What is the dosing regimen for Ozempic (semaglutide) and its incremental timeline?

Ozempic Dosing and Incremental Timeline

Start Ozempic at 0.25 mg subcutaneously once weekly for 4 weeks, then increase to 0.5 mg weekly; if additional glycemic control is needed after at least 4 weeks on 0.5 mg, increase to 1 mg weekly (maximum dose for type 2 diabetes). 1

Standard Dosing Schedule for Type 2 Diabetes

The FDA-approved titration schedule follows a structured approach to minimize gastrointestinal adverse effects while achieving glycemic control:

Initial Phase (Weeks 1-4):

• 0.25 mg subcutaneously once weekly for the first 4 weeks 1
• This dose is intended solely for treatment initiation and is not effective for glycemic control 1
• The purpose is to allow GI tolerance to develop 2

Maintenance Phase (Week 5 onwards):

• Increase to 0.5 mg once weekly after completing the 4-week initiation period 1
• This is the first therapeutic dose for glycemic control 3

Optional Escalation (If Needed):

• If additional glycemic control is required after at least 4 weeks on the 0.5 mg dose, increase to 1 mg once weekly 1
• Maximum recommended dose for type 2 diabetes is 1 mg once weekly 1

Alternative Dosing for Weight Management

For patients using semaglutide specifically for obesity or weight management (note: this refers to the higher-dose formulation marketed as Wegovy, not Ozempic):

• Start at 0.25 mg weekly for 4 weeks 2
• Increase to 0.5 mg weekly for 4 weeks 2
• Increase to 1.0 mg weekly for 4 weeks 2
• Increase to 1.7 mg weekly for 4 weeks 2
• Target maintenance dose of 2.4 mg weekly is reached after 16 weeks 2, 3

Administration Guidelines

Timing and Frequency:

• Administer once weekly on the same day each week 4, 1
• Can be given at any time of day, with or without meals 4, 1
• The day of weekly administration can be changed if necessary, as long as at least 2 days (>48 hours) separate the doses 1

Injection Technique:

• Administer subcutaneously to the abdomen, thigh, or upper arm 1
• Use a different injection site each week when injecting in the same body region 1
• Inspect visually before use—should appear clear and colorless 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 and administer the next dose on the regularly scheduled day 1

For multiple missed doses:

• If more than 2 consecutive doses are missed, clinical judgment is required 2
• If the patient tolerated the medication well previously, resuming at the same dose can be considered 2
• If 3 or more consecutive doses are missed, consider restarting the titration schedule 2

Important Clinical Considerations

Dose Adjustments:

• No dose adjustment required for renal impairment, including end-stage renal disease 4, 3
• No dose adjustment required based on age in elderly patients 3
• Use with caution in severe hepatic impairment due to limited experience 3

Drug Interactions and Contraindications:

• Do not use with other GLP-1 receptor agonists or DPP-4 inhibitors 2
• When using with insulin or sulfonylureas, monitor closely for hypoglycemia and adjust doses as needed 2
• May delay gastric emptying and impact absorption of oral medications requiring rapid onset 2
• Contraindicated in patients with personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2 4

Common Pitfalls:

• The 0.25 mg starting dose is not therapeutic—patients must advance to at least 0.5 mg for glycemic benefit 1
• Rushing the titration schedule increases risk of nausea and vomiting (reported in 21-22% of patients) 5
• Some patients achieve adequate response at submaximal doses and can continue that dose long-term rather than escalating 2