Ozempic Highest Dose
The maximum FDA-approved dose of Ozempic (semaglutide) for type 2 diabetes is 1 mg once weekly, though a higher 2 mg dose exists and has been studied for additional glycemic control. 1
FDA-Approved Dosing for Type 2 Diabetes
The standard Ozempic dosing regimen follows a structured titration schedule 1:
- Initial dose: 0.25 mg subcutaneously once weekly for 4 weeks (this is a tolerance-building dose, not therapeutic) 1
- Standard maintenance dose: 0.5 mg once weekly after the initial 4 weeks 1
- Maximum standard dose: 1 mg once weekly if additional glycemic control is needed after at least 4 weeks on 0.5 mg 1
- FDA-labeled maximum: 1 mg once weekly is the maximum recommended dosage per the official prescribing information 1
Higher Dose Evidence: 2 mg Weekly
A 2 mg once-weekly dose of semaglutide has been studied and shows superior efficacy compared to the 1 mg dose 2:
- HbA1c reduction: The 2 mg dose achieved a mean HbA1c reduction of 2.2 percentage points versus 1.9 percentage points with 1 mg (treatment difference -0.23 percentage points, p=0.0003) 2
- Weight loss: The 2 mg dose produced 6.9 kg weight loss versus 6.0 kg with 1 mg (treatment difference -0.93 kg, p=0.015) 2
- Safety profile: The 2 mg dose had a similar safety profile to 1 mg, with gastrointestinal disorders being the most common adverse events (34% vs 31%) 2
Important Distinction: Ozempic vs Wegovy
Critical caveat: While Ozempic is FDA-approved only up to 1 mg weekly for diabetes, the same medication (semaglutide) is available as Wegovy at a 2.4 mg weekly dose specifically for chronic weight management 3, 4. This represents the highest approved dose of semaglutide available:
- Wegovy 2.4 mg weekly is the maximum dose for obesity management, reached after a 16-week titration schedule 4
- This formulation achieves 14.9% mean weight loss at 68 weeks 3
- It provides proven cardiovascular benefits with 20% reduction in cardiovascular death, nonfatal MI, or nonfatal stroke (HR 0.80) 3
Clinical Context for Dose Selection
For patients with type 2 diabetes requiring maximum glycemic control:
- Start with the standard Ozempic titration to 1 mg weekly 1
- If inadequate response after 3 months at 1 mg, consider switching to Wegovy 2.4 mg (if weight loss is also a goal) or adding other glucose-lowering medications 3
- The 2 mg dose studied in SUSTAIN FORTE provides an intermediate option for treatment intensification 2
No dose adjustments are required for:
- Renal impairment (including end-stage renal disease) 5, 6
- Age or sex 6
- Hepatic impairment (though use caution in severe hepatic impairment due to limited data) 5
Body weight is the only covariate affecting semaglutide exposure, but this does not necessitate dose adjustments in clinical practice 6.