What is the recommended dosing schedule for Ozempic (semaglutide) in the management of type 2 diabetes?

Ozempic (Semaglutide) Dosing Schedule for Type 2 Diabetes

Start Ozempic at 0.25 mg subcutaneously once weekly for 4 weeks, then increase to 0.5 mg once weekly, with optional escalation to 1 mg once weekly after at least 4 additional weeks if glycemic control remains inadequate. 1

Initial Dosing Phase

• Begin with 0.25 mg subcutaneously once weekly for exactly 4 weeks 1
• This initial dose is for treatment initiation only and is not effective for glycemic control—it serves solely to minimize gastrointestinal side effects during the titration period 1

Maintenance Dosing

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

Administration Instructions

• Administer once weekly on the same day each week, at any time of day, with or without meals 1
• Inject subcutaneously into the abdomen, thigh, or upper arm, rotating injection sites each week within the same body region 1
• The day of weekly administration can be changed if the time between doses is at least 2 days (>48 hours) 1

Missed Dose Management

• If a dose is missed, administer as soon as possible within 5 days after the missed dose 1
• If more than 5 days have passed, skip the missed dose entirely and administer the next dose on the regularly scheduled day 1

Concomitant Medication Adjustments

• When using Ozempic with insulin, reduce insulin doses to minimize hypoglycemia risk 2, 1
• Administer Ozempic and insulin as separate injections—never mix them 1
• Injections can be given in the same body region but should not be adjacent to each other 1
• Consider reducing doses of insulin secretagogues (sulfonylureas, meglitinides) when initiating Ozempic 2

Critical Safety Considerations

Absolute Contraindications

• Do not use in patients with personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) 1
• Contraindicated in patients with known hypersensitivity to semaglutide 1

Important Warnings

• Avoid in patients with a history of pancreatitis—consider alternative antidiabetic therapies 1
• Counsel patients about potential thyroid tumor symptoms: neck mass, dysphagia, dyspnea, persistent hoarseness 1
• Inform patients about transient nausea and vomiting, which the gradual dose titration is designed to minimize 2

Perioperative Management

• Be aware that semaglutide delays gastric emptying, potentially increasing aspiration risk during anesthesia 2

Product Inspection

• Visually inspect Ozempic before each use—it should appear clear and colorless 1
• Do not use if particulate matter or discoloration is present 1