Recommended Dosing Regimen for Ozempic (Semaglutide)
The recommended dosing regimen for Ozempic (semaglutide) starts with 0.25 mg subcutaneously once weekly for 4 weeks, then increases 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 only and is 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 dose for glycemic control is 1 mg once weekly 1
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
- Administer subcutaneously to the abdomen, thigh, or upper arm, using a different injection site each week when injecting in the same body region 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
Special Population Considerations
- No dosage adjustment is required for patients with renal impairment, including those with end-stage renal disease 2
- No dosage adjustment is required for patients with hepatic impairment 2
- When using Ozempic with insulin, administer as separate injections and never mix the products 1
Clinical Efficacy
- Semaglutide has demonstrated superior glycemic control compared to other GLP-1 receptor agonists, with HbA1c reductions of 1.21-1.64% at doses of 0.5-1.0 mg weekly 3
- In addition to glycemic control, semaglutide provides significant weight loss benefits, with average reductions of 3.47-5.17 kg at doses of 0.5-1.0 mg weekly 3
- Recent evidence shows semaglutide reduces the risk of kidney disease progression in patients with type 2 diabetes and chronic kidney disease 4
Common Side Effects and Management
- Gastrointestinal side effects are most common, including nausea, vomiting, and diarrhea 5
- The gradual dose titration schedule helps minimize these gastrointestinal adverse effects 6
- Monitor for potential consequences of delayed absorption of oral medications with narrow therapeutic indices 2
- Use caution when combining with insulin or insulin secretagogues due to potential hypoglycemia risk; dose adjustments of these medications may be needed 2
Important Safety Considerations
- Semaglutide carries a black box warning regarding the risk of thyroid C-cell tumors in rodents (human relevance not determined); do not use in individuals with personal or family history of medullary thyroid cancer or multiple endocrine neoplasia type 2 2
- May cause cholelithiasis and gallstone-related complications 2
- May cause gastrointestinal disorders including severe constipation and small bowel obstruction/ileus progression 2
- May cause elevated heart rate 2
By following this dosing regimen and monitoring for potential side effects, Ozempic can be effectively used for glycemic control in patients with type 2 diabetes.