Semaglutide Dosing Schedule for Option 1
For option 1, the semaglutide dosing schedule starts at 0.25 mg once weekly for 4 weeks, then increases to 0.5 mg once weekly, with potential further increase to 1 mg once weekly after at least 4 more weeks if additional glycemic control is needed. 1
Detailed Titration Schedule
- Initial dose: 0.25 mg subcutaneously once weekly for 4 weeks 1
- First titration: Increase to 0.5 mg once weekly after the initial 4 weeks 1
- Second titration: If additional glycemic control is needed after at least 4 weeks on 0.5 mg, increase to 1 mg once weekly 1
- Administration timing: Can be administered at any time of day, with or without meals 1
- Injection site: Subcutaneously in the abdomen, thigh, or upper arm 1
Important Clinical Considerations
- Missed doses: If a dose is missed, it should be administered within 5 days of the missed dose 1
- Half-life: Semaglutide has a half-life of approximately 7 days, reaching steady state in 4-5 weeks 2
- No dose adjustment: No dose adjustment is required for patients with renal impairment 3
- Drug interactions: Semaglutide may delay gastric emptying and potentially impact absorption of oral medications 3, 2
Adverse Effects Management
- GI side effects: To minimize gastrointestinal adverse effects (nausea, vomiting, diarrhea), gradual dose titration as described above is recommended 3
- Hypoglycemia risk: When used with insulin secretagogues or insulin, consider lowering the dose of these medications to reduce hypoglycemia risk 3
- Monitoring: Regular monitoring for potential adverse effects is recommended, particularly gastrointestinal symptoms 3
Special Populations
- Renal impairment: No dose adjustment required for patients with chronic kidney disease, including those with eGFR as low as 20 ml/min/1.73 m² 3
- Pregnancy: Discontinue semaglutide at least 2 months before a planned pregnancy due to the long washout period 1
Clinical Pearls
- Titration flexibility: Clinical judgment can be used to adjust the titration schedule based on individual patient response, tolerance, and adverse effects 3
- Restarting after missed doses: If 3 or more consecutive doses are missed, consider restarting the titration schedule 3
- Submaximal dosing: Some patients may achieve good response at submaximal doses and could continue at that dose long-term 3