Semaglutide dosing follows two different FDA-approved titration schedules, depending on which drug you are taking and why. For weight loss (Wegovy), the semaglutide dosage runs 0.25 mg, 0.5 mg, 1 mg, 1.7 mg, 2.4 mg once weekly, with at least 4 weeks at each step.1 For type 2 diabetes (Ozempic), the schedule runs 0.25 mg, 0.5 mg, 1 mg, 2 mg once weekly, with the same 4-week minimum.2 Both drugs contain the same semaglutide molecule. The titration shape is nearly identical; the maintenance dose is not.
This article walks both approved ladders, covers the newer Wegovy 25 mg daily tablet and Wegovy HD 7.2 mg injection added to the label in March 2026, pairs the 2.4 mg dose with the STEP-1 trial weight-loss result, and addresses what the label says about missed doses. It also explains how compounded semaglutide, dispensed by 503A and 503B pharmacies, diverges from these FDA schedules. For prescribing decisions, work with a licensed clinician.
Key Takeaways
- Every approved semaglutide regimen starts at 0.25 mg once weekly for 4 weeks. The 0.25 mg dose is for initiation, it is not approved as a maintenance dose.1
- Wegovy (weight loss) titrates 0.25 → 0.5 → 1 → 1.7 → 2.4 mg weekly; 2.4 mg is the recommended maintenance dose. A 7.2 mg high-dose option (Wegovy HD) was added to the label in March 2026.1
- Ozempic (type 2 diabetes) titrates 0.25 → 0.5 → 1 → 2 mg weekly. Maximum is 2 mg.2
- Wegovy tablets (oral semaglutide) start at 1.5 mg daily for 30 days, titrate every 30 days, and reach a 25 mg daily maintenance dose.1
- In STEP-1, mean weight change at 68 weeks was −14.9% on semaglutide 2.4 mg vs −2.4% on placebo, with 86.4% of treated patients losing at least 5% of body weight (N=1,961).3
- Missed-dose rules differ by formulation. Wegovy injection: inject within 2 days of the next scheduled dose, otherwise skip. Ozempic: take within 5 days. Wegovy tablets: skip, take next day.12
What is the semaglutide dose schedule?
Semaglutide is sold under three brand names by Novo Nordisk, each with its own FDA-approved indication and dose ladder. The molecule is identical; the schedules are not. Here is the side-by-side view, drawn from the current FDA-approved labels published in the DailyMed Structured Product Label (SPL) system.
| Brand | Indication | Dose Ladder | Maintenance Dose |
|---|---|---|---|
| Wegovy injection | Chronic weight management, CV risk reduction | 0.25 → 0.5 → 1 → 1.7 → 2.4 mg weekly | 2.4 mg (or HD 7.2 mg) |
| Wegovy tablets | Weight management, CV risk reduction | 1.5 → 4 → 9 → 25 mg daily | 25 mg daily |
| Ozempic | Type 2 diabetes, kidney/CV risk reduction | 0.25 → 0.5 → 1 → 2 mg weekly | 0.5, 1, or 2 mg |
| Compounded | Not FDA-approved (off-label via 503A/503B) | Provider-specific, commonly mirrors Wegovy | Provider-specific |
Sources: Wegovy Full Prescribing Information, DailyMed SPL published March 3, 2026;1 Ozempic Full Prescribing Information, DailyMed SPL revised October 2025.2 All injections are subcutaneous. All weekly titrations require at least 4 weeks at each step before increasing.
What is the starting dose of semaglutide?
Every injectable semaglutide prescription starts at 0.25 mg once weekly, regardless of body weight, BMI, or indication. The Wegovy label is explicit: "Initiate at 0.25 mg once weekly for 4 weeks. Then follow the dosage escalation schedule."1 Ozempic uses identical language.2 Four weeks at the starter dose is the minimum before any step up.
The 0.25 mg starter dose is not designed to produce significant weight loss or meaningful blood-sugar change. Its job is tolerance-building, letting the gastrointestinal system adapt to delayed gastric emptying, which is how semaglutide produces the satiety signal that drives appetite reduction. Most patients see modest weight change during this window, and some see none. That is expected on-label behavior, not a sign the drug is failing.
Nausea, diarrhea, and constipation are the most common adverse events at initiation. They concentrate during the dose-escalation period before patients reach a steady maintenance dose.3 If tolerability at 0.25 mg is poor, clinicians can hold at the starter dose longer before titrating up, or step down if the patient has already climbed one rung. There is no mandatory pace. The label sets a minimum time at each dose, not a maximum.
