What is the recommended weekly dose of semaglutide (generic name) given a concentration of 5mg/mL and a volume of 2mL?

Recommended Weekly Dose of Semaglutide 5mg/mL 2mL

The recommended weekly dose of semaglutide for weight management is 2.4 mg, which would be 0.48 mL of a 5mg/mL concentration solution. 1

Dosing and Administration

Standard Dosing for Weight Management

• For weight management in adults with obesity (BMI ≥30 kg/m²) or overweight (BMI ≥27 kg/m²) with at least one weight-related comorbidity, the target maintenance dose is 2.4 mg once weekly 1
• For glycemic control in type 2 diabetes, the standard maintenance doses are 0.5 mg or 1.0 mg once weekly 1, 2

Dose Calculation

• With a concentration of 5mg/mL:
  • 2.4 mg dose = 0.48 mL (2.4 ÷ 5 = 0.48) 1
  • 1.0 mg dose = 0.2 mL (1.0 ÷ 5 = 0.2) 1
  • 0.5 mg dose = 0.1 mL (0.5 ÷ 5 = 0.1) 1

Titration Schedule

• Gradual dose titration is essential to minimize gastrointestinal side effects 1
• For weight management, the recommended titration schedule is:
  • Week 1-4: 0.25 mg (0.05 mL) once weekly
  • Week 5-8: 0.5 mg (0.1 mL) once weekly
  • Week 9-12: 1.0 mg (0.2 mL) once weekly
  • Week 13-16: 1.7 mg (0.34 mL) once weekly
  • Week 17 and onward: 2.4 mg (0.48 mL) once weekly 1

Clinical Efficacy

Weight Management

• At the 2.4 mg weekly dose, semaglutide achieves significantly greater weight loss compared to placebo:
  • 15% total body weight loss threshold achieved by 46.1% of patients vs 5.4% with placebo 1
  • Mean weight loss of 9.7-16.8 kg vs 1.5-6.2 kg with placebo 1

Glycemic Control

• For type 2 diabetes, semaglutide demonstrates dose-dependent HbA1c reductions:
  • 0.5 mg dose: approximately 1.2% reduction in HbA1c 3
  • 1.0 mg dose: approximately 1.6% reduction in HbA1c 3
  • Higher doses (up to 16 mg) provide only modest additional glycemic benefits but more weight loss 4

Safety Considerations

Common Side Effects

• Gastrointestinal adverse effects are most common:
  • Nausea (37.3% with semaglutide vs 13.2% with placebo) 5
  • Vomiting, diarrhea, constipation, and esophageal reflux 6
  • These effects are typically dose-dependent and more pronounced during initial treatment or dose escalation 6

Serious Adverse Events

• 38% higher risk of serious adverse events compared to placebo 1, 6
• Potential serious adverse events include:
  • Pancreatitis
  • Cholelithiasis and cholecystitis
  • Acute myocardial infarction
  • Gastroenteritis 1, 6

Contraindications

• Personal or family history of medullary thyroid cancer
• Multiple endocrine neoplasia syndrome type 2 1, 6
• Should not be used with other GLP-1 receptor agonists or dipeptidyl peptidase-4 inhibitors 1

Special Considerations

Renal Impairment

• No dosage adjustments required for renal impairment 1
• Can be used in patients with eGFR ≥2 mL/min per 1.73 m² 1

Medication Interactions

• May delay gastric emptying, potentially affecting absorption of other oral medications 6, 7
• Caution advised when using with insulin or insulin secretagogues due to hypoglycemia risk 1
• Monitor for potential consequences of delayed absorption of oral medications with narrow therapeutic index 1

Missed Doses

• If more than 2 consecutive doses are missed, clinical judgment is required for subsequent dosing 1
• For patients who tolerated the medication well, resuming at the same dose can be considered 1
• Consider lowering the dose or restarting the titration schedule if 3 or more consecutive doses are missed 1