What is the dosing regimen for initiating Ozempic (semaglutide) 4 mg in a patient?

Ozempic Dosing Regimen

Ozempic does not come in a 4 mg dose; the maximum FDA-approved dose is 1 mg once weekly for glycemic control. 1

Standard Dosing Protocol

The FDA-approved titration schedule for Ozempic (semaglutide subcutaneous injection) follows a specific escalation pattern:

Initial Dosing

• Start with 0.25 mg subcutaneously once weekly for 4 weeks 1
• This initial dose is for treatment initiation only and is not effective for glycemic control 1
• Administer on the same day each week, at any time of day, with or without meals 1

Maintenance Dosing

• After 4 weeks, increase to 0.5 mg once weekly 1
• If additional glycemic control is needed after at least 4 weeks on 0.5 mg, increase to 1 mg once weekly 1
• The maximum recommended dose is 1 mg once weekly 1

Administration Details

• Inject subcutaneously in the abdomen, thigh, or upper arm 1
• Use a different injection site each week when injecting in the same body region 1
• The day of weekly administration can be changed if at least 2 days (>48 hours) pass between doses 1

Important Clarification on Higher Doses

The 2.4 mg weekly dose exists only for Wegovy (semaglutide for weight management), not Ozempic 2. If you are seeking higher doses for weight management rather than diabetes control, that would require prescribing Wegovy, which follows a different titration schedule up to 2.4 mg weekly 3.

Missed Dose Management

• If a dose is missed, administer as soon as possible within 5 days 1
• If more than 5 days have passed, skip the missed dose and resume the regular schedule 1

Special Population Considerations

• No dose adjustment required for renal impairment, including end-stage renal disease 2, 4
• No dose adjustment required for hepatic impairment 4

Critical Safety Warnings

• Black box warning: Contraindicated in patients with personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) 1
• When used with insulin or insulin secretagogues, dose adjustments of these medications may be needed due to hypoglycemia risk 4
• The gradual titration schedule minimizes gastrointestinal adverse effects 4