Ozempic (Semaglutide) Dosing for Weight Loss
For weight loss, use semaglutide 2.4 mg once weekly subcutaneously, not the lower doses marketed as Ozempic (which are FDA-approved only for type 2 diabetes at 0.5-1 mg). The 2.4 mg dose is the FDA-approved formulation for chronic weight management and achieves significantly greater weight reduction than diabetes-indicated doses 1.
FDA-Approved Dosing Regimen
Titration Schedule for Weight Loss (2.4 mg target dose):
- Week 1-4: Start with 0.25 mg once weekly 2
- Week 5-8: Increase to 0.5 mg once weekly 2
- Week 9-12: Increase to 1.0 mg once weekly 1
- Week 13-16: Increase to 1.7 mg once weekly 1
- Week 17 onward: Maintenance dose of 2.4 mg once weekly 1
The gradual dose escalation every 4 weeks minimizes gastrointestinal side effects (nausea, vomiting, diarrhea), which are the most common adverse events and typically transient 1, 3, 4.
Administration Details
- Route: Subcutaneous injection to abdomen, thigh, or upper arm 2
- Frequency: Once weekly, same day each week, any time of day, with or without meals 2
- Flexibility: Day of administration can be changed if at least 48 hours pass between doses 2
- Missed dose: Administer within 5 days; if >5 days have passed, skip and resume regular schedule 2
- Injection site rotation: Use different site each week within the same body region 2
Treatment Course and Duration
Long-term continuous therapy is required to maintain weight loss benefits. 1
- Initial assessment period: Evaluate efficacy at 16 weeks; discontinue if <4% weight loss achieved 1
- Expected outcomes at 68 weeks: Mean weight loss of 14.9-15.3% from baseline 1, 3, 4
- Responder rates: 86% achieve ≥5% weight loss, 69% achieve ≥10% weight loss, 51% achieve ≥15% weight loss 3, 4
- Maintenance: Continue indefinitely beyond reaching weight goals; sudden discontinuation results in weight regain and worsening cardiometabolic risk factors 1
Monitoring Requirements
Monthly assessment for first 3 months, then quarterly thereafter: 1
- Weight and BMI tracking
- Gastrointestinal tolerability (nausea, vomiting, diarrhea, constipation) 1, 3
- Heart rate (may increase modestly) 1
- Signs of pancreatitis (discontinue if suspected) 1
- Gallbladder disease symptoms (cholelithiasis risk) 1
- Hydration status (especially if on insulin or sulfonylureas) 1
- Malnutrition screening after significant weight loss 1
Key Safety Considerations and Contraindications
Absolute contraindications: 1
- Personal or family history of medullary thyroid carcinoma
- Multiple endocrine neoplasia type 2 (MEN2)
- Pregnancy and breastfeeding
Precautions and warnings: 1
- History of pancreatitis (use caution; discontinue if pancreatitis develops)
- Severe renal impairment (dehydration from vomiting can worsen kidney function)
- History of cholelithiasis (increased risk of gallstone-related complications)
- Diabetic retinopathy (monitor in patients with diabetes)
- Suicidal ideation risk (monitor behavioral changes)
Clinical Pitfalls to Avoid
Do not use Ozempic brand (0.5-1 mg) for weight loss indication - this is the diabetes formulation with inadequate dosing for obesity management; the weight loss indication requires 2.4 mg weekly 1
Do not discontinue prematurely - weight regain occurs rapidly after stopping; this is chronic disease management requiring indefinite treatment 1
Do not advance doses too quickly - the 4-week titration intervals are critical to minimize gastrointestinal adverse events that cause treatment discontinuation 1, 3
Do not ignore early non-responders - if <4% weight loss at 16 weeks, discontinue and consider alternative therapies rather than continuing ineffective treatment 1
Additional Cardiometabolic Benefits
Beyond weight loss, semaglutide 2.4 mg provides: 3, 4
- Reduction in blood pressure
- Improvement in atherogenic lipid profile
- Enhanced physical functioning and quality of life
- Cardiovascular event reduction (demonstrated in patients with preexisting cardiovascular disease) 1
Cost Considerations
The 30-day supply cost ranges from $1,295-$1,619 for semaglutide 2.4 mg 1, making it one of the more expensive weight management options, though the magnitude of weight loss (15% mean reduction) exceeds all other available pharmacotherapies except tirzepatide 1.