What is the recommended dose of Ozempic (semaglutide) for weight loss?

Recommended Ozempic (Semaglutide) Dosing for Weight Loss

For weight management in adults with obesity (BMI ≥30 kg/m²) or overweight (BMI ≥27 kg/m²) with weight-related comorbidities, the recommended dose of semaglutide is 2.4 mg weekly, administered subcutaneously, following a gradual titration schedule to minimize gastrointestinal side effects.

Dosing Schedule and Titration

• Start with 0.25 mg subcutaneously once weekly for 4 weeks (initiation dose) 1
• Increase to 0.5 mg once weekly for 4 weeks 1
• Increase to 1.0 mg once weekly for 4 weeks 2, 1
• Increase to 1.7 mg once weekly for 4 weeks 2
• Reach maintenance dose of 2.4 mg once weekly 2

Efficacy for Weight Loss

• Semaglutide 2.4 mg weekly produces clinically significant weight loss of approximately 15% of total body weight over 68 weeks 3
• Weight loss outcomes with semaglutide are superior to other GLP-1 receptor agonists, with studies showing:
  • 86.4% of patients achieve ≥5% weight loss
  • 69.1% achieve ≥10% weight loss
  • 50.5% achieve ≥15% weight loss 3
• Recent research shows that a higher dose of 7.2 mg weekly may provide additional weight loss benefits (18.7% vs 15.6% with 2.4 mg) but is not yet FDA-approved for routine use 4

Important Administration Instructions

• Administer subcutaneously to the abdomen, thigh, or upper arm 1
• Use a different injection site each week when injecting in the same body region 1
• Administer on the same day each week, at any time of day, with or without meals 1
• 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

Monitoring and Evaluation

• Assess efficacy and safety at least monthly for the first 3 months and quarterly thereafter 5
• If a patient has not lost at least 5% of baseline body weight after 12 weeks at the maintenance dose, consider discontinuation 2
• Monitor for gastrointestinal disorders, including severe constipation and small-bowel obstruction 5

Common Side Effects and Management

• Gastrointestinal side effects are most common (nausea, vomiting, diarrhea) 2, 3
• Gradual dose titration helps mitigate these adverse effects 2, 5
• Nausea occurs in approximately 40% of patients (vs 14.8% with placebo) 2
• Vomiting occurs in approximately 16% of patients (vs 4.3% with placebo) 2

Contraindications and Precautions

• Contraindicated in patients with personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) 1
• Not recommended for patients with a history of pancreatitis 1
• Use caution in patients with history of cholelithiasis due to increased risk of gallbladder disease 2, 5
• Monitor for potential development of acute pancreatitis (<0.1% risk) 2

Special Considerations

• For patients unable to tolerate injections, oral semaglutide (14 mg) may be considered, though it produces less weight loss (approximately 5.7%) compared to injectable formulations 6
• In patients with diabetes, semaglutide provides additional benefits of improved glycemic control and reduced cardiovascular risk 2, 7
• Semaglutide may delay gastric emptying, potentially affecting absorption of oral medications that require rapid onset of action 2, 5

Clinical Pearls

• Maintain treatment beyond reaching weight loss goals to sustain health benefits 2
• Sudden discontinuation often results in weight regain and worsening of cardiometabolic risk factors 2
• For patients not reaching treatment goals, consider intensifying treatment with additional approaches (e.g., metabolic surgery, additional pharmacologic agents, structured lifestyle programs) 2