What are the dosing recommendations for Ozempic (semaglutide)?

Ozempic Dosing Recommendations

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 if additional glycemic control is needed after at least 4 weeks at the 0.5 mg dose. 1

Standard Dosing Protocol

Initial Titration Schedule

• Begin with 0.25 mg subcutaneously once weekly for 4 weeks - this dose is for treatment initiation only and is not effective for glycemic control 1
• 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, escalate to 1 mg once weekly - this is the maximum recommended dose for Ozempic 1

The gradual titration is essential to minimize gastrointestinal adverse effects, which are the most common side effects 2, 3

Administration Guidelines

• Administer once weekly on the same day each week, at any time of day, with or without meals 4, 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 necessary, as long as at least 2 days (>48 hours) pass between doses 1

Missed Dose Management

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

For multiple consecutive missed doses:

• 2 consecutive doses missed: Use clinical judgment - consider resuming at the same dose if previously well-tolerated, or lower the dose 2
• 3 or more consecutive doses missed: Consider restarting the full titration schedule 2

Special Population Considerations

Renal and Hepatic Impairment

• No dosage adjustment required for any degree of renal impairment, including end-stage renal disease 3, 4
• No dosage adjustment required for hepatic impairment 3, 4

Combination Therapy Precautions

• When using with insulin or insulin secretagogues, dose reduction of these medications may be needed due to hypoglycemia risk 3, 4
• Administer Ozempic and insulin as separate injections; never mix the products 1
• Do not use with other GLP-1 receptor agonists or DPP-4 inhibitors 2

Critical Safety Considerations

Black Box Warning

Ozempic carries a black box warning for thyroid C-cell tumors observed in rodents (human relevance undetermined) - do not use in patients with personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2 3, 4

Common Adverse Effects

• Gastrointestinal effects (nausea, vomiting, diarrhea, constipation) are most common, typically transient and mild-to-moderate 2, 3
• Monitor for cholelithiasis and gallstone-related complications 3
• Watch for severe constipation and potential small bowel obstruction/ileus 3
• May cause elevated heart rate 3

Medication Interactions

Monitor for delayed absorption of oral medications with narrow therapeutic indices, as semaglutide delays gastric emptying 3

Clinical Context

For patients with established cardiovascular disease, GLP-1 receptor agonists including semaglutide are preferred as first-line therapy with or without metformin due to proven cardiovascular benefits 4

Some patients may achieve significant clinical response at submaximal doses (0.5 mg) and can continue at that dose long-term rather than escalating to 1 mg 2