Ozempic Starting Dose
Start Ozempic at 0.25 mg subcutaneously once weekly for the first 4 weeks, then increase to 0.5 mg weekly. 1
Standard Dosing Protocol
The FDA-approved titration schedule for Ozempic follows a structured escalation designed to minimize gastrointestinal side effects while achieving therapeutic benefit:
- Weeks 1-4: 0.25 mg subcutaneously once weekly 1
- Week 5 onward: Increase to 0.5 mg once weekly, maintain for at least 4 weeks 1
- Optional escalation: If additional glycemic control is needed after at least 4 weeks on 0.5 mg, increase to 1 mg weekly 1
The 0.25 mg starting dose is not a therapeutic dose—it serves solely as an initiation dose to improve gastrointestinal tolerability. 1 The maintenance dose for most patients is 0.5 mg or 1 mg weekly, depending on glycemic response. 1
Administration Details
- Inject subcutaneously in the abdomen, thigh, or upper arm 1
- Administer at any time of day, with or without meals 1
- Choose the same day each week for consistency 1
- The injection site can be rotated with each dose 1
Critical Safety Considerations
Absolute contraindications include personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2. 1 Screen for these conditions before initiating therapy.
Common adverse effects include nausea (20-22% of patients), diarrhea, and vomiting, which are typically transient and diminish with continued use. 1 The gradual dose escalation strategy specifically mitigates these gastrointestinal symptoms. 1
Renal Dosing
No dose adjustment is required for any degree of renal impairment, including end-stage renal disease or dialysis. 1 This makes semaglutide particularly valuable in patients with diabetic kidney disease. 1
Managing Dose Escalation Challenges
If gastrointestinal symptoms are severe at any dose level, maintain the current dose for an additional 4 weeks before attempting further escalation. 1 If two consecutive doses are missed, consider restarting at a lower dose to minimize gastrointestinal symptoms upon resumption. 1
Important Distinction
The oral formulation of semaglutide (Rybelsus) is not interchangeable with subcutaneous Ozempic and requires different dosing. 1 This guidance applies specifically to the injectable Ozempic formulation.