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Semaglutide · Dosing

How Semaglutide Is Actually Dosed

What does a real Semaglutide (Ozempic / Wegovy) dose schedule look like?

S-Tier Weight Loss FDA-approved

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The plain-English version

You start at 0.25mg once a week and step up every four weeks. Wegovy (for weight) tops out at 2.4mg weekly. Ozempic (for diabetes) tops out at 2mg weekly. One shot, under the skin, same day each week. Always with a doctor.

Route: subcutaneous injection, oral capsule. Evidence tier for the dose: FDA-approved. FDA-approved with multiple randomized trials behind it. The strongest evidence tier in this matrix.

The dose at a glance

What's typical What's the max in research
Starting dose: 0.25 mg subQ (under-the-skin shot) once weekly for the first 4 weeks. Like tirzepatide, this is a wake-up dose, not a working dose. Max observed in research: Wegovy max is 2.4 mg weekly (STEP trials). Ozempic max is 2 mg weekly (SUSTAIN-FORTE). Compounded products sometimes go to 3 mg in protocols beyond label - not advised without strong clinical reason.
Maintenance dose: Wegovy (weight): 1.7 mg or 2.4 mg weekly. Ozempic (diabetes): 1 mg or 2 mg weekly. Many users stabilize one rung below the max if side effects bite.
Frequency: Once weekly. Same day each week. Half-life: About 7 days. Longest of the GLP-1s, which is why one shot per week is enough.

Titration (how to ramp the dose)

Wegovy ladder: 0.25 mg for 4 weeks -> 0.5 mg for 4 weeks -> 1 mg for 4 weeks -> 1.7 mg for 4 weeks -> 2.4 mg max. Ozempic ladder: 0.25 mg for 4 weeks -> 0.5 mg for 4+ weeks -> 1 mg for 4+ weeks -> 2 mg max. Move up only when current dose is tolerable AND not producing the result you need.

Cycle length and time off

On cycle: Indefinite for chronic obesity or diabetes. Some weight-loss users do a 6 to 12 month run for a defined goal.

Off cycle: Same as tirzepatide - no required off cycle. Appetite returns over weeks to months without it.

Timing notes: Time of day does not matter. Inject in stomach, thigh, or upper arm. Rotate sites. If you miss a dose: take it within 5 days, otherwise skip and resume normal schedule.

What's commonly prescribed (per published protocols and clinical write-ups)

Branded Wegovy and Ozempic come as pre-filled multi-dose pens at fixed weekly doses. Compounded semaglutide from US pharmacies (during and post-shortage) typically ships in mg/mL concentration vials (commonly 2.5 mg/mL or 5 mg/mL) - patient draws their own dose. Many compounded versions add B12 (cyanocobalamin) which is just B12 along for the ride and does not change the drug's behavior. Oral semaglutide (Rybelsus) exists but is rarely prescribed for weight loss - dose is 7 or 14 mg daily, taken first thing on an empty stomach.

Source: prescribing labels, published protocols, and clinical write-ups. We have not independently tested each prescriber pattern.

Reconstitution (mixing the vial)

Compounded semaglutide ships pre-mixed (already liquid) at a labeled concentration. At 2.5 mg/mL, 0.1 mL on the syringe equals 0.25 mg. Store in fridge. Discard at expiration printed on vial. CRITICAL: compounded mg/mL is NOT the same as the dot on a Wegovy pen - confirm concentration with your pharmacy and write the math down before drawing.

Reconstitution = mixing freeze-dried (lyophilized) powder with bacteriostatic water (sterile water with preservative) so you can draw a dose into a syringe.

Drug interactions to watch

  • Slows gastric emptying - separate oral medications by at least 1 hour where possible.
  • Insulin and sulfonylureas: combine with caution, hypoglycemia risk - your prescriber should adjust.
  • Birth control: efficacy may dip during titration and dose changes (less risk than tirzepatide but real). Use backup.

Who should not take this (contraindications)

  • Personal or family history of medullary thyroid carcinoma.
  • Multiple Endocrine Neoplasia syndrome type 2.
  • Active pancreatitis.
  • Pregnancy and breastfeeding (stop 2 months pre-conception).

Common side effects

  • Nausea (especially first 4-8 weeks). Up to 44 percent of users in STEP-1.
  • Constipation or diarrhea.
  • Reflux and burping.
  • Fatigue early in titration.
  • Injection-site reactions.

Serious side effects (call a doctor)

  • Pancreatitis (severe stomach pain radiating to back).
  • Gallbladder problems and stones, more common during rapid loss.
  • Severe dehydration from GI side effects.
  • Diabetic retinopathy worsening in diabetics.
  • Allergic reactions including angioedema (face swelling) - rare but documented.

What to monitor while you're on it

  • Weight and waist weekly for first 12 weeks.
  • A1C and fasting glucose at baseline and every 3 months if diabetic.
  • Lipid panel and liver enzymes every 6 months.
  • DEXA or InBody at start and 6 months to track lean mass.

How to stop

No formal taper. Step down a dose level for 4 weeks before stopping if you want a softer landing. Lock in protein and resistance training during that window.

Where this dosing comes from

  • STEP-1 through STEP-5 trials (NEJM and Lancet, 2021-2022)
  • SUSTAIN trial program (Diabetes Care, 2017-2020)
  • SELECT trial (NEJM, 2023)
  • FDA prescribing information for Ozempic, Wegovy, and Rybelsus
  • Compounded semaglutide telehealth dosing protocols (Hims, Henry Meds, Mochi, Eden, Ro 2024-2025)

Where these doses come from

These doses come from FDA-approved prescribing labels for Semaglutide. The protocols are well-characterized in the STEP and SUSTAIN trials. Standard medical practice.

Always work with a real prescriber. Don't self-prescribe.

Safety reminder: None of this replaces a doctor. Peptides are gray-market in the US for most uses. Talk to a real prescriber before you change anything.

Where to go next

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Last reviewed · 2026-05-07 · Page generated by Protocol One matrix engine. None of this replaces a doctor. Peptides are gray-market in the US for most uses. Talk to a real prescriber before you change anything.