Semaglutide Dosing Chart: Complete Schedule & Titration Guide
Master semaglutide dosing with this comprehensive guide. Learn week-by-week titration schedules, Ozempic vs Wegovy differences, and how to optimize your dosing strategy.
Understanding Semaglutide Titration
Semaglutide requires a structured titration protocol—gradual dose escalation over several weeks—to minimize side effects while reaching therapeutic doses. This isn't arbitrary; the schedule reflects pharmacological research showing optimal tolerability when doses increase incrementally.
The standard 4-week escalation interval allows your gastrointestinal system to adapt to semaglutide's effects on gastric motility and appetite signaling. Rushing this process significantly increases nausea, vomiting, and other GI side effects that may cause treatment discontinuation. Patience with titration is patience with success.
Semaglutide accumulates in your system with each weekly injection. By week 5 of a given dose level, you reach steady-state pharmacokinetics—meaning your blood levels stabilize and you experience the dose's full effects. This 5-week mark is crucial for determining whether a dose is working before escalating.
Standard Ozempic Dosing Schedule (Diabetes)
Week 1-4: 0.25mg once weekly - This starter dose establishes tolerance. Most users experience mild appetite suppression and minimal side effects. Blood sugar improvements typically begin this week if diabetic. Inject the same day each week (e.g., every Monday).
Week 5-8: 0.5mg once weekly - Escalate after the 4-week interval. This dose intensifies appetite suppression and GI effects may emerge. Many users experience nausea during this phase, usually resolving by week 7-8. Continue consistent weekly timing.
Week 9-12: 1mg once weekly - The standard therapeutic dose for diabetes. At this level, most users achieve significant appetite suppression and blood sugar control. For some, this is the ideal maintenance dose. Many tolerate 1mg very well with minimal side effects.
Week 13+ (Optional): 1.4-1.7mg or 2mg - Ozempic is approved only up to 1mg for diabetes (in the U.S., though some countries allow higher). If using for weight loss purposes, some doctors prescribe off-label at 1.4mg or 1.7mg. Always follow your prescriber's guidance.
Standard Wegovy Dosing Schedule (Weight Loss)
Week 1-4: 0.25mg once weekly - Identical to Ozempic's starter phase. Mild appetite reduction begins. Side effects usually minimal at this dose.
Week 5-8: 0.5mg once weekly - Appetite suppression increases noticeably. Many users report food no longer interests them, and portion sizes naturally shrink. Nausea may occur but typically subsides.
Week 9-12: 1mg once weekly - Substantial appetite suppression and weight loss acceleration. This is the first dose at which many users feel 'the full effect' of the medication.
Week 13-16: 1.7mg once weekly - An intermediate dose that balances efficacy with tolerability for many weight loss patients. Significant appetite suppression with manageable side effects.
Week 17+: 2.4mg once weekly - The maximum approved maintenance dose. Most clinical weight loss occurs at or approaching this dose. By this point, many users have achieved 10-20% body weight reduction.
Detailed Week-by-Week Progression Chart
Weeks 1-4 (0.25mg) - Injection: 0.25mg subcutaneous once weekly. Expected effects: Mild appetite reduction, minimal nausea, possible headache or fatigue. Weight loss: 0-2 lbs. Side effects: Rare; most users tolerate excellently.
Weeks 5-8 (0.5mg) - Injection: 0.5mg subcutaneous once weekly. Expected effects: Moderate appetite suppression, early nausea in 'sensitive users, GI adjustment period. Weight loss: 2-5 lbs accumulated. Side effects: Nausea peaks mid-week, usually resolves by weekend.
Weeks 9-12 (1mg) - Injection: 1mg subcutaneous once weekly. Expected effects: Strong appetite suppression, food aversions common, significant weight loss acceleration. Weight loss: 5-12 lbs accumulated. Side effects: Nausea rare, occasional loose stools, taste changes.
Weeks 13-16 (1.7mg) - Injection: 1.7mg subcutaneous once weekly (Wegovy only). Expected effects: Very strong appetite suppression, profound fullness on small portions, continued weight loss. Weight loss: 12-20 lbs accumulated. Side effects: Minimal for most, occasional nausea if dose is new to system.
