Dosage guide
Ozempic dose escalation schedule
Week-by-week titration for Ozempic (semaglutide) — starting dose, step-up schedule, maintenance, maximum, and what to do if you miss a dose.
Starting dose
0.25 mg once weekly
Maintenance
0.5–2.0 mg subcutaneous once weekly
Maximum dose
2.0 mg/week
Dose form & administration
- Dose form
- Multi-dose prefilled pen, subcutaneous injection
- Dosing frequency
- Once weekly, same day each week
Titration timeline
FDA-labeled step-up schedule. Most clinicians follow this exactly, but may pause at a step for an additional 4 weeks if side effects are intolerable.
- 1
Weeks 1–4
0.25 mg/week
Initiation — not a therapeutic dose, intended to reduce GI side effects.
- 2
Weeks 5–8
0.5 mg/week
First therapeutic dose.
- 3
Weeks 9+
1.0 mg/week
Step up after ≥4 weeks if additional glycemic control needed.
- 4
Optional
2.0 mg/week
Maximum FDA-approved dose for additional A1c reduction.
If a step-up is poorly tolerated
Hold the current dose for an additional 4 weeks if a step-up is poorly tolerated. Many patients achieve target A1c on 0.5 or 1.0 mg without needing 2.0 mg.
Missed-dose protocol
Max skip window
5 days
If less than 5 days since the missed dose, inject it as soon as possible. If more than 5 days, skip the missed dose and resume the regular schedule.
When to contact your prescriber
- Multiple consecutive missed doses — may need re-titration.
- Severe persistent GI symptoms during step-up.
- New abdominal pain, vision changes, or signs of pancreatitis.
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