What is the maintenance dose of semaglutide (Glucagon-like peptide-1 (GLP-1) receptor agonist) for weight loss?

From the Guidelines

The maintenance dose of semaglutide for weight loss is 2.4 mg injected subcutaneously once weekly, as recommended by the AGA clinical practice guideline on pharmacological interventions for adults with obesity 1. This dose is reached after a gradual titration schedule to minimize gastrointestinal side effects, starting at 0.25 mg weekly for the first 4 weeks, followed by doses of 0.5 mg, 1.0 mg, and 1.7 mg weekly every 4 weeks at each dose, until the maintenance dose of 2.4 mg is reached after 16 weeks 1. Some key points to consider when using semaglutide for weight loss include:

• The importance of lifestyle interventions, such as a reduced-calorie diet and increased physical activity, in conjunction with semaglutide therapy 1
• The potential for gastrointestinal side effects, such as nausea, vomiting, diarrhea, and constipation, which often improve over time 1
• The need for clinical judgment when adjusting the titration schedule or deciding on subsequent dosing if a patient misses more than 2 consecutive doses 1
• The potential for some patients to achieve a strong response at a submaximal dose and continue that dose long-term 1 The use of semaglutide for weight loss has been shown to be effective in adults with obesity or overweight with weight-related complications, with a conditional recommendation and moderate certainty evidence 1. Overall, semaglutide is a valuable treatment option for weight loss, and its use should be guided by the latest clinical practice guidelines and evidence-based recommendations 1.

From the FDA Drug Label

The mean population-PK estimated steady-state concentrations following once weekly subcutaneous administration of 0.5 mg and 1 mg semaglutide were approximately 65.0 ng/mL and 123. 0 ng/mL, respectively.

The maintenance dose of semaglutide for weight loss is 2.4 mg or 2.5 mg once weekly, but this information is not present in the provided drug labels. However, based on the information provided, the maintenance dose for type 2 diabetes is 0.5 mg or 1 mg once weekly.

• The 0.5 mg dose is achieved after 4 weeks of dose escalation, starting with 0.25 mg once weekly for 4 weeks, then increased to 0.5 mg once weekly.
• The 1 mg dose is achieved after 8 weeks of dose escalation, starting with 0.25 mg once weekly for 4 weeks, then increased to 0.5 mg once weekly for 4 weeks, then increased to 1 mg once weekly. Note that semaglutide doses of 0.5 mg and 1 mg provide adequate systemic exposure over the body weight range of 40-198 kg evaluated in the clinical trials 2.

From the Research

Maintenance Dose Semaglutide for Weight Loss

• Semaglutide is a glucagon-like peptide-1 receptor agonist that has been approved for chronic weight management in adults with obesity or overweight with at least one weight-related condition 3, 4.
• The maintenance dose of semaglutide for weight loss is 2.4 mg once weekly, which has been shown to result in significant weight loss and improvements in cardiovascular risk factors 3, 4, 5.
• Studies have demonstrated that semaglutide 2.4 mg once weekly can lead to a mean weight loss of approximately 15% of initial weight at 68 weeks, accompanied by improvements in cardiovascular risk factors and physical functioning 4, 5.
• The safety and efficacy of semaglutide for weight loss have been established in several clinical trials, including the STEP 2 trial, which showed that semaglutide 2.4 mg once weekly achieved a superior and clinically meaningful decrease in body weight compared to placebo in adults with overweight or obesity and type 2 diabetes 5.
• Real-world studies have also shown that semaglutide is associated with superior reductions in HbA1c and weight compared to other glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes, and is also associated with a lower number of major adverse cardiovascular events and is more cost-effective 6.

Dosage and Administration

• The recommended maintenance dose of semaglutide for weight loss is 2.4 mg once weekly, administered via subcutaneous injection 3, 4.
• Semaglutide should be used in conjunction with a weight management program consisting of a reduced calorie diet and increased physical activity 3.

Safety and Efficacy

• The safety and efficacy of semaglutide for weight loss have been established in several clinical trials, including the STEP 2 trial, which showed that semaglutide 2.4 mg once weekly achieved a superior and clinically meaningful decrease in body weight compared to placebo in adults with overweight or obesity and type 2 diabetes 5.
• Common adverse events associated with semaglutide include gastrointestinal adverse events, such as nausea, vomiting, and diarrhea, which are mostly mild to moderate in severity 5, 7.