Weeks 17+ (2.4mg) - Injection: 2.4mg subcutaneous once weekly (Wegovy only). Expected effects: Maximum appetite suppression, sustained fullness, metabolic benefits. Weight loss: 20%+ of body weight possible. Side effects: Well-tolerated in most maintenance patients.
Ozempic vs Wegovy: Key Dosing Differences
The primary difference isn't pharmacological—both contain identical semaglutide—but rather approved endpoints. Ozempic for type 2 diabetes maxes out at 1mg weekly because clinical trials showed excellent glycemic control at this dose. Going higher didn't improve diabetes management, so the FDA approved only 1mg.
Wegovy for weight loss continues to 2.4mg because weight loss efficacy keeps improving at higher doses. Clinical trials demonstrated progressive weight loss from 0.25mg through 2.4mg, with the steepest decline at 2.4mg. Therefore, the FDA approved the full 2.4mg escalation.
Some physicians prescribe Ozempic off-label at 1.4mg or 1.7mg for weight loss purposes. This is legal and increasingly common, though less studied than Wegovy's approved 2.4mg. Compounded semaglutide may use either dosing framework, so verify which schedule your pharmacy follows.
Injection pens differ slightly: Ozempic pens dial to specific dose marks (0.25, 0.5, 1, 2mg), while Wegovy pens go 0.25, 0.5, 1, 1.7, 2.4mg. If switching between formulations, ensure your prescriber accounts for this difference.
Extended Titration Schedules for Sensitive Users
Some users experience significant side effects during standard 4-week intervals. If this applies to you, discuss an extended titration with your doctor: staying at each dose level for 6 or even 8 weeks before escalating.
Extended Schedule Example: Weeks 1-6 at 0.25mg, weeks 7-12 at 0.5mg, weeks 13-18 at 1mg, weeks 19-24 at 1.7mg, weeks 25+ at 2.4mg. This doubles the timeline but dramatically reduces GI side effects for sensitive individuals.
The trade-off is slower weight loss during titration—your dose is lower for longer periods. However, if side effects prevent compliance, a gentler schedule is preferable. Some users report better long-term weight loss with extended titration because they maintain treatment continuity.
Reaching Your Optimal Dose
Not everyone needs 2.4mg. Many users achieve excellent results at 0.5mg, 1mg, or 1.7mg. Work with your doctor to find your minimum effective dose—the lowest dose producing your desired weight loss or glycemic control.
Signs you may not need escalation: You're achieving your weight loss goals, side effects are minimal, and appetite suppression is sufficient for adherence. There's no prize for reaching the highest dose. A lower dose you tolerate well beats a higher dose you can't sustain.
If you respond excellently at 1mg, discuss staying there instead of escalating. Weight loss may be slightly slower than at 2.4mg, but your quality of life and GI health may improve. The 'best' dose is the one matching your individual goals and tolerability.
Handling Dose Adjustments and Setbacks
If you experience severe nausea or vomiting at a new dose, contact your physician. You may stay at your current dose longer (6-8 weeks instead of 4) before attempting escalation. This isn't failure—it's optimization.
If side effects are unbearable, you can temporarily reduce to your previous dose for 1-2 weeks, then attempt escalation again. Alternatively, delay escalation until side effects fully resolve. There's no deadline for reaching your target dose.
Some users find certain dose levels trigger side effects disproportionately (e.g., 1.7mg causes nausea but 1mg and 2.4mg don't). If this occurs, discuss skipping the problematic dose and going directly to the next level. This is uncommon but medically sound when it happens.
Maintaining Your Dose: Long-Term Considerations
Once you reach your target dose, maintain consistent weekly injections. Semaglutide's effectiveness depends on sustained treatment. Stopping abruptly causes appetite to return within days, sometimes with rebound eating and rapid weight regain.
Plan injections for the same day weekly. This creates a pattern your body adjusts to and makes remembering easier. Many users pick a specific day (Monday, Wednesday, Friday, etc.) and never miss. Setting phone reminders helps.
Every 6-12 months, discuss dose adjustments with your physician. As weight loss progresses, your body's needs change. Some users reduce doses after reaching goal weight to minimize long-term side effects while maintaining weight loss. Others increase if weight loss plateaus.
