What is the recommended dosing and treatment approach for Ozempic (semaglutide)?

Recommended Dosing and Treatment Approach for Ozempic (Semaglutide)

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 once weekly, with further titration to 1 mg once weekly if additional glycemic control is needed after at least 4 weeks. 1

Standard Dosing Protocol

• Start with 0.25 mg subcutaneously once weekly for 4 weeks (this initial dose is for treatment initiation and not effective for glycemic control) 1
• After 4 weeks, increase to 0.5 mg once weekly as the maintenance dose 1
• If additional glycemic control is needed after at least 4 weeks on the 0.5 mg dose, the dosage may be increased to 1 mg once weekly 1
• The maximum recommended dosage for glycemic control is 1 mg once weekly 1
• For weight management in patients with obesity, a target dose of 2.4 mg once weekly may be used 2

Administration Guidelines

• 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
• 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

Missed Dose Management

• If a dose is missed, administer Ozempic as soon as possible within 5 days after the missed dose 1
• If more than 5 days have passed, skip the missed dose and administer the next dose on the regularly scheduled day 1
• If 3 or more consecutive doses are missed, consider restarting the titration schedule 3

Special Populations

• No dosage adjustment is required for patients with renal impairment, including those with end-stage renal disease 2
• No specific dose adjustment is required based on age for elderly patients 2
• Use with caution in patients with severe hepatic impairment due to limited experience in this population 2

Potential Adverse Effects and Precautions

• Gradual dose titration is essential to minimize gastrointestinal adverse effects, which are the most common side effects 3
• GI side effects include nausea (reported in 20-24% of patients on semaglutide vs. 8% on placebo) and diarrhea (11-13% on semaglutide vs. 2% on placebo) 4
• Counsel patients on potential for GI side effects and provide guidance on dietary modifications to mitigate them (reduction in meal size, mindful eating practices, decreasing intake of high-fat or spicy food) 3
• Monitor for thyroid C-cell tumors, as semaglutide carries a boxed warning regarding the risk based on rodent studies 1
• Ozempic is contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) 1

Drug Interactions and Concomitant Therapy

• When using Ozempic with insulin, administer as separate injections and never mix the products 1
• Ozempic should not be used with other GLP-1 receptor agonists or with dipeptidyl peptidase-4 inhibitors 3
• Because GLP-1 RAs can delay gastric emptying, they may impact the absorption of some oral medications that require rapid onset of action 3
• Use caution when combining with insulin or insulin secretagogues (e.g., sulfonylureas) due to potential hypoglycemia risk; doses should be adjusted as clinically indicated 3

Clinical Benefits Beyond Glycemic Control

• Semaglutide has demonstrated significant weight loss benefits (3.47-5.17 kg with semaglutide vs. 1.15 kg weight gain with insulin glargine) 5
• Semaglutide has shown cardiovascular benefits, reducing the risk of major adverse cardiovascular events in patients with established cardiovascular disease 6
• Semaglutide has demonstrated renal benefits in clinical trials, particularly for albuminuria outcomes 3

Treatment Monitoring

• Regular monitoring of glycemic control is essential to assess treatment efficacy 3
• Close monitoring of retinopathy is recommended in patients at high risk (older individuals and those with longer duration of T2D ≥10 years) 3
• Monitor for biliary disease and evaluate for gallbladder disease if cholelithiasis or cholecystitis is suspected 3