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

Recommended Dosing of Semaglutide (Ozempic) for Weight Loss

For weight management in adults with obesity or overweight with weight-related complications, semaglutide should be administered at a target dose of 2.4 mg subcutaneously once weekly. 1, 2

Dosing Schedule and Titration

• Start with 0.25 mg subcutaneously once weekly for 4 weeks (this initial dose is for titration only and not effective for weight management) 3, 4
• After 4 weeks, increase to 0.5 mg once weekly 3, 4
• Continue dose escalation as tolerated:
  • After at least 4 weeks on 0.5 mg, increase to 1.0 mg once weekly 3, 4
  • After at least 4 weeks on 1.0 mg, increase to 2.4 mg once weekly for weight management 3, 2

Efficacy for Weight Loss

• At the 2.4 mg weekly dose, semaglutide produces significantly greater weight loss compared to placebo:

  • Mean weight reduction of 14.9% from baseline after 68 weeks (vs. 2.4% with placebo) 2
  • 86.4% of patients achieve ≥5% weight loss 2
  • 69.1% achieve ≥10% weight loss 2
  • 50.5% achieve ≥15% weight loss 2

• When combined with intensive behavioral therapy and initial low-calorie diet, semaglutide 2.4 mg produces even greater results:

  • Mean weight reduction of 16.0% from baseline after 68 weeks 5
  • 86.6% of patients achieve ≥5% weight loss 5
  • 75.3% achieve ≥10% weight loss 5
  • 55.8% achieve ≥15% weight loss 5

Administration Guidelines

• Administer subcutaneously to the abdomen, thigh, or upper arm 4
• Use a different injection site each week when injecting in the same body region 4
• Can be administered on the same day each week, at any time of day, with or without meals 4
• 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 4

Important Considerations

• Gradual dose titration is essential to minimize gastrointestinal adverse effects 3, 2
• Weight management pharmacotherapy should be continued beyond reaching weight loss goals to maintain health benefits 1
• Sudden discontinuation often results in weight regain and worsening of cardiometabolic risk factors 1
• For patients not reaching treatment goals, consider intensifying treatment with additional approaches (e.g., metabolic surgery, additional pharmacologic agents, structured lifestyle management programs) 1

Potential Benefits Beyond Weight Loss

• Semaglutide 2.4 mg has demonstrated reduction in cardiovascular events in people with overweight or obesity and preexistent cardiovascular disease 1, 6
• Treatment is associated with improvements in cardiometabolic risk factors and increased physical functioning 2
• Population-level models suggest semaglutide 2.4 mg could prevent approximately 500,000 major adverse cardiovascular events and over 300,000 deaths over 10 years in eligible patients 6

Common Adverse Effects

• Gastrointestinal effects are most common: nausea (most frequent), vomiting, diarrhea, constipation, dyspepsia 1, 2
• These effects are typically transient, mild-to-moderate in severity, and subside with time 2
• Treatment discontinuation due to gastrointestinal events occurs in approximately 4.5% of patients 2

Contraindications

• Personal or family history of medullary thyroid carcinoma (MTC) 4
• Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) 4
• Known hypersensitivity to semaglutide or any product components 4

Monitoring Recommendations

• Screen patients who have lost significant weight for malnutrition, especially those treated with weight management pharmacologic therapy 1
• Monitor for potential adverse effects, particularly gastrointestinal symptoms 1, 2

Alternative Considerations

• For patients who cannot tolerate or prefer to avoid injections, oral semaglutide at 14 mg daily may be considered, though it produces more modest weight loss (average 5.7% after one year) 7
• Approximately 46% of patients on oral semaglutide achieve clinically significant weight loss, though typically less than 10% 7