Semaglutide Dosing Schedule
The recommended dosing schedule for semaglutide begins with 0.25 mg subcutaneously once weekly for 4 weeks, followed by gradual titration to 0.5 mg, 1.0 mg, and up to 2.4 mg weekly depending on the indication and patient response. 1, 2
Subcutaneous Semaglutide Dosing
For Type 2 Diabetes Management:
- Initial dose: 0.25 mg subcutaneously once weekly for 4 weeks
- First titration: Increase to 0.5 mg once weekly after 4 weeks
- Second titration: May increase to 1.0 mg once weekly after another 4 weeks if additional glycemic control is needed 1, 2
- Maintenance dose: 0.5 mg or 1.0 mg once weekly
For Weight Management:
- Initial dose: 0.25 mg subcutaneously once weekly for 4 weeks
- Titration schedule:
Oral Semaglutide Dosing
- Initial dose: 3 mg once daily for 30 days
- First titration: Increase to 7 mg once daily after 30 days
- Second titration: May increase to 14 mg once daily after another 30 days if additional glycemic control is needed 2
Administration Guidelines
- Administer on the same day each week, at any time of day, with or without meals
- Subcutaneous injection can be administered in the abdomen, thigh, or upper arm
- Oral semaglutide must be taken on an empty stomach with no more than 4 oz of plain water, at least 30 minutes before the first food, beverage, or other oral medications of the day 2
Dose Adjustments
Missed doses:
- If a dose is missed and the next scheduled dose is more than 2 days away, administer as soon as possible
- If more than 2 consecutive doses are missed, clinical judgment is required for subsequent dosing 1
- Consider resuming at the same dose if previously well-tolerated; otherwise, lower the next dose 1
- If 3 or more consecutive doses are missed, restart the titration schedule 1
Renal impairment: No dose adjustment required, including for patients with eGFR ≥2 mL/min/1.73m² 2
Special Considerations
- Monitor for gastrointestinal side effects, particularly during dose escalation (affects 31-34% of patients) 2
- When used with insulin or insulin secretagogues (e.g., sulfonylureas), doses of these medications may need to be reduced to minimize hypoglycemia risk 1
- Semaglutide should not be used with other GLP-1 receptor agonists or dipeptidyl peptidase-4 inhibitors 1
- May delay gastric emptying, potentially affecting absorption of other oral medications 4
Higher Doses for Specific Populations
- Recent evidence suggests that higher doses (7.2 mg weekly) may provide additional benefits for patients with obesity and type 2 diabetes who don't achieve weight reduction goals with the 2.4 mg dose 5
The gradual dose titration schedule is crucial for minimizing gastrointestinal adverse effects while maximizing efficacy. Careful monitoring during the titration period is essential for optimal patient outcomes.