What is the recommended dosage of Ozempic (semaglutide) for type 2 diabetes management and chronic weight management?

Recommended Dosage of Ozempic (Semaglutide) for Type 2 Diabetes and Weight Management

For type 2 diabetes management, Ozempic (semaglutide) should be initiated at 0.25 mg subcutaneously once weekly for 4 weeks, then increased to 0.5 mg weekly, with a maximum recommended dose of 1 mg weekly if additional glycemic control is needed after at least 4 weeks on the 0.5 mg dose. 1 For weight management in adults with obesity, the recommended dose is 2.4 mg weekly. 2

Dosing Schedule for Type 2 Diabetes

• Start with 0.25 mg subcutaneously once weekly for 4 weeks (initiation dose only, not effective for glycemic control) 1
• After 4 weeks, increase to 0.5 mg once weekly 1
• If additional glycemic control is needed after at least 4 weeks on the 0.5 mg dose, may increase to 1 mg once weekly 1
• Maximum recommended dose for type 2 diabetes is 1 mg once weekly 1

Dosing Schedule for Weight Management

• For weight management in adults with BMI ≥30 kg/m² or BMI ≥27 kg/m² with at least one weight-related comorbidity, the recommended dose is 2.4 mg once weekly 2
• Dose escalation is required to reach the 2.4 mg maintenance dose 2

Administration Guidelines

• Administer on the same day each week, at any time of day, with or without meals 1
• The day of weekly administration can be changed if necessary, as long as the time between two doses is at least 2 days (>48 hours) 1
• If a dose is missed, administer 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 1
• Inject subcutaneously into the abdomen, thigh, or upper arm 1
• Use a different injection site each week when injecting in the same body region 1

Efficacy Considerations

• Semaglutide has demonstrated superior glucose-lowering activity compared to other GLP-1 receptor agonists 3
• For weight management, semaglutide 2.4 mg weekly has shown significant weight reduction (9.6% loss from baseline compared to 3.4% with placebo) 2
• Early response (typically defined as >5% weight loss after 3 months) predicts improved long-term outcomes 2

Special Populations

• No dosage adjustments are required for patients with renal impairment 2
• Semaglutide has been shown to be effective in patients with type 2 diabetes and moderate renal impairment 4
• Semaglutide is recommended for patients with type 2 diabetes and eGFR ≤2 mL/min per 1.73 m² or UACR ≥30 mg/g, particularly with existing or high risk of ASCVD, or with metabolic risk factors such as poorly controlled diabetes and obesity 2

Safety Considerations

• Common side effects include gastrointestinal symptoms (nausea, vomiting, diarrhea, esophageal reflux), injection site reactions, and elevated heart rate 2
• Pancreatitis has been reported in clinical trials, but causality has not been established; discontinue if pancreatitis is suspected 2
• Black box warning: Risk of thyroid C-cell tumors in rodents; human relevance not determined 2
• Contraindicated in pregnancy and breastfeeding 2
• When using with insulin, administer as separate injections and never mix the products 1

Monitoring and Continuation of Therapy

• Assess efficacy and safety at least monthly for the first 3 months and at least quarterly thereafter 2
• If early use appears ineffective (typically <5% weight loss after 3 months), consider discontinuing the medication and exploring other treatment options 2
• For weight management, if a patient has not lost at least 4% of body weight 16 weeks after initiation, the medication should be discontinued 2