How to Restart Semaglutide: Understanding Dosage and Timing

March 23, 2024
A doctor providing medication advice

Semaglutide, along with liraglutide and tirzepatide, are next-generation weight-loss medications that, when combined with a reduced-calorie diet and exercise plan, can help people lose over 10% to 15% of their body weight. As a once-weekly injectable, GLP-1 agonists like semaglutide are convenient to administer and have the potential to cause more weight loss than previous options (15-20% vs. 3-9%).1

Semaglutide, like all medications, can cause side effects. The most common of these are digestive symptoms. Researchers have found that gradually increasing the semaglutide dose reduces the frequency and severity of these side effects. Whether you are starting semaglutide for the first time or returning to the medication after a break, it is critical to follow the dosage and timing instructions. Doing so increases your chances of successfully tolerating the medication.

Semaglutide Therapy Basics

Semaglutide is a GLP-1 agonist that mimics the actions of your body’s natural GLP-1 hormone, resulting in increased satiety, delayed stomach emptying, and increased insulin release from the pancreas. Semaglutide has helped people lose an average of 15% of their body weight.

This is the typical starting dose and dose escalation plan when first starting semaglutide.1

How to Restart Semaglutide: Understanding Dosage and Timing

The most common side effects associated with taking semaglutide and other GLP-1s include:

  • Nausea (44%)
  • Vomiting (24%)
  • Diarrhea (30%)
  • Constipation (24%)
  • Abdominal pain (20%)
  • Headache (14%)
  • Fatigue (11%)
  • Indigestion (9%)
  • Dizziness (8%)
  • Bloating (7%)
  • Gastroenteritis (4%)

Most side effects are transient and mild to moderate in intensity. Side effects are more common when first starting semaglutide and when increasing the dose.1 To reduce the risk of side effects, the semaglutide dosage should be started at a low dose and slowly increased to the maintenance dose.2

Understanding Treatment Interruptions

Disruptions in the supply chain are one of the major reasons semaglutide treatment has been interrupted.3 Novo Nordisk, the manufacturer of brand-name Ozempic and Wegovy, cannot meet the worldwide demand for their products. Semaglutide remains on the Drug Shortages database.

Other potential reasons people may miss dosages of semaglutide include:

  • A medical or surgical condition
  • Cost of the medication
  • Side effects such as nausea, vomiting, or injection site reactions
  • Lack of insurance coverage
  • Reaching a weight-loss goal
  • Interaction with another medication
  • No longer wanting to take medication
  • Switching between GLP-1 agonists

Many people experience increased appetite and weight gain when they stop taking semaglutide for an extended period of time. According to research, when people stop taking semaglutide, they regain approximately two-thirds of their lost weight. This is why it is important to work on lifestyle changes while taking semaglutide.

Other benefits, such as improved cardiovascular health, are also lost when weight is regained. Because obesity is a chronic disease, semaglutide treatment is usually recommended as a long-term solution to treat obesity.4

Because side effects are more common when starting, restarting, or increasing the dose of semaglutide, it is essential to follow the restarting semaglutide instructions carefully.

The Critical Question: Duration of Interruption and Restart Protocol

Clinical guidelines for restarting semaglutide when more than one dose has been missed are not currently available. However, Whitley et al. suggest that if five or more doses are missed, treatment should be restarted from the initial dose.

The injectable form of semaglutide has a half-life of 5.7 to 6.7 days. Half-life is the time it takes for the concentration or amount of semaglutide in the body to be reduced by 50%. About half of your semaglutide remains about one week after you take your dosage.2

If you miss your semaglutide dose, contact your doctor. They will suggest a semaglutide restart plan based on your previous history of side effects, medical history, and the reason you needed to discontinue treatment.

A doctor answering a question

Restarting Semaglutide: Dosage and Timing Considerations

Guidelines for restarting semaglutide are based on whether any of the medication remains in your system.

Guidelines for restarting semaglutide if less than one week has been missed.

If you miss a dose and the next scheduled dose is more than two days away, take the missed dose as soon as possible.

If more than five days have passed since the dose was missed, skip the dose and resume semaglutide on the regularly scheduled dosage day.1

Guidelines for restarting semaglutide if more than one week has been missed.

Clinical guidelines for restarting semaglutide when more than one dose has been missed are not currently available. However, assuming you are currently taking semaglutide 1 mg once a week, Whitley et al. suggest the following restart semaglutide plan:

  • If ≤2 doses are missed, restart semaglutide at 1 mg (same dose) once weekly.
  • If 3–4 doses are missed, restart semaglutide at 0.5 mg (half-dose) weekly.
  • If ≥5 doses are missed, restart semaglutide at 0.25 mg (starting dose) once weekly.

The American Diabetes Association offers additional guidance on switching between GLP-1 agonists. They emphasize the importance of clear communication between the prescriber and patients when starting, stopping, increasing the dose, or changing GLP-1 agonists.

GLP-1 medications can cause gastrointestinal side effects. Following dosage instructions carefully can reduce the risk of these side effects and improve your chances of successfully taking semaglutide or another GLP-1 agonist. It takes time to see the full weight-loss benefits of semaglutide.

Restarting semaglutide at too high a dose or escalating the dose too quickly can slow stomach emptying too much, resulting in uncomfortable side effects such as nausea, vomiting, bloating, and heartburn.

Talk with an Invigor Medical treatment specialist about semaglutide.

Author: Leann Poston, M.D.
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Sources

  • Bergmann NC, Davies MJ, Lingvay I, Knop FK. Semaglutide for the treatment of overweight and obesity: A review. Diabetes Obes Metab. 2023;25(1):18-35.
  • Marx, N., Husain, M., Lehrke, M., Verma, S., & Sattar, N. (2022). GLP-1 receptor agonists for the reduction of atherosclerotic cardiovascular risk in patients with type 2 diabetes. Circulation, 146(24), 1882–1894. https://doi.org/10.1161/circulationaha.122.059595
  • Whitley HP, Trujillo JM, Neumiller JJ. Special Report: Potential Strategies for Addressing GLP-1 and Dual GLP-1/GIP Receptor Agonist Shortages. Clin Diabetes. 2023 Summer;41(3):467-473. doi: 10.2337/cd23-0023. Epub 2023 Apr 7. PMID: 37456085; PMCID: PMC10338283.
  • Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553-1564. doi:10.1111/dom.14725
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