Maximum Dose of Ozempic (Semaglutide)
The maximum recommended dose of Ozempic (semaglutide) for glycemic control is 2 mg once weekly, administered subcutaneously.
Dosing Information
Ozempic (semaglutide) is administered as a once-weekly subcutaneous injection with the following recommended dosing schedule:
Initial Titration
- Start with 0.25 mg once weekly for 4 weeks (initiation dose)
- After 4 weeks, increase to 0.5 mg once weekly
Maintenance and Maximum Dosing
- Maintenance dose options: 0.5 mg, 1 mg, or 2 mg once weekly
- If additional glycemic control is needed after at least 4 weeks:
- 0.5 mg dose may be increased to 1 mg once weekly
- 1 mg dose may be increased to 2 mg once weekly
- Maximum dose: 2 mg once weekly 1
Clinical Evidence Supporting Higher Doses
The SUSTAIN FORTE trial demonstrated that semaglutide 2.0 mg provided superior glycemic control compared to the 1.0 mg dose:
- Mean HbA1c reduction: -2.2% with 2.0 mg vs. -1.9% with 1.0 mg
- Additional weight loss: -6.9 kg with 2.0 mg vs. -6.0 kg with 1.0 mg
- Similar safety profile between doses 2
Administration Considerations
- Administer on the same day each week
- Can be given at any time of day, with or without meals
- Inject subcutaneously in the abdomen, thigh, or upper arm
- Use a different injection site each week when injecting in the same body region
- 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 regular schedule 1
Special Populations
For patients with Type 2 diabetes and chronic kidney disease:
- After at least 4 weeks on the 0.5 mg dosage, increase to the maintenance dosage of 1 mg once weekly 1
- Semaglutide can be used in patients with eGFR ≥20 ml/min/1.73 m² without dose adjustment 3
Common Side Effects
The most common adverse events are gastrointestinal:
Important Considerations
- Titrate slowly to minimize gastrointestinal side effects
- For weight management, the American Diabetes Association recommends the 2.4 mg weekly dose, which has shown mean weight loss of 9.6% at 68 weeks 3, 4
- Long-term maintenance therapy is recommended as discontinuation results in significant weight regain 4
Clinical Pearl
When using semaglutide for glycemic control in patients with type 2 diabetes, the maximum FDA-approved dose is 2 mg weekly. However, when specifically used for weight management (under the brand name Wegovy), the maximum dose is 2.4 mg weekly 3, 4.
Remember that dose escalation should be gradual to minimize gastrointestinal side effects, which are the most common adverse events associated with semaglutide therapy.