Ozempic Starting Dose
The starting dose of Ozempic (semaglutide) for adults with type 2 diabetes is 0.25 mg subcutaneously once weekly for 4 weeks. 1, 2, 3
Initial Dosing Protocol
- Week 1-4: Start with 0.25 mg once weekly subcutaneously 1, 2, 3
- This initial dose is not therapeutic—it serves solely to minimize gastrointestinal side effects during the titration phase 2, 3
- Administer at any time of day, with or without food, injected subcutaneously in the abdomen, thigh, or upper arm 2
Standard Titration Schedule
After the initial 4-week period on 0.25 mg, follow this escalation:
- Week 5-8: Increase to 0.5 mg once weekly 1, 2, 3
- Week 9+: If additional glycemic control is needed, escalate to 1.0 mg once weekly after at least 4 weeks on the 0.5 mg dose 1, 2, 3
- Maximum dose: 2.0 mg once weekly is available for patients requiring further intensification after at least 4 weeks on 1.0 mg 2, 3
Key Clinical Considerations
The 0.5 mg dose is the standard maintenance dose for most patients with type 2 diabetes. 2 Only escalate to 1.0 mg or 2.0 mg if glycemic targets are not achieved after adequate trial at the lower dose 2, 3
No dose adjustments are required for:
- Renal impairment of any degree, including end-stage renal disease 1, 2
- Hepatic impairment 2
- Elderly patients 2
Common Pitfalls to Avoid
- Never skip the 0.25 mg starting dose—jumping directly to 0.5 mg or higher significantly increases gastrointestinal adverse effects (nausea, vomiting, diarrhea) 2, 3
- Do not rush titration—each dose level requires at least 4 weeks before escalation to allow tolerance development 1, 2, 3
- Reduce insulin or sulfonylurea doses when initiating Ozempic to prevent hypoglycemia, as the glucose-lowering effect is additive 2
Efficacy Data
At the 0.5 mg maintenance dose, Ozempic reduces HbA1c by approximately 1.3-1.4% from baseline, with 66-73% of patients achieving HbA1c <7% 3 The 1.0 mg dose provides slightly greater HbA1c reduction of approximately 1.5% 3