Semaglutide Dosage: Mastering the Semaglutide Dosing Schedule

April 4, 2024
A woman measuring her waist circumference.

Internet and social media users are probably very familiar with the term semaglutide. This medication, found in Wegovy, Rybelsus, and Ozempic, is a game-changer when it comes to treating type 2 diabetes and obesity. However, with so many products carrying the same active pharmaceutical ingredient, determining semaglutide dosage can be difficult. To make matters worse, the semaglutide dose for weight loss changes throughout your treatment. Depending on potential side effects, your semaglutide dose may vary from the dosage of semaglutide your friends may take.

What is Semaglutide?

Semaglutide is a medication in the glucagon-like peptide (GLP-1) receptor agonist class. Because it mimics the actions of naturally produced GLP-1, it can induce weight loss and stabilize your blood sugar levels.

Cells in your intestines secrete GLP-1. After circulating in your bloodstream, GLP-1 hormone binds to receptors on your pancreas, stomach lining, kidneys, brain, and heart.

When GLP-1 binds to receptors on pancreatic cells, it causes them to secrete more insulin and decrease glucagon production. Insulin ushers glucose (sugar) from your bloodstream into muscle and liver cells, where it can be stored or used for energy. By lowering your blood sugar levels, GLP-1 hormone reduces the risk of damage to your blood vessels and, subsequently, your risk of heart disease.

GLP-1 hormone, along with insulin and amylin, binds to cells in specific areas of your brain to signal fullness and satiety. People who take semaglutide report that they don’t think about food nearly as much as they did before starting the medication. They also feel more satisfied after eating less food.

Finally, when GLP-1 hormone binds to receptors in the stomach’s lining, it slows how quickly your stomach empties. When food stays in your stomach longer, you feel full longer. Unfortunately, slowing stomach emptying and how fast food moves through your intestines can cause some of semaglutide’s most common side effects. Understanding the correct semaglutide dosage can help ensure you achieve the best weight loss outcomes from taking semaglutide while minimizing side effects.

Understanding Semaglutide Dosage

Semaglutide comes in several different formulations, both an oral tablet and an injectable.

Wegovy, Rybelsus, and Ozempic are branded forms of semaglutide.

  • Wegovy is dosed between 0.25 mg and 2.4 mg. It is administered as a subcutaneous (just under the skin) injection once a week. It is approved for weight management.
  • Rybelsus is available in 3 mg to 14 mg strengths. It is approved to treat type 2 diabetes. Your Rybelsus dosage is determined by the amount of medication you need to effectively manage your blood sugar levels.
  • Ozempic is available in a 0.25 mg to 2 mg dose and is approved to treat type 2 diabetes. Like Wegovy, It is administered as a once-weekly subcutaneous injection.

To reduce the risk of side effects, semaglutide dosage typically starts low and is gradually increased. Patients report side effects are most common when the semaglutide dosage is increased or when the medication is first started.

The semaglutide dosing schedule is designed to allow your body to adjust to a semaglutide dosage before moving to a higher strength. For example, semaglutide for weight loss is typically dosed at 0.25 mg once weekly for four weeks and then increased to 0.5 mg for the next four weeks.

Even though there is a standard dosing schedule for semaglutide for weight loss, factors such as your kidney function, concurrent medication use, and whether you have any other medical conditions can influence how much semaglutide you can take and the side effects you might expect. This is why it is essential to provide your Invigor Medical healthcare provider with your complete medical history, including a list of all current over-the-counter and prescription medications you are taking.

pharmacist looking at a semaglutide dosage

The Importance of Correct Semaglutide Dosing

As the popularity of semaglutide increased, poison control centers reported an increase in calls reporting semaglutide overdosage. A desire to accelerate weight loss by taking more medication than prescribed or not understanding how to administer a correct semaglutide dose (especially when taking compounded semaglutide) are potential concerns.

