When do you restart Ozempic (semaglutide) titration?

Restarting Ozempic (Semaglutide) Titration

When restarting Ozempic (semaglutide) after missed doses, you should restart titration from the lowest dose (0.25 mg weekly) if 3 or more consecutive doses have been missed, based on the most recent clinical guidelines.

Restart Protocol Based on Duration of Missed Doses

The appropriate approach to restarting Ozempic depends on how many doses were missed:

If 1-2 consecutive doses were missed:

• If within 5 days of the scheduled dose: Administer the missed dose as soon as possible, then resume regular weekly schedule 1
• If more than 5 days have passed: Skip the missed dose and administer the next dose on the regularly scheduled day 1
• In these cases, no dose adjustment or re-titration is typically necessary if the patient previously tolerated the medication well

If 3 or more consecutive doses were missed:

• Restart the full titration schedule from 0.25 mg once weekly 2
• Follow the standard titration protocol:
  • Start with 0.25 mg weekly for 4 weeks (initiation dose)
  • Increase to 0.5 mg weekly for at least 4 weeks
  • If needed and tolerated, may increase to 1.0 mg weekly (maximum dose) 1

Clinical Considerations When Restarting

Gastrointestinal Tolerance

• Restarting at a higher dose after missing multiple doses significantly increases the risk of gastrointestinal side effects
• Common adverse effects include nausea, vomiting, and diarrhea, which are typically transient but can be severe enough to cause discontinuation 3
• In clinical trials, 4.5% of patients discontinued semaglutide due to gastrointestinal events 3

Patient-Specific Factors to Consider

• Previous tolerance: If the patient previously experienced significant GI side effects, consider a more gradual titration
• Clinical judgment is required to decide on subsequent dosing based on individual patient response and tolerance 2
• For patients with renal impairment (eGFR <30 mL/min/1.73m²), use caution when restarting 4

Monitoring After Restart

• Assess for gastrointestinal side effects (nausea, vomiting, diarrhea)
• Monitor weight response
• For patients with diabetes, monitor blood glucose levels
• Consider more frequent follow-up during the re-titration period

Common Pitfalls to Avoid

1. Rushing the titration: Attempting to reach the previous dose too quickly can lead to increased adverse effects and potential discontinuation
2. Inadequate patient education: Patients should understand that GI side effects are common but typically transient
3. Failure to consider comorbidities: Patients with renal impairment may require more cautious titration
4. Overlooking drug interactions: Be cautious when restarting in patients taking insulin or insulin secretagogues due to hypoglycemia risk 2

Remember that the 0.25 mg dose is intended for treatment initiation only and is not effective for glycemic control or significant weight management. The therapeutic benefits of Ozempic are typically seen at doses of 0.5 mg and higher 1.