Ozempic Dosing for Type 2 Diabetes
Start Ozempic at 0.25 mg subcutaneously once weekly for 4 weeks (this is an initiation dose only, not effective for glycemic control), then increase to 0.5 mg once weekly, and if additional glycemic control is needed after at least 4 weeks, escalate to the maximum dose of 1 mg once weekly. 1
Standard Dosing Protocol
The FDA-approved dosing regimen follows a structured titration schedule 1:
- Weeks 1-4: 0.25 mg once weekly (initiation dose)
- Week 5 onward: 0.5 mg once weekly (first therapeutic dose)
- Optional escalation: After at least 4 weeks on 0.5 mg, may increase to 1 mg once weekly if additional glycemic control is required
- Maximum dose: 1 mg once weekly 1
Administration Guidelines
Timing and flexibility 1:
- Administer once weekly on the same day each week
- Can be given at any time of day, with or without meals
- The day of weekly administration can be changed if at least 2 days (>48 hours) pass between doses
Injection technique 1:
- Inject subcutaneously into abdomen, thigh, or upper arm
- Rotate injection sites each week within the same body region
- When using with insulin, administer as separate injections—never mix products
- Injections can be in the same body region but not adjacent to each other
Missed dose management 1:
- If <5 days since missed dose: administer as soon as possible
- If >5 days have passed: skip the missed dose and resume regular schedule
Special Population Considerations
No dose adjustments required for 2:
- Renal impairment (including end-stage renal disease)
- Hepatic impairment
Safety Monitoring and Precautions
Black box warning 2:
- Risk of thyroid C-cell tumors observed in rodents (human relevance undetermined)
- Contraindicated in patients with personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2
Key safety concerns 2:
- Gastrointestinal disorders: nausea (most common), vomiting, diarrhea, constipation—the gradual titration schedule minimizes these effects
- Cholelithiasis and gallstone-related complications
- Severe constipation with potential progression to small bowel obstruction/ileus
- Elevated heart rate
- Hypoglycemia risk when combined with insulin or insulin secretagogues—dose adjustments of these medications may be needed 2, 3
Medication interactions 2:
- Monitor for delayed absorption of oral medications with narrow therapeutic indices due to delayed gastric emptying
Clinical Context
Semaglutide demonstrates superior glycemic control compared to other GLP-1 receptor agonists, with HbA1c reductions of 1.21-1.64% at the 0.5-1.0 mg doses 4. It also produces significant weight loss of 3.5-5.2 kg compared to weight gain with insulin glargine 4. The medication has a 7-day half-life, reaching steady state in 4-5 weeks 5. For patients with established cardiovascular disease, GLP-1 receptor agonists with proven cardiovascular benefits (including semaglutide) are preferred agents and can be used as first-line therapy with or without metformin 6.