Semaglutide Dosing for Weekly Injections
For semaglutide injections, the standard concentration is 1.34 mg/mL, which means 1 mL contains 100 units of the medication. 1
Standard Dosing Regimen
- Semaglutide for type 2 diabetes is typically initiated at 0.25 mg once weekly for 4 weeks, then increased to 0.5 mg once weekly 2, 3
- After at least 4 weeks at 0.5 mg, if additional glycemic control is needed, the dose can be increased to 1 mg once weekly 1, 3
- For weight management, the titration schedule starts at 0.25 mg weekly for 4 weeks, then increases every 4 weeks (0.5 mg, 1.0 mg, 1.7 mg) until reaching the maintenance dose of 2.4 mg once weekly 4
Specific Dosing Calculations
- At 0.25 mg dose: This equals approximately 18.7 units per injection (0.25 mg ÷ 1.34 mg/mL × 100 units/mL) 1
- At 0.5 mg dose: This equals approximately 37.3 units per injection (0.5 mg ÷ 1.34 mg/mL × 100 units/mL) 1
- At 1.0 mg dose: This equals approximately 74.6 units per injection (1.0 mg ÷ 1.34 mg/mL × 100 units/mL) 1
- At 2.4 mg dose: This equals approximately 179 units per injection (2.4 mg ÷ 1.34 mg/mL × 100 units/mL) 4
Clinical Considerations
- Gradual dose titration is essential to minimize gastrointestinal adverse effects, which are the most common side effects 3, 4
- Some patients may achieve significant clinical response at submaximal doses and could continue at that dose long-term 3, 4
- No dosage adjustment is required for patients with renal impairment, including those with end-stage renal disease 2, 3
Administration Guidelines
- Semaglutide can be administered at any time of day, with or without meals 1
- The injection should be administered subcutaneously in the abdomen, thigh, or upper arm 1
- If a dose is missed and it has been less than 5 days since the missed dose, administer as soon as possible; if more than 5 days have passed, skip the missed dose 1
Efficacy Considerations
- The SUSTAIN FORTE trial demonstrated that semaglutide 2.0 mg provided superior glycemic control compared to 1.0 mg, with additional weight loss benefits 5
- In real-world practice, both 0.5 mg and 1.0 mg doses have shown similar effectiveness in HbA1c reduction (-2.1%) and weight loss (-6.1 kg vs -6.2 kg) 6
- Higher doses of semaglutide (0.2 mg or more) have demonstrated significantly greater weight loss compared to liraglutide 3.0 mg (-13.8% to -11.2% vs -7.8%) 7
Safety Considerations
- Gastrointestinal adverse effects (nausea, vomiting, diarrhea, constipation) are common but typically transient and mild-to-moderate in severity 2, 1
- Semaglutide should not be used with other GLP-1 receptor agonists or dipeptidyl peptidase-4 inhibitors 4
- Use caution when combining with insulin or insulin secretagogues due to potential hypoglycemia risk; dose adjustments of these medications may be needed 3, 4