How do you titrate Wegovy from 0.25 mg to 2.4 mg?
After 4 weeks at 0.25 mg, the Wegovy label permits an increase to 0.5 mg, then 1 mg, then 1.7 mg, then 2.4 mg, with at least 4 weeks at each dose before the next step.1 The recommended maintenance dose is 2.4 mg once weekly. Reaching 2.4 mg takes a minimum of 16 weeks of injections, assuming no dose holds or step-backs.
Unlike tirzepatide, which permits three different maintenance doses (5, 10, 15 mg), the Wegovy label identifies 2.4 mg as the recommended maintenance target for weight loss and cardiovascular risk reduction. There is flexibility on the path to 2.4 mg, the label explicitly allows delaying escalation for up to 4 additional weeks and considering a lower maintenance dose if 2.4 mg is not tolerated, but 2.4 mg is the labeled goal rather than an optional ceiling.1
The 4-week interval between increases is firm. A prescriber cannot compress it without deviating from the approved label. The interval aligns with the time required to reach steady-state plasma concentrations of semaglutide (approximately 4 to 5 weeks of once-weekly injections), after which the body has adapted to the current exposure.1
How do you titrate Ozempic from 0.25 mg to 2 mg?
Ozempic shares Wegovy's 0.25 mg starter dose and 4-week-per-step cadence, but the ladder runs shorter: 0.25 → 0.5 → 1 → 2 mg weekly, stopping at 2 mg.2 The FDA label also treats 0.5 mg, 1 mg, and 2 mg all as acceptable maintenance options for type 2 diabetes, with increases driven by glycemic control targets rather than weight loss.
The Ozempic label states: "If additional glycemic control is needed, increase the dosage to 1 mg once weekly after at least 4 weeks on the 0.5 mg dose. If additional glycemic control is needed, increase the dosage to 2 mg once weekly after at least 4 weeks on the 1 mg dosage."2 Many patients stop at 1 mg because that dose produces adequate HbA1c reduction, whereas Wegovy patients continue past 1 mg because weight loss accelerates at 1.7 mg and 2.4 mg in the STEP trials.
Ozempic is sometimes prescribed off-label for weight loss, particularly before Wegovy was widely available. When it is, the titration tends to follow the Ozempic ladder rather than the Wegovy one, capping at 2 mg rather than climbing to 2.4 mg. For a head-to-head look at semaglutide versus tirzepatide, see our semaglutide vs tirzepatide comparison.
What is the Wegovy 25 mg tablet dose schedule?
The FDA added oral Wegovy tablets to the Wegovy label in March 2026, making it the first oral semaglutide approved for chronic weight management and cardiovascular risk reduction. The Wegovy tablet is a once-daily oral dose, taken on an empty stomach with up to 4 ounces of water, and patients wait at least 30 minutes before eating, drinking other beverages, or taking other oral medications.1
| Days on Therapy | Daily Dose | Label Role |
|---|---|---|
| Days 1–30 | 1.5 mg orally | Starter dose |
| Days 31–60 | 4 mg orally | Titration step |
| Days 61–90 | 9 mg orally | Titration step |
| Day 91+ | 25 mg orally | Maintenance dose |
Source: Wegovy Full Prescribing Information, section 2.1 and 2.3, DailyMed SPL published March 3, 2026.1
The tablet schedule is a 30-day-per-step, four-step ladder reaching the 25 mg daily maintenance dose. This is a separate product from the Wegovy pen and is not the same as Rybelsus, which is Novo Nordisk's earlier oral semaglutide approved for type 2 diabetes at lower doses (3, 7, and 14 mg). Patients already on Wegovy injection can switch to Wegovy tablets one week after their final 2.4 mg injection by starting 25 mg orally, bypassing the oral titration ladder.1
What is the Wegovy HD 7.2 mg maximum dose?
Wegovy HD is a 7.2 mg high-dose injection added to the Wegovy product family in March 2026, delivered in a single-dose pen, and it is now the FDA-approved maximum dose for semaglutide injection.1 It is positioned for patients who have been on 2.4 mg Wegovy and need additional weight reduction, not as an initial dose for new patients. Patients do not skip the 2.4 mg step and start at 7.2 mg, the HD dose is an escalation option for patients already on maintenance who tolerate 2.4 mg but have not reached their weight-loss goal.