Joseph E. Lambson, PharmD, Utah Poison Control Center, along with his colleagues, reported three cases of studies of adverse events when people inadvertently took the incorrect dose of semaglutide.1

  • Case 1: A 50-year-old man with type 2 diabetes took 50 units of semaglutide instead of 5 units as a treatment for weight loss. He experienced vomiting for 2 days and nausea for 1 week. He took semaglutide with B12 compounded medication dosed in units and milliliters rather than milligrams.
  • Case 2: A 37-year-old woman incorrectly took 1 mL (2.5 mg) of semaglutide 2.5 mg/1 mL subcutaneously instead of 0.1 mL (0.25 mg) as her first dose for weight loss. She vomited for 1 day and then had a headache, decreased appetite, weakness, and fatigue. She took semaglutide with B12 compounded medication and reported never receiving counseling from a pharmacist on how to dose semaglutide or administer the medication properly.
  • Case 3: A 33-year-old woman received semaglutide from an aesthetic spa. It is unclear how much medication she received. She was treated in the emergency room for intractable nausea, vomiting, and abdominal pain.

Dr. Lambson expresses his concern when people receive semaglutide without pharmacist counseling on proper drug administration. He is particularly concerned about compounded semaglutide because the variability of dosage units used can contribute to patient confusion. He encourages increased vigilance when labeling, dispensing, and counseling patients who take compounded semaglutide.1

The significance of correct semaglutide dosing cannot be overstated. An accurate dose ensures that patients receive the maximum benefit from their medication while minimizing potential risks. Incorrect dosing can cause a variety of problems, including inadequate blood sugar control, unnecessary side effects, and even serious health complications.

Correct dosing is especially important when considering the role of semaglutide in weight management. The doses of semaglutide used for weight loss are typically higher than those used for diabetes treatment. This underscores the need for proper dose escalation and monitoring to ensure patients do not experience adverse effects while striving to achieve their weight loss goals.

How to Determine the Right Semaglutide Dose

Your healthcare provider will determine the correct semaglutide dose for you based on your reasons for taking the medication and your medical history. They will need to consider whether you have comorbid conditions such as type 2 diabetes, obesity, or kidney or liver disease.

Since semaglutide is used to treat both type 2 diabetes and obesity, it comes in a variety of dosages. The option to adjust the dosage gradually allows for an increase in dose depending on how a person responds to treatment and any side effects they may experience.

A sign that says weight loss ahead on it

Comparing Different Semaglutide Doses

Due to the enormous demand for weight loss medications, Wegovy is in short supply. If a medication is on the U.S. Food and Drug Administration’s drug shortage list, semaglutide compounding pharmacies can step in and fill the demand gap by producing compounded semaglutide.

Wegovy Dosing

Wegovy is approved for chronic weight management.

Following your healthcare provider’s instructions, Wegovy (semaglutide) dosing is according to the following schedule:

Month 1: (weeks 1-4): take 0.25 mg each week

Month 2: (weeks 5-8): take 0.5 mg each week

Month 3: (weeks 9-12): take 1 mg each week

Month 4: (weeks 13-16): take 1.7 mg each week

Month 5: (weeks 17 and onward): 2.4 mg each week (full dose)

According to the manufacturer, you can take Wegovy with or without food. The auto-injecting pen is a single preset dose.

Rybelsus Dosing

Rybelsus tablets are taken by mouth daily in the morning when you first wake up with no more than 4 ounces of water. According to the manufacturer, wait 30 minutes after taking Rybelsus before you eat or drink anything.

When treating your type 2 diabetes, your healthcare provider will typically prescribe the 3 mg dose initially. After 30 days on the 3 mg dose, they will increase your dose to 7 mg once daily. If necessary to control your blood sugar, they may recommend increasing your Rybelsus dose to 14 mg once daily after you take the 7mg dose for at least 30 days.

Ozempic Dosing

Ozempic is used to treat type 2 diabetes. Like Wegovy, it is taken once a week as a subcutaneous injection.

Month 1: (weeks 1-4): take 0.25 mg each week.

Month 2: (weeks 5-8): take 0.5 mg each week.

Month 3: (weeks 9-12): take 1 mg each week if additional blood sugar control is needed.

Month 4: (weeks 13-16): take 2 mg each week if additional blood sugar control is needed.

Compounded Semaglutide Dosing

When you receive a prescription for compounded semaglutide, it is very important to talk with your pharmacist about your semaglutide dosage and how to administer the medication.

An example of a compounded semaglutide dosage schedule:

  • Month 1: (weeks 1-4): take 0.25 mg each week.
  • Month 2: (weeks 5-8): take 0.5 mg each week.
  • Month 3: (weeks 9-12): take 1 mg each week.
  • Month 4: (weeks 13-16): take 1.75  mg each week.
  • Month 5 (week 17-20): take 2.5 mg each week.

