What is the recommended initiation dose and titration schedule for Ozempic (semaglutide) therapy?

Ozempic (Semaglutide) Initiation and Titration Protocol

For Ozempic (semaglutide) therapy, start with 0.25 mg subcutaneously once weekly for 4 weeks, then increase to 0.5 mg once weekly, with potential further increase to 1 mg once weekly if additional glycemic control is needed after at least 4 weeks on the 0.5 mg dose. 1

Initial Dosing and Titration Schedule

• 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 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 Ozempic is 1 mg once weekly 1

Administration Guidelines

• Administer Ozempic once weekly, 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
• Administer subcutaneously to the abdomen, thigh, or upper arm 1
• Instruct patients to use a different injection site each week when injecting in the same body region 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
• After handling a missed dose, patients can resume their regular once-weekly dosing schedule 1

Special Considerations

• Gradual dose titration is essential to minimize gastrointestinal adverse effects, which are the most common side effects 2
• No dosage adjustment is required for patients with renal impairment, including those with end-stage renal disease 2
• When using Ozempic with insulin, administer as separate injections and never mix the products 1
• It is acceptable to inject Ozempic and insulin in the same body region, but the injections should not be adjacent to each other 1

Efficacy and Safety Considerations

• Semaglutide has demonstrated superior glycemic control compared to other GLP-1 receptor agonists in clinical trials 3, 4
• The most common adverse events are gastrointestinal in nature, particularly nausea, which is typically dose-related 5, 6
• In clinical trials, semaglutide has shown significant reductions in HbA1c (1.45-1.55% reduction with 0.5-1.0 mg doses) 6
• For patients requiring additional glycemic control, the SUSTAIN FORTE trial demonstrated that a higher 2.0 mg dose provided additional HbA1c reduction compared to the 1.0 mg dose, though this higher dose is not currently approved for Ozempic 7

Common Pitfalls to Avoid

• Failing to start with the 0.25 mg dose may lead to increased gastrointestinal side effects and potential treatment discontinuation 6
• Not allowing sufficient time between dose escalations can increase the risk of adverse effects 2
• Mixing Ozempic with other GLP-1 receptor agonists or dipeptidyl peptidase-4 inhibitors should be avoided 2
• When used with insulin or insulin secretagogues, doses of these medications may need adjustment to prevent hypoglycemia 2