Ozempic (Semaglutide) Dosing Guidelines
Ozempic (semaglutide) subcutaneous injection is administered once weekly with a standard dosing schedule of 0.25 mg initially for 4 weeks, then increased to 0.5 mg, with further titration to 1 mg or 2 mg as needed for glycemic control. 1
Standard Dosing Schedule
- Initial dose: 0.25 mg subcutaneously once weekly for 4 weeks (this is a titration dose, not intended for glycemic control) 2
- Maintenance dose: 0.5 mg subcutaneously once weekly after the initial 4 weeks 1
- Dose escalation: If additional glycemic control is required after at least 4 weeks on the 0.5 mg dose, the dose can be increased to 1 mg once weekly 1
- Higher dose option: For patients requiring additional glycemic control, a 2 mg once weekly dose is available (after at least 4 weeks on the 1 mg dose) 3
Administration Guidelines
- Ozempic can be administered at any time of day, with or without meals 1, 2
- The injection should be given on the same day each week 2
- If a dose is missed, it should be administered as soon as possible within 5 days after the missed dose. If more than 5 days have passed, skip the missed dose and administer the next dose on the regularly scheduled day 2
- Ozempic is administered subcutaneously in the abdomen, thigh, or upper arm 2
Special Populations
- Renal Impairment: No dosage adjustment is required for patients with renal impairment, including those with end-stage renal disease 1
- Hepatic Impairment: Limited experience in patients with severe hepatic impairment; use with caution 1
- Elderly: No specific dose adjustment is required based on age 1
Weight Management Dosing
- For weight management in patients with obesity (BMI ≥30 kg/m²) or overweight (BMI ≥27 kg/m²) with at least one weight-related comorbidity, the target dose is 2.4 mg once weekly 1
- In clinical trials, higher doses of semaglutide (7.2 mg) have shown greater weight reduction in patients with obesity and type 2 diabetes, but this dose is not yet FDA-approved 4
Practical Considerations
- Gradual dose titration is essential to minimize gastrointestinal adverse effects 5
- Each pen delivers multiple doses: the 0.25 mg or 0.5 mg pen contains 2 mg of semaglutide total, while the 1 mg pen contains 4 mg of semaglutide total 2
- Store unused pens in the refrigerator between 36°F to 46°F (2°C to 8°C) 2
- After first use, the pen can be stored at room temperature between 59°F to 86°F (15°C to 30°C) or in a refrigerator for up to 56 days 2
Common Side Effects and Management
- Gastrointestinal effects are the most common adverse events, including nausea (20-24%), diarrhea (11-13%), and vomiting 6
- These side effects are typically transient and can be minimized with gradual dose titration 7
- The risk of hypoglycemia is low when used as monotherapy but increases when combined with insulin secretagogues (e.g., sulfonylureas) 7, 3
Clinical Efficacy
- In clinical trials, semaglutide 0.5 mg and 1.0 mg reduced HbA1c by 1.2% and 1.6%, respectively, compared to 0.8% with insulin glargine 7
- Weight reduction of 3.5 kg with 0.5 mg and 5.2 kg with 1.0 mg semaglutide has been observed, compared to weight gain with insulin glargine 7
- Semaglutide 2.0 mg provides additional HbA1c reduction (-0.2%) compared to the 1.0 mg dose in patients with inadequate glycemic control 3