Semaglutide dose schedule (Ozempic & Wegovy)
The FDA-approved semaglutide ramps for Wegovy (obesity) and Ozempic (type 2 diabetes), what each step is supposed to feel like, when to hold versus advance, and how compounded versions affect the schedule.
Last verified · Independent. Sources cited.
Verified May 10, 2026: Semaglutide titration is the simplest of the GLP-1 ramps and the easiest to get wrong. Most prescribers move too fast because the patient is impatient. Most patients move too fast because the side effects of the previous step were "manageable." Both miss the point of titration: the slowest tolerable ramp gets the longest sustainable result.
The FDA-approved ramps
Wegovy (the obesity dose) and Ozempic (the type 2 diabetes dose) follow different ladders. Both move every 4 weeks. Both can be paused or backed off if side effects spike.
| Step | Wegovy weekly | Ozempic weekly | Minimum hold |
|---|---|---|---|
| 1 | 0.25 mg | 0.25 mg | 4 weeks |
| 2 | 0.5 mg | 0.5 mg | 4 weeks |
| 3 | 1.0 mg | 1.0 mg | 4 weeks |
| 4 | 1.7 mg | 2.0 mg (max) | 4 weeks |
| 5 | 2.4 mg (max) | — | ongoing |
The 0.25 mg starting dose is therapeutic for almost no one. It exists to let the GI tract wake up to GLP-1 receptor agonism without going into open revolt. Skipping or shortening this step is the single most common reason people quit semaglutide entirely. Source: Wegovy FDA label.
What each step is supposed to feel like
- Weeks 1-4 (0.25 mg): mild appetite reduction. Food takes longer to empty. Some nausea after large meals — that signals dose engagement, not toxicity.
- Weeks 5-8 (0.5 mg): real appetite reduction. Sweet cravings often disappear first. If GI side effects are still present at week 7, hold this dose; do not advance.
- Weeks 9-12 (1.0 mg): most users find this is the working dose for the year. The weight loss curve flattens between months 4-6 — this is the body adapting, not the drug failing.
- Weeks 13+ (1.7 mg / 2.0 mg / 2.4 mg): reserved for users who need the higher dose to push past a plateau. Over half of long-term users stay on 1.0 mg indefinitely.
When to hold vs. when to advance
Hold the current dose if:
- Nausea is still daily at week 3 of any step
- You skipped a dose in the past 2 weeks
- Body weight dropped >2 lb/week consistently
- You started a new medication that changed GI motility
Advance if:
- You've had 2 clean weeks at the current dose with no GI symptoms
- Appetite suppression is wearing off
- A doctor specifically directs it
Compounded semaglutide and the same ramp
Compounded semaglutide is the same active molecule as Wegovy and Ozempic. The titration ramp applies identically. What changes is the math — your concentration depends on how the pharmacy reconstituted the vial. See the compounded semaglutide guide for the full operational checklist.
- Vial mg and BAC water volume. A 5 mg vial in 1 mL is 5 mg/mL; in 2 mL it's 2.5 mg/mL. Same dose, different syringe units.
- The titration ladder still applies. Compounded prescribers sometimes jump to 1.0 mg or 2.0 mg to "save time." The GI tract doesn't care that the drug is compounded.
- Storage requirements are tighter. 28-day beyond-use date post-reconstitution; refrigerate, never freeze.
How Titrate handles the ramp
The reconstitution calculator takes vial mg + BAC water volume + target dose and outputs the syringe units to draw. The dose log anchors to the plasma-decay curve so you can see where you are in the half-life when you log a side effect.
Sometimes the nausea is from titration, sometimes from a lunch that got eaten too fast. Reading both on the same chart tells you which.
Frequently asked questions
Should I skip the 0.25 mg starter dose?
No. The starter dose exists to let the GI tract adapt. Skipping it is the single most common reason people quit semaglutide entirely from intolerable side effects.
Can I stay on 0.5 mg or 1.0 mg long-term?
Yes. Over half of long-term users stay on 1.0 mg indefinitely. There is no clinical mandate to climb to 2.4 mg unless you've plateaued and need additional appetite suppression.
What happens if I miss a weekly dose?
If less than 5 days have passed, take the dose as soon as possible. If more than 5 days have passed, skip it and resume at the regular weekly schedule. Do not double-dose. Source: Wegovy FDA label, section 2.2.
How long until I see weight loss?
Appetite suppression typically appears within 2-3 weeks. Visible weight loss starts around week 4-6 and peaks between months 4 and 9. The curve flattens after month 6 — this is metabolic adaptation, not the drug failing.
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider before starting, modifying, or stopping any medication or peptide protocol. Information is current as of the publication date and may change.