Traveling and Injection Management
Semaglutide pens must be refrigerated before first use (2-8°C) and then kept at room temperature after opening. This matters for travel. Plan ahead if flying internationally: pack pens in a small cooler with ice packs or frozen water bottles for long flights.
Always carry your pens in carry-on luggage, never checked bags. TSA allows injectable medications. Bring your prescription or doctor's letter if concerned. If traveling across time zones, keep injections on your home time initially, then adjust gradually if staying long-term.
Don't skip doses while traveling. Missing injections allows appetite to return and disrupts your progress. A few minutes finding a private space for injection maintains your treatment continuity.
Dosing After Weight Loss Goals Are Met
Once you reach your target weight, discuss maintenance strategies with your doctor. Some users stay on their current dose indefinitely to maintain weight loss. Others gradually reduce to a lower maintenance dose (e.g., 0.5mg weekly).
Long-term treatment is increasingly supported by research. Many users find that stopping semaglutide leads to appetite return and weight regain. Continuing at a lower maintenance dose often prevents this. Your doctor can help determine if ongoing treatment aligns with your goals.
Some users achieve their weight loss and discontinue semaglutide, relying on developed habits and continued nutrition discipline. This works for some but fails for others. Discuss your individual situation—your metabolism, previous weight cycling, and lifestyle—with your physician.
Monitoring Response and Adjusting Strategy
Track weight weekly (same day, same time, same scale if possible), but expect variability. Water retention, hormonal cycles, and digestion affect daily weight. Weekly averages matter more than daily fluctuations. Monthly or quarterly trends reveal true progress.
Notice how you feel: energy, mood, cravings, fullness, side effects. These qualitative measures often matter more than scale weight. If you feel great but weight loss slows, you may be near your healthy set point. If you feel terrible, dose adjustments may be needed.
Take progress photos monthly. Scales miss body composition changes—muscle gain may offset fat loss, but visually you're dramatically transforming. Clothes fit better even when weight plateaus, indicating positive body recomposition.
Frequently Asked Questions
Gradual dose escalation allows your body to adapt to the medication and minimize GI side effects like nausea and vomiting. Starting at 0.25mg and increasing every 4 weeks gives your system time to adjust before reaching therapeutic doses. Rapid escalation often results in intolerable side effects.
Not recommended. Semaglutide works best on a consistent weekly schedule. Skipping doses may reduce effectiveness and allow appetite to return. If you miss a dose, take it as soon as you remember, then resume your normal schedule the following week.
Ozempic for diabetes caps at 1mg weekly, while Wegovy for weight loss continues to 2.4mg weekly. Both use the same 0.25mg starting dose and 4-week escalation pattern. The difference reflects their approved therapeutic endpoints.
For most users, 2.4mg weekly is the standard maintenance dose approved by the FDA. Some compounded versions go higher, but limited data supports doses above 2.4mg. Many users achieve excellent results at 1mg or 1.7mg.
You should always consult your prescribing physician before dose adjustments. They monitor your response, side effects, and overall health. Self-adjusting doses risks ineffectiveness or dangerous side effects. Professional guidance ensures safety.
Contact your doctor immediately. You may stay at your current dose longer (extending the 4-week interval), reduce to the previous dose, or discontinue temporarily. Don't push through severe nausea or vomiting without medical guidance.
Many users notice appetite suppression within days of the first injection. Measurable weight loss typically begins by week 2-4. Most significant loss occurs between weeks 8-16 as doses escalate and your body adapts.
Yes. Some users achieve their weight loss goals at 0.5mg, 1mg, or 1.7mg and maintain these doses long-term. There's no requirement to reach 2.4mg. Work with your doctor to find the minimum effective dose for your goals.
If missed by a few days, take it as soon as possible. If more than a week has passed, skip that dose and resume your normal schedule. Don't double-dose to catch up. Your appetite may temporarily increase, but appetite suppression returns with the next dose.
Most compounded semaglutide follows the same 0.25mg starting dose and 4-week titration. However, compounding quality varies. Verify your compounding pharmacy follows FDA guidelines and uses pharmaceutical-grade materials.
Related Resources
For additional information, explore our guides on Ozempic dosing specifics, managing semaglutide side effects, and realistic weight loss expectations.