Semaglutide dosing guide
Semaglutide dosing follows a structured titration schedule that gradually increases the dose over 16–20 weeks to minimize side effects. The target dose depends on the indication — 1.0 mg weekly for type 2 diabetes, 2.4 mg weekly for weight management. This page covers the complete semaglutide dosage chart for each indication, injection site rotation, reconstitution math for compounded formulations, and what to do about missed doses.
Semaglutide dosage chart: weight loss
The semaglutide dosage chart for weight loss follows a five-step titration that takes approximately 16–20 weeks to reach the full maintenance dose. The gradual escalation is designed to reduce the severity of gastrointestinal side effects — patients who start at the full dose experience significantly more nausea and vomiting than those who titrate up slowly.
| Weeks | Weekly dose | Purpose |
|---|---|---|
| Weeks 1–4 | 0.25 mg | Initial dose. GI acclimation period. Minimal weight loss expected. |
| Weeks 5–8 | 0.5 mg | First escalation. Appetite suppression typically begins. Early weight loss starts. |
| Weeks 9–12 | 1.0 mg | Second escalation. Matches the type 2 diabetes maintenance dose. Noticeable hunger reduction. |
| Weeks 13–16 | 1.7 mg | Third escalation. Significant appetite suppression. Weight loss accelerates. |
| Week 17+ | 2.4 mg | Maintenance dose for weight management. Continue indefinitely. |
If a patient cannot tolerate a dose increase due to persistent nausea, vomiting, or other GI side effects, the prescriber may extend the time at the current dose for an additional 4 weeks before attempting the increase again. Some patients reach an effective dose at 1.7 mg and choose to stay there rather than escalate to 2.4 mg — this is a clinical judgment call between patient and provider based on tolerability and weight loss progress. The semaglutide side effects page covers GI symptom management during titration.
Semaglutide dosing schedule: type 2 diabetes
The semaglutide dosing schedule for type 2 diabetes uses a simpler two-step titration with lower target doses than the weight management indication.
| Weeks | Weekly dose | Purpose |
|---|---|---|
| Weeks 1–4 | 0.25 mg | Initial dose. GI acclimation. Blood sugar improvement begins within the first week. |
| Week 5+ | 0.5 mg | First maintenance option. Adequate A1C control for many patients. |
| Week 9+ (optional) | 1.0 mg | Higher maintenance dose if additional A1C reduction is needed. Maximum approved diabetes dose. |
The choice between 0.5 mg and 1.0 mg maintenance depends on the patient's A1C response. If the 0.5 mg dose achieves adequate glycemic control (generally A1C at target per the patient's treatment plan), there is no clinical need to escalate to 1.0 mg. In the SUSTAIN trials, both the 0.5 mg and 1.0 mg doses produced meaningful A1C reductions — the 1.0 mg dose simply produced slightly greater reductions (roughly 0.3 percentage points more on average). See the semaglutide for type 2 diabetes page for trial-by-trial A1C data at each dose.
Semaglutide injection sites
Semaglutide is injected subcutaneously — into the fat layer just beneath the skin — not into a vein or muscle. The three approved semaglutide injection sites are the abdomen (at least 2 inches from the navel), the front of the thigh (upper thigh, midway between knee and hip), and the upper arm (back/outer area). Each of these locations has adequate subcutaneous fat in most patients to ensure proper absorption.
Injection site rotation is important. Using the same exact spot repeatedly can cause lipodystrophy — localized changes in the fat tissue that can reduce semaglutide absorption and produce hard, lumpy areas under the skin. The standard recommendation is to rotate between the three major sites (abdomen → thigh → arm → abdomen) and to vary the specific spot within each site by at least 1 inch from the previous injection. Most patients find the abdomen the easiest and least painful injection site, particularly in the lower abdomen where subcutaneous fat is thickest.
Semaglutide can be injected at any time of day, with or without food, as long as it is given on the same day each week. If the injection day needs to change, the new injection should be at least 2 days (48 hours) after the previous dose.