Compounded semaglutide dosages may vary depending on the compounding pharmacy. Be sure to ask the pharmacist if you have any questions about the dosage or how to administer the medication.

Common Mistakes in Semaglutide Dosing

Weight loss when taking semaglutide is not immediate, which can lead to a common semaglutide dosage mistake—escalating the dose too quickly. Many people are anxious to get their weight loss journey underway, so they increase their semaglutide dosage too fast, increasing their risk of side effects. It is not uncommon for people to increase their dosage too fast and then stop taking semaglutide because they can’t tolerate the side effects.

Another common mistake that can lead to problems with semaglutide dosing is not providing a complete medical history to the person prescribing the medication. You may need to escalate your semaglutide dose more slowly or stop escalating at a lower dose if you have comorbid kidney or liver disease.

When two medications are metabolized or broken down in the liver using the same enzymes, then one medication and its dosage can impact the drug levels of the other medication. This can either increase or decrease your semaglutide drug levels and cause side effects.

Finally, if you are prescribed compounded semaglutide, it is essential to seek counseling with the compounding pharmacist to ensure that you understand how the medication is prepared, dosed, and administered.

Infographics Semaglutide

The Impact of Overdosing and Underdosing Semaglutide

The impact of overdosing on semaglutide can be pretty serious. Excessive doses can lead to an increased risk of severe side effects, such as extreme nausea, vomiting, and hypoglycemia (low blood sugar). In extreme cases, overdosing can result in hospitalization and even be life-threatening. It’s crucial to adhere to the prescribed semaglutide dose and to immediately seek medical attention if an overdose is suspected.

Semaglutide side effects and their prevalence rate in clinical trials include:2

  • Nausea (44%)
  • Diarrhea (30%)
  • Vomiting (24%)
  • Constipation (24%)
  • Stomach pain (20%)
  • Headache (14%)
  • Fatigue (11%)
  • Heartburn (9%)
  • Dizziness (8%)
  • Stomach bloating (7%)
  • Burping/flatulence (7%)
  • Low blood sugar in people with type 2 diabetes (6%)
  • Gas (6%)
  • Gastroenteritis (6%)
  • Acid reflux (5%)
  • Stomach irritation (4%)
  • Viral gastroenteritis (4%)
  • Hair loss (3%)

Underdosing, on the other hand, can lead to inadequate blood sugar control or suboptimal weight loss.

Both overdosing and underdosing highlight the importance of accurate dosing. Maintaining this delicate balance requires careful consideration of your weight loss goals and professional guidance.

Adjusting Your Semaglutide Dosage: When and How

If you have increased side effects or reach a weight-loss plateau, your doctor may suggest adjusting your semaglutide dosage. Always talk with your doctor or pharmacist before making any changes in your medication dosage or how you are taking it.

Semaglutide dosage adjustments are made gradually to reduce the risk of side effects. Your doctor may suggest dropping your semaglutide dosage to a lower dose or staying at the same dosage level for more than four weeks.

Each person tolerates medications differently, so it is important to be patient and ensure you are taking semaglutide at a dosage that maximizes its safety and effectiveness.

If you are interested in starting a weight loss treatment plan, calculate your body mass index (BMI) to see if you qualify for semaglutide. If your BMI is 30 or higher or 27 or higher with a weight-related medical condition, the next step is to complete the medical forms. An Invigor Medical physician will review your records and discuss your treatment options. If you are eligible for semaglutide treatment, your prescription will be sent to one of our partner compounding pharmacies.

Author: Leann Poston, M.D.
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  • Lambson JE, Flegal SC, Johnson AR. Administration errors of compounded semaglutide reported to a poison control center-Case series. J Am Pharm Assoc (2003). 2023 Sep-Oct;63(5):1643-1645. doi: 10.1016/j.japh.2023.06.017. Epub 2023 Jun 29. PMID: 37392810
  • Shu Y, He X, Wu P, Liu Y, Ding Y, Zhang Q. Gastrointestinal adverse events associated with semaglutide: A pharmacovigilance study based on FDA adverse event reporting system. Front Public Health. 2022 Oct 20;10:996179. doi: 10.3389/fpubh.2022.996179. PMID: 36339230; PMCID: PMC9631444.
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