Starting Dose of Ozempic
The starting dose of Ozempic (semaglutide) is 0.25 mg subcutaneously once weekly for 4 weeks, then increase to 0.5 mg weekly as the standard maintenance dose. 1, 2
Initial Dosing Protocol
The low 0.25 mg starting dose serves specifically to minimize gastrointestinal side effects—particularly nausea, vomiting, and diarrhea—which are the most common adverse effects of semaglutide. 1 This is not a therapeutic dose but rather an adaptation period for your body to adjust to the medication. 1, 2
After the initial 4-week period at 0.25 mg, you should increase to 0.5 mg once weekly, which is the standard maintenance dose for most patients. 1, 2
Dose Escalation Beyond Maintenance
If you need additional glycemic control after at least 4 weeks at 0.5 mg, your dose can be increased to 1.0 mg weekly. 1, 2 For patients requiring further intensification, a 2.0 mg weekly dose is available after at least 4 weeks at 1.0 mg. 1, 2 The maximum approved dose for diabetes management is 2.0 mg weekly. 1
For weight management specifically (not just diabetes), a higher 2.4 mg weekly dose is available and FDA-approved, requiring a longer titration schedule over 16-20 weeks. 1, 2
Administration Details
- Inject subcutaneously in the abdomen, thigh, or upper arm 1, 2
- Administer once weekly on the same day each week, at any time of day, with or without meals 1, 2
- Rotate injection sites within one anatomical area to minimize absorption variability 1
Critical Medication Adjustments When Starting
If you are taking insulin, reduce your insulin dose by 20% when starting Ozempic to prevent hypoglycemia. 1 If you are on sulfonylureas (like glipizide or glyburide), these should be discontinued or reduced by 50% due to hypoglycemia risk. 1, 3
Do not combine Ozempic with other GLP-1 receptor agonists (like Trulicity, Victoza, Mounjaro) or DPP-4 inhibitors (like Januvia, Tradjenta). 1, 3
Special Populations
No dose adjustment is required for any degree of kidney impairment, including dialysis patients. 1, 2 Similarly, no dose adjustment is needed for liver impairment. 1
Absolute Contraindications
Do not start Ozempic if you have:
- Personal or family history of medullary thyroid cancer 1, 2
- Multiple endocrine neoplasia syndrome type 2 (MEN2) 1, 2
- Pregnancy or breastfeeding 1
- History of severe allergic reaction to semaglutide 1
Monitoring During Titration
You should be assessed every 4 weeks during dose escalation for gastrointestinal tolerance, weight changes, blood pressure, and signs of pancreatitis or gallbladder disease. 1 After reaching your maintenance dose, monitoring should occur every 3 months. 1
Common Pitfall to Avoid
Do not skip the 0.25 mg starting dose and jump directly to 0.5 mg or higher. The gradual titration is essential for tolerability—patients who start at higher doses experience significantly more nausea and vomiting, leading to treatment discontinuation. 1, 2 Even though 0.25 mg is subtherapeutic, this 4-week adaptation period dramatically improves your ability to tolerate the medication long-term. 1
Treatment Duration
Semaglutide is considered lifelong therapy to maintain glycemic control and weight loss benefits. 1 Discontinuation results in significant weight regain (approximately 50-67% of lost weight within one year) and worsening of cardiometabolic risk factors. 1, 3