What is the starting dose of Ozempic (semaglutide) for a typical adult patient with type 2 diabetes and no significant kidney disease?

Starting Dose of Oral Ozempic

There is no oral formulation of Ozempic approved for any indication. Ozempic (semaglutide) is exclusively available as a subcutaneous injection for type 2 diabetes treatment, and the confusion likely stems from the existence of oral semaglutide marketed under a different brand name (Rybelsus), which is FDA-approved only for type 2 diabetes—not for obesity management 1, 2.

Subcutaneous Ozempic Dosing for Type 2 Diabetes

For injectable Ozempic, the FDA-approved starting dose is 0.25 mg subcutaneously once weekly for 4 weeks, followed by an increase to 0.5 mg weekly. 2, 3, 4

Standard Titration Protocol

• Initiate at 0.25 mg subcutaneously once weekly for the first 4 weeks to minimize gastrointestinal adverse effects 2, 3, 4
• After 4 weeks, increase to 0.5 mg once weekly, which serves as the standard maintenance dose for most patients 2, 3, 4
• If additional glycemic control is needed after at least 4 weeks on 0.5 mg, escalate to 1.0 mg once weekly 2, 3, 4
• For patients requiring further intensification, a 2.0 mg weekly dose is available after at least 4 weeks on 1.0 mg, though this higher dose demonstrated only modest additional benefit (HbA1c reduction of -0.23% compared to 1.0 mg) 3, 5

Administration Details

• Inject subcutaneously in the abdomen, thigh, or upper arm at any time of day, with or without meals, on the same day each week 2, 3
• The 0.25 mg starting dose is not therapeutic—it exists solely to improve gastrointestinal tolerability during the initiation phase 2, 4

Oral Semaglutide (Rybelsus) Dosing

If you are asking about oral semaglutide specifically:

• Oral semaglutide (Rybelsus) starts at 3 mg once daily for 30 days, then increases to 7 mg daily, with optional escalation to 14 mg daily if needed 2, 3
• Oral semaglutide is FDA-approved only for type 2 diabetes treatment, not for obesity management 1, 2
• Oral and injectable formulations are not interchangeable and require different dosing schedules 2

Critical Safety Considerations

• Absolute contraindications include personal or family history of medullary thyroid carcinoma and multiple endocrine neoplasia syndrome type 2 (MEN2) 2, 3, 4
• Common adverse effects include nausea (20-22%), diarrhea, and vomiting, which are typically transient and diminish with continued use 1, 2
• No dose adjustment is required for any degree of renal impairment, including end-stage renal disease or dialysis 2, 3

Concomitant Medication Adjustments

• Reduce basal insulin by 20% when initiating semaglutide to prevent hypoglycemia 3
• Consider discontinuing or reducing sulfonylurea doses by 50% to minimize hypoglycemia risk 2, 3