Semaglutide is a GLP-1 receptor agonist originally developed for type 2 diabetes management and now widely prescribed for weight management. Understanding proper dosing, titration schedules, and the differences between formulations is essential for safe and effective use.
How Semaglutide Works
Semaglutide mimics the incretin hormone GLP-1, which is released after eating. It works through several mechanisms: slowing gastric emptying, reducing appetite by acting on brain hunger centers, enhancing insulin secretion, and suppressing glucagon release. These combined effects lead to reduced food intake, improved blood sugar control, and significant weight loss.
Semaglutide Dosage for Weight Loss (Wegovy Protocol)
The FDA-approved weight loss titration follows a gradual escalation over 16 weeks to minimize gastrointestinal side effects:
| Phase | Weeks | Weekly Dose | Purpose |
|---|---|---|---|
| Month 1 | Weeks 1-4 | 0.25mg | Initial tolerance assessment |
| Month 2 | Weeks 5-8 | 0.5mg | First escalation |
| Month 3 | Weeks 9-12 | 1.0mg | Second escalation |
| Month 4 | Weeks 13-16 | 1.7mg | Third escalation |
| Maintenance | Week 17+ | 2.4mg | Full therapeutic dose |
Semaglutide Dosage for Diabetes (Ozempic Protocol)
| Phase | Weeks | Weekly Dose | Purpose |
|---|---|---|---|
| Initiation | Weeks 1-4 | 0.25mg | GI tolerance building |
| Standard dose | Week 5+ | 0.5mg | Blood sugar management |
| Escalation (if needed) | After 4+ weeks at 0.5mg | 1.0mg | Additional glycemic control |
| Maximum | If 1.0mg insufficient | 2.0mg | Maximum approved dose |
Semaglutide Formulation Comparison
| Factor | Wegovy (Weight Loss) | Ozempic (Diabetes) | Rybelsus (Oral) |
|---|---|---|---|
| Route | Subcutaneous injection | Subcutaneous injection | Oral tablet |
| Frequency | Once weekly | Once weekly | Once daily |
| Max dose | 2.4mg/week | 2.0mg/week | 14mg/day |
| FDA indication | Weight management | Type 2 diabetes | Type 2 diabetes |
| Bioavailability | ~89% (SC) | ~89% (SC) | ~1% (oral) |
Injection Timing and Technique
When to Inject
- Choose the same day each week for consistency
- Can be administered any time of day, with or without food
- If you miss a dose by less than 5 days, take it as soon as possible
- If more than 5 days have passed, skip and resume on the next scheduled day
Injection Sites
- Abdomen: At least 2 inches from the navel (most common site)
- Thigh: Front or outer area of the upper thigh
- Upper arm: Back of the upper arm (may need assistance)
- Rotate sites each week to prevent lipodystrophy
Managing Side Effects by Dose
| Side Effect | Likelihood at Low Dose | Likelihood at Full Dose | Management |
|---|---|---|---|
| Nausea | Common (30-40%) | Very common (40-50%) | Eat smaller meals, avoid fatty foods |
| Vomiting | Occasional (5-10%) | Common (15-25%) | Stay hydrated, eat bland foods |
| Diarrhea | Occasional (10-15%) | Common (15-20%) | Stay hydrated, probiotics may help |
| Constipation | Occasional (5-10%) | Common (15-20%) | Increase fiber and water intake |
| Injection site reaction | Rare | Rare | Rotate injection sites |
Frequently Asked Questions
What is the standard semaglutide dose for weight loss?
The target maintenance dose for weight loss is 2.4mg injected subcutaneously once weekly (Wegovy). This dose is reached through a gradual 16-week titration starting at 0.25mg and increasing monthly. The slow titration is critical for minimizing gastrointestinal side effects. Some patients achieve satisfactory results at lower doses (1.0mg or 1.7mg).
How fast does semaglutide work for weight loss?
Most people notice reduced appetite within the first 1-2 weeks of starting semaglutide. Measurable weight loss typically begins within 4-8 weeks. Clinical trials showed an average of 15-17% body weight loss over 68 weeks at the 2.4mg dose. The rate of weight loss is fastest during months 3-8 and gradually plateaus.
Can I stay on a lower semaglutide dose if it's working?
Yes. While the clinical trials used the full 2.4mg dose, many patients achieve meaningful weight loss at intermediate doses (0.5mg, 1.0mg, or 1.7mg) with fewer side effects. If you're experiencing good results and tolerating a lower dose well, discuss with your prescribing physician whether continuing at that dose is appropriate for your goals.
Conclusion
Semaglutide dosing requires a careful, gradual titration to maximize effectiveness while minimizing side effects. Whether using it for weight management or diabetes control, following the prescribed escalation schedule and communicating with your healthcare provider about tolerability is essential for achieving optimal outcomes.