How to restart Ozempic (semaglutide) after a pause?

How to Restart Ozempic After a Pause

For patients who have missed Ozempic (semaglutide) doses, the restart approach should be based on the number of consecutive doses missed, with dose titration required if 3 or more doses have been missed. 1

Restart Protocol Based on Time Since Last Dose

• If a dose is missed but it has been less than 5 days since the scheduled dose, administer Ozempic as soon as possible and then resume the regular once-weekly dosing schedule 2
• If more than 5 days have passed since the missed dose, skip that dose and administer the next dose on the regularly scheduled day 2
• For 1-2 consecutive missed doses with previous good tolerance, resume at the same dose that was previously tolerated 1, 3
• For 3 or more consecutive missed doses, restart the titration schedule to minimize gastrointestinal side effects 1, 3

Titration Schedule When Restarting

• Start with 0.25 mg subcutaneous injection once weekly for 4 weeks (note: this initial dose is for titration only and not effective for glycemic control) 2
• After 4 weeks on the 0.25 mg dose, increase to 0.5 mg once weekly 2
• 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 2
• The maximum recommended dosage is 1 mg once weekly 2

Managing Side Effects During Restart

• Gastrointestinal side effects (nausea, vomiting, diarrhea) are common with semaglutide, especially at higher doses 1
• Slow dose titration is crucial to minimize these adverse effects 1
• Monitor for side effects more closely during the restart period, particularly if the patient experienced significant gastrointestinal effects previously 3

Special Considerations

• For patients with diabetes who are restarting Ozempic, monitor blood glucose more frequently, especially if also taking insulin or insulin secretagogues 3
• Administer Ozempic on the same day each week, at any time of day, with or without meals 2
• 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) 2
• Do not use Ozempic with other GLP-1 receptor agonists or dipeptidyl peptidase-4 inhibitors 1

Administration Instructions

• Administer subcutaneously to the abdomen, thigh, or upper arm 2
• Use a different injection site each week when injecting in the same body region 2
• When using Ozempic with insulin, administer as separate injections and never mix the products 2

Clinical Outcomes to Monitor

• Resuming Ozempic promptly and appropriately is important to maintain glycemic control and weight management benefits 1
• Semaglutide has demonstrated significant weight reduction benefits (14.9% mean weight loss over 68 weeks) and improvements in cardiometabolic risk factors 4
• In patients with diabetic nephropathy, semaglutide may offer renoprotective benefits in addition to glycemic control 5