Compounded semaglutide dosing
Compounded semaglutide is typically supplied as a lyophilized (freeze-dried) powder in a vial that must be reconstituted with bacteriostatic water before injection. The dosing protocol is the same as the branded titration schedule — the compounding simply changes the product format, not the dosing. However, because compounded semaglutide concentrations vary by pharmacy, patients must calculate the correct injection volume based on their specific vial concentration.
Reconstitution math
To determine injection volume: divide the desired dose by the vial concentration. For example, if a vial contains 5 mg of semaglutide and is reconstituted with 2 mL of bacteriostatic water, the concentration is 2.5 mg/mL. To inject a 0.25 mg dose, draw up 0.1 mL (0.25 ÷ 2.5 = 0.1). To inject a 1.0 mg dose, draw up 0.4 mL. Always confirm the concentration with the compounding pharmacy and use an insulin syringe with clear unit markings for accurate measurement.
Reconstituted compounded semaglutide should be stored in the refrigerator (36–46°F / 2–8°C) and used within the timeframe specified by the compounding pharmacy — typically 28–30 days after reconstitution. Do not freeze reconstituted semaglutide. Do not use the vial if the solution is cloudy, discolored, or contains visible particles after reconstitution.
Maximum dose of semaglutide
The maximum approved semaglutide dose for weight management is 2.4 mg injected subcutaneously once weekly. For type 2 diabetes, the maximum is 1.0 mg weekly (subcutaneous) or 14 mg daily (oral). Some prescribers use off-label doses above 2.4 mg for patients who plateau at the standard maximum, but this is not supported by published clinical trial data and carries unknown risk. Higher doses are being studied — a 7.2 mg weekly dose is in clinical trials for weight management — but no results are available yet.
The maximum dose of semaglutide should not be exceeded without direct physician oversight. The dose-response curve for semaglutide GI side effects is steep: higher doses produce proportionally more nausea, vomiting, and diarrhea. This is one of the primary reasons the titration schedule exists — the GI system needs time to adapt at each dose level before further increases.
Missed dose protocol
If a semaglutide dose is missed, the guidance depends on how much time has passed since the scheduled injection day. If the missed dose is remembered within 5 days (120 hours) of the scheduled day, take it as soon as possible and resume the regular schedule. If more than 5 days have passed, skip the missed dose entirely and take the next dose on the regularly scheduled day. Do not take two doses at once or within 48 hours of each other to make up for a missed dose.
Missing a single dose occasionally is unlikely to significantly affect overall treatment outcomes. However, frequent missed doses can reduce semaglutide's effectiveness and may cause GI side effects to return when dosing resumes, similar to the initial titration period. Patients who anticipate difficulty maintaining a weekly injection schedule may want to discuss oral semaglutide as a daily alternative that may be easier to incorporate into a routine.
What time of day should I take semaglutide?
Semaglutide can be taken at any time of day, with or without food. There is no clinical evidence that morning vs evening dosing affects efficacy. Most patients choose a consistent day and time that is easiest to remember — many prefer the same day each week, often tied to a recurring weekly activity as a memory cue.
Can I change my semaglutide injection day?
Yes. To change the injection day, take the next dose on the new preferred day as long as at least 48 hours (2 days) have passed since the last injection. Then continue on the new weekly schedule going forward.
What happens if I take too much semaglutide?
Semaglutide overdose primarily causes severe nausea, vomiting, and diarrhea. In clinical trials, overdose events resolved without serious complications, but any suspected overdose should be reported to a healthcare provider. There is no specific antidote — treatment is supportive (hydration, anti-nausea medication).
How long does a semaglutide vial last?
This depends on the vial concentration and the dose. A 5 mg vial at the 0.25 mg starting dose lasts 20 weeks (20 doses). At the 2.4 mg maintenance dose, a 5 mg vial lasts approximately 2 weeks (2 doses). However, reconstituted compounded semaglutide typically expires 28–30 days after reconstitution regardless of how much product remains, so vial size should match the expected usage within that window.