement is unlikely 1
• For responders, continue indefinitely to prevent weight regain 2, 5

Important Safety Considerations

1. Contraindications:

   • Personal or family history of medullary thyroid carcinoma
   • Multiple Endocrine Neoplasia syndrome type 2
   • Pregnancy
   • Known hypersensitivity to semaglutide 3

2. Common adverse effects:

   • Gastrointestinal symptoms (nausea, vomiting, diarrhea) occur in up to 74% of patients
   • Typically transient and mild-to-moderate in severity
   • About 4.5% of patients discontinue treatment due to GI effects 4

3. Monitoring recommendations:

   • Monthly assessment for first 3 months
   • Quarterly assessment thereafter
   • Monitor for gallbladder disease and pancreatitis 1, 2

Comparison to Other GLP-1 Receptor Agonists

For context, other GLP-1 receptor agonists used for weight management include:

• Liraglutide: Maximum dose 3.0 mg daily, produces ~8% weight loss at 56 weeks
• Tirzepatide: Doses of 5-15 mg weekly produce 15-21% weight loss at 72 weeks 2

While tirzepatide shows greater efficacy, semaglutide 2.4 mg weekly remains a highly effective option for weight management with established safety and efficacy data.

Clinical Pearls

• The 1 mg weekly dose (maximum for diabetes treatment) is lower than the 2.4 mg dose approved for weight management 3
• Missing doses: If <5 days since missed dose, administer as soon as possible; if >5 days, skip and resume regular schedule 3
• Weight loss with semaglutide is dose-dependent, with greater efficacy at higher doses 6
• Weight regain is common if treatment is discontinued, highlighting the importance of long-term therapy 5