Ozempic Dose Chart: Titration and Maintenance

What the Ozempic injection chart says

Ozempic is a once-weekly subcutaneous injection. The label says it is given on the same day each week, at any time of day, with or without meals, into the abdomen, thigh or upper arm [1].

The label's ladder has four steps:

• 0.25 mg once weekly for 4 weeks, as a starting dose
• 0.5 mg once weekly
• 1 mg once weekly, after at least 4 weeks at 0.5 mg, if additional glycemic control is needed
• 2 mg once weekly, after at least 4 weeks at 1 mg, if additional glycemic control is still needed

Two mg once weekly is the maximum [1]. The 0.25 mg step is a starter dose that the label does not treat as a maintenance dose [1].

How long each step lasts

After 4 weeks at 0.25 mg, the Ozempic injection dose increases to 0.5 mg. For additional glycemic control, the label allows an increase to 1 mg after at least 4 weeks at 0.5 mg, then to 2 mg after at least 4 weeks at 1 mg. For the kidney indication, the label specifies 1 mg once weekly after at least 4 weeks at 0.5 mg [1]. Two mg once weekly is the maximum, and the maintenance doses are 0.5 mg, 1 mg or 2 mg once weekly [1]. The 4-week intervals are minimums, and the 1 mg and 2 mg steps apply only if more glycemic control is needed [1].

The label also reports that the majority of nausea, vomiting and diarrhea reports in the Ozempic trials occurred during dose escalation [1].

What the maintenance doses were tested at

The 2 mg dose was compared with 1 mg in SUSTAIN FORTE, a 40-week trial of 961 adults with type 2 diabetes on metformin. In the Ozempic label's analysis, HbA1c fell 2.1 points on 2 mg and 1.9 points on 1 mg [1]; the trial report gives mean weight change of -6.9 kg on 2 mg and -6.0 kg on 1 mg [3]. In the label's safety analysis of 959 patients on 1 mg or 2 mg, gastrointestinal reactions were reported by 34% on 2 mg and 30.8% on 1 mg, and no new safety signals were identified [1].

The 0.5 mg and 1 mg doses are the ones used in SUSTAIN-6, which followed 3,297 adults with type 2 diabetes for 104 weeks: cardiovascular death, non-fatal heart attack or non-fatal stroke occurred in 6.6% on semaglutide versus 8.9% on placebo (hazard ratio 0.74) [4].

For the kidney indication — reducing the risk of sustained eGFR decline, end-stage kidney disease and cardiovascular death in adults with type 2 diabetes and chronic kidney disease — the label's route is 1 mg once weekly after at least 4 weeks at 0.5 mg [1]. FLOW randomized 3,533 adults with type 2 diabetes and chronic kidney disease to 1 mg or placebo and stopped early at a planned interim analysis; the kidney composite occurred in 18.7% versus 23.2% (hazard ratio 0.76) over a median 3.4 years [5].

Ozempic tablets use a different chart

Ozempic also comes as 1.5 mg, 4 mg and 9 mg tablets [6], and the tablet schedule is not the pen schedule. Days 1 to 30: 1.5 mg once daily, a dose the label states is not effective for glycemic control [7]. Days 31 to 60: 4 mg once daily [7]. From day 61: 4 mg or 9 mg once daily, depending on whether more glycemic control is needed [7]. The label says tablets are taken on an empty stomach in the morning with no more than 4 ounces of plain water, swallowed whole, with at least 30 minutes before food, other drinks or other oral medicines, and that a missed tablet is skipped [7]. Rybelsus and Ozempic tablets are not substitutable milligram for milligram: Rybelsus 7 mg matches Ozempic tablets 4 mg, and Rybelsus 14 mg matches 9 mg [7].

Does this chart apply to weight loss?

Ozempic's labeled uses are all in type 2 diabetes: improving glycemic control, reducing major adverse cardiovascular events in adults with type 2 diabetes and established cardiovascular disease, and reducing the risk of sustained eGFR decline, end-stage kidney disease and cardiovascular death in adults with type 2 diabetes and chronic kidney disease [1]. There is no weight-loss indication [1].

Wegovy is the semaglutide product labeled for weight management [10]. Drugs@FDA lists Wegovy injection strengths of 0.25, 0.5, 1, 1.7 and 2.4 mg, plus a 7.2 mg strength [2], and Wegovy tablets (1.5, 4, 9 and 25 mg) were approved on 2025-12-22 [8]. The Wegovy dose schedule is a separate chart from the Ozempic pen chart.

Missed doses and moving the injection day

The label says to give a missed dose within 5 days of the dose that was due; otherwise skip it and take the next dose on the usual day [1]. The label also says the day of the week can change as long as more than 48 hours separate the two doses [1].

Side effects at each step

In the pooled placebo-controlled Ozempic trials — 262 people on placebo, 260 on 0.5 mg and 261 on 1 mg, mean 32.9 weeks — nausea occurred in 6.1%, 15.8% and 20.3% respectively; vomiting in 2.3%, 5% and 9.2%; diarrhea in 1.9%, 8.5% and 8.8% [1]. Any gastrointestinal reaction was reported by 15.3%, 32.7% and 36.4%, and treatment was stopped for a gastrointestinal reason by 0.4%, 3.1% and 3.8% [1]. Severe gastrointestinal reactions occurred in 0.4% at 0.5 mg, 0.8% at 1 mg and 0% on placebo [1].

The Ozempic label also lists acute pancreatitis (with instruction to discontinue if it is suspected), acute gallbladder disease, acute kidney injury from volume depletion and serious hypersensitivity reactions, and states that Ozempic is not recommended in people with severe gastroparesis [1].

Compounded semaglutide

The chart above belongs to the FDA-approved Ozempic pen. FDA says compounded drugs are not FDA approved and are not reviewed for safety, effectiveness or quality before marketing, and it has reported dosing errors with compounded injectable semaglutide, including patients measuring the wrong dose, clinicians miscalculating, and doses above the label [9].