Restarting Ozempic After 2-Month Hiatus
After a 2-month interruption of Ozempic at 1 mg weekly, restart at the initial titration dose of 0.25 mg weekly for 4 weeks, then increase to 0.5 mg weekly, and finally return to 1 mg weekly after at least 4 additional weeks at 0.5 mg. 1, 2, 3
Rationale for Restarting at Lower Dose
When 3 or more consecutive doses are missed (approximately 3 weeks or more), the titration schedule should be restarted from a lower dose to minimize gastrointestinal adverse effects. 1, 2 After 2 months off therapy (approximately 8 missed doses), more than 3-4 half-lives have passed since the last dose, meaning semaglutide has been essentially cleared from your system. 4 Semaglutide has a half-life of approximately 7 days, so after 2 months (8-9 weeks), the drug is no longer providing therapeutic coverage or GI tolerance. 4, 2
Specific Restart Protocol
Week 1-4: Start with 0.25 mg subcutaneously once weekly. This dose is intended for treatment initiation only and is not effective for glycemic control, but allows GI tolerance to redevelop. 1, 3
Week 5-8 (minimum): Increase to 0.5 mg once weekly after completing 4 weeks at 0.25 mg. 1, 3
Week 9+ (minimum): Return to your previous maintenance dose of 1 mg once weekly after at least 4 weeks on 0.5 mg. 1, 3
Why Full Retitration Is Necessary
Gradual dose titration is essential to minimize gastrointestinal adverse effects including nausea, vomiting, diarrhea, and abdominal pain, which are dose-dependent and most common when initiating or escalating doses. 1, 5, 2 Even though you previously tolerated 1 mg weekly, the GI tolerance you developed has been lost after 2 months without medication. 1, 2 Restarting directly at 1 mg would significantly increase the risk of severe GI side effects that could lead to treatment discontinuation. 2, 6
Clinical Monitoring During Restart
Monitor blood glucose more frequently when resuming treatment, especially if you are also taking insulin or insulin secretagogues, as missing multiple doses may have compromised blood glucose control. 2
Assess for gastrointestinal symptoms at each dose escalation, particularly nausea, vomiting, diarrhea, and abdominal pain. 2, 6
Weight and glycemic control benefits will take time to re-establish, as steady state is reached in 4-5 weeks at each dose level. 4
Important Safety Considerations
If you need to reduce sulfonylurea or insulin doses: These medications may need adjustment during retitration to prevent hypoglycemia, though this is less critical at the lower starting doses. 5, 2
Common pitfall to avoid: Do not attempt to accelerate the titration schedule by shortening the 4-week intervals at each dose level, as this increases the risk of intolerable GI side effects leading to treatment discontinuation. 1, 3