The arrival of a higher-dose semaglutide option narrows one of tirzepatide's advantages. Before Wegovy HD, the semaglutide injection ceiling was 2.4 mg. Patients or prescribers seeking stronger pharmacologic effect often switched to tirzepatide (maximum 15 mg), which produced larger mean weight loss in SURMOUNT-1 than semaglutide did in STEP-1.
Because Wegovy HD entered the label recently, published long-term outcome data at the 7.2 mg dose is thinner than data at 2.4 mg. Expect that to change. Cost, insurance coverage, and compounded-equivalent availability at the HD dose are still settling out; our semaglutide cost guide tracks current pricing across pathways.
How much weight do people lose on each semaglutide dose?
STEP-1 is the phase 3 trial that generated the weight-loss data now referenced across every semaglutide dosing conversation. Published in the New England Journal of Medicine in March 2021, the trial enrolled 1,961 adults with obesity (or overweight with a weight-related condition, excluding diabetes) and randomly assigned them in a 2:1 ratio to semaglutide 2.4 mg weekly or placebo, plus lifestyle intervention, over 68 weeks.3
| Group | Mean Weight Change at Week 68 | % With ≥5% Weight Loss |
|---|---|---|
| Placebo | −2.4% | 31.5% |
| Semaglutide 2.4 mg weekly | −14.9% | 86.4% |
| Treatment difference: −12.4 percentage points (P<0.001) | ||
Source: Wilding JPH et al. STEP-1 phase 3 trial, New England Journal of Medicine, March 18, 2021; 384(11):989–1002.3 Intention-to-treat population, treatment-policy estimand.
Two observations sit under this table. First, the 0.25 mg, 0.5 mg, and 1 mg titration doses were not tested as standalone maintenance arms. STEP-1 only evaluated 2.4 mg against placebo. That matters, because the dose-response curve across the lower steps is not well characterized, and the trial only establishes the endpoint effect at 2.4 mg, not the effect at each rung. Second, the 86.4% of semaglutide patients who reached the 5% weight-loss threshold is a higher proportion than the 31.5% in placebo, and higher than the 5% threshold response in most earlier pharmacologic weight-loss trials, which is why 2.4 mg became the labeled maintenance target.
For a dose-by-dose efficacy breakdown comparable to the tirzepatide SURMOUNT-1 table, the semaglutide literature relies on dose-ranging studies that tested 0.05 mg to 0.4 mg daily (the pre-2.4 mg weekly formulation) in obesity, plus the STEP-2 and STEP-5 trials at the same 2.4 mg weekly maintenance dose. A side-by-side with tirzepatide lives in our semaglutide vs tirzepatide comparison.
What happens if you miss a semaglutide dose?
Missed-dose rules for semaglutide differ by formulation, and the differences matter: Wegovy injection, Wegovy tablets, and Ozempic each have their own protocol written into the FDA label.
Wegovy injection (2.4 mg, 7.2 mg, and lower titration doses)
The Wegovy label states: "If one dose of WEGOVY injection is missed and the next scheduled dose is more than 2 days away, administer WEGOVY injection as soon as possible. Less than 2 days away, do not administer the WEGOVY injection dose. Resume dosing on the regularly scheduled day of the week."1
- More than 2 days before next dose: Inject the missed dose as soon as possible.
- Less than 2 days before next dose: Skip the missed dose. Inject on the regular day.
- Two or more consecutive doses missed: The label permits resuming on schedule or reinitiating the full dose-escalation ladder if gastrointestinal tolerance has regressed.1
Ozempic
The Ozempic missed-dose window is longer: "If a dose is missed, administer within 5 days of missed dose."2 Beyond 5 days, skip the missed dose and take the next dose on the regular day.
Wegovy tablets
Because the tablet is daily rather than weekly, the rule is simpler: "If a dose of WEGOVY tablets is missed, skip the missed dose and take the next dose the following day."1
Across all three formulations, the label does not specify an automatic restart protocol for longer gaps (several weeks or more). Prescribers frequently recommend dropping back to a lower dose if a multi-week gap has erased steady-state exposure, because restarting at the prior maintenance dose can reintroduce the gastrointestinal side effects seen during the original titration. This is a clinical judgment call, not a label-mandated one.
How does compounded semaglutide dosing differ?
Compounded semaglutide is dispensed by state-licensed 503A pharmacies or federally registered 503B outsourcing facilities, typically in multi-dose vials at a specified concentration (commonly 2.5 mg/mL or 5 mg/mL). It is not FDA-approved semaglutide, and its dose schedule is set by the prescribing provider rather than by an FDA label.4 For a full explainer on the regulatory framework, see what is compounded semaglutide.
In practice, most compounded telehealth providers titrate patients along a schedule that mirrors the Wegovy ladder: 0.25 mg weekly for 4 weeks, then 0.5 mg, 1 mg, 1.7 mg, 2.4 mg, with 4-week minimums. That is the common case. Some providers pause or compress the ladder at patient request, and some dispense doses that do not map exactly onto the Wegovy label, for example, 0.5 mg as a multi-week starter, or maintenance doses between 1 mg and 1.7 mg.
A few implications follow:
- The safety and efficacy data for the FDA-approved Wegovy ladder do not automatically transfer to compounded preparations. STEP-1 tested Novo Nordisk's FDA-approved formulation, not 503A-compounded semaglutide. The trial result (−14.9% at 2.4 mg) applies to the molecule, but compounded preparations can differ in purity, excipients, and fill accuracy.
- Compounded semaglutide dispensing narrowed significantly after the FDA declared the semaglutide shortage resolved in February 2025. 503A compounding based on the shortage listing is more restricted, though compounding continues under other 503A provisions (patient-specific clinical need, dosage-form variation).
- Vial dosing introduces a measurement layer that pen-based FDA products do not. A 5 mg/mL compounded vial dispensed at 0.5 mg requires drawing 0.1 mL into a syringe, an additional step where dosing error can happen. Patients receiving compounded semaglutide should confirm the concentration and the milliliter equivalent of each prescribed dose with their provider.
Editorial note: compounded GLP-1s are a legal, regulated pathway under 503A and 503B statute. Not a "loophole." Not a "knockoff." Novo Nordisk has argued against compounded dispensing on shortage-list grounds, and federal courts have ruled on associated injunctions; the current legal state remains contested. Our Henry Meds review covers one of the larger compounded-semaglutide telehealth providers.
What side effects concentrate during titration?
The reason the FDA mandates 4-week steps rather than faster escalation is that gastrointestinal adverse events cluster during titration. In the STEP-1 trial, gastrointestinal disorders were reported by 74.2% of semaglutide-treated patients versus 47.9% of placebo patients, with nausea (44.2%), diarrhea (31.5%), vomiting (24.8%), and constipation (23.4%) the most common. Most events were mild to moderate and concentrated during the 16-week dose-escalation period rather than at steady state.3
Treatment discontinuation due to adverse events in STEP-1 was 7.0% in the semaglutide group versus 3.1% in placebo, a 3.9 percentage-point gap.3 Slower titration, lower maintenance doses, or temporary dose holds are standard clinical levers when side effects are the limiting factor rather than response. For a fuller side-effect profile including rarer events, see our semaglutide side effects spoke.
How do you inject semaglutide?
A few label-level specifics that come up often in clinical practice:
- Frequency and timing (injection): Once weekly, any time of day, with or without meals.1 The injection day is anchored to your starting day, you do not shift it week to week.
- Frequency and timing (tablets): Once daily in the morning, on an empty stomach, with up to 4 ounces of water, wait at least 30 minutes before eating, drinking other beverages, or taking other oral medications.1
- Pre-procedure fasting: Semaglutide delays gastric emptying, and postmarketing reports describe pulmonary aspiration during elective surgery or procedures requiring general anesthesia or deep sedation.1 Tell your surgical team you are on semaglutide before any planned procedure.
Injection sites are the abdomen, thigh, or upper arm, and the FDA-approved pens work equally well at any of the three.1 Rotate between sites to reduce local skin reactions. For storage, refrigerate unused pens at 36°F to 46°F; after first use, Wegovy pens can sit at up to 86°F for 28 days.1 Compounded vials have separate handling instructions set by the dispensing pharmacy, so follow the label that came with your vial.
- ☐ Week 4 complete at 0.25 mg, confirm with prescriber before titrating to 0.5 mg
- ☐ Week 8 complete at 0.5 mg, step up to 1 mg
- ☐ Week 12 complete at 1 mg, step up to 1.7 mg
- ☐ Week 16 complete at 1.7 mg, step up to 2.4 mg
- ☐ Week 17+ at 2.4 mg, recommended maintenance dose
- ☐ If additional reduction needed after time at 2.4 mg: discuss Wegovy HD 7.2 mg with prescriber
- ☐ Missed-dose rule: >2 days before next dose = inject; <2 days = skip
Frequently Asked Questions
What is the semaglutide dosage