Semaglutide Weight Loss Schedule
The recommended semaglutide weight loss schedule begins with 0.25 mg weekly for the first 4 weeks, then increases to 0.5 mg weekly for weeks 5-8,1.0 mg weekly for weeks 9-12,1.7 mg weekly for weeks 13-16, and finally reaches the maintenance dose of 2.4 mg weekly from week 17 onwards. 1
Detailed Titration Schedule
The gradual titration schedule is designed to minimize gastrointestinal side effects while optimizing tolerability:
| Week | Semaglutide Dose |
|---|---|
| 1-4 | 0.25 mg weekly |
| 5-8 | 0.5 mg weekly |
| 9-12 | 1.0 mg weekly |
| 13-16 | 1.7 mg weekly |
| 17+ | 2.4 mg weekly (maintenance) |
This schedule is supported by the American Diabetes Association and has been shown to be effective in clinical trials 1.
Efficacy and Expected Outcomes
When following this dosing schedule, patients can expect:
- Mean weight loss of 14.9-16.0% at 68 weeks 1, 2
- Significant improvements in cardiometabolic risk factors 2
- Increased physical functioning 2, 3
In the STEP 1 trial, 86.4% of participants achieved weight reductions of at least 5%, 69.1% achieved at least 10%, and 50.5% achieved at least 15% at week 68 2.
Managing Common Side Effects
Gastrointestinal side effects are the most common adverse events with semaglutide:
- Nausea (40% vs 14.8% with placebo): Avoid in patients with gastroparesis
- Vomiting (16% vs 4.3% with placebo): Typically transient and mild-to-moderate
- Diarrhea: Reduce meal size
- Dyspepsia: The gradual titration schedule helps minimize this side effect
- Gastrointestinal reflux: Limit alcohol and carbonated drinks 1
These side effects are typically transient and mild-to-moderate in severity, subsiding with time 2. Only 4.5% of participants in clinical trials discontinued treatment due to gastrointestinal events 2.
Long-term Maintenance
For long-term weight management:
- Continue medication indefinitely: Discontinuation results in regain of 50-67% of weight loss within one year 1, 3
- Maintenance dose options:
- Continue at full therapeutic dose (2.4 mg weekly) if well-tolerated
- Reduce to lowest effective dose that maintains weight loss (commonly 0.5-1.0 mg weekly)
- Consider intermittent therapy with close monitoring if continuous therapy isn't feasible 1
Special Considerations
- Asian populations: Consider lower BMI thresholds (≥23 kg/m²) for treatment initiation 1, 4
- Renal impairment: No dose adjustment required, even in advanced renal insufficiency 1
- Contraindications: Personal or family history of medullary thyroid cancer, multiple endocrine neoplasia syndrome type 2, pregnancy 1
- Precautions: History of pancreatitis or gallbladder disease 1
Mechanism of Action
Semaglutide promotes weight loss through:
- Reduced appetite and food cravings
- Better control of eating
- Lower preference for high-fat, energy-dense foods
- Decreased overall energy intake (studies show 24% reduction in total energy intake) 5
Following this structured titration schedule is essential for optimizing both tolerability and efficacy of semaglutide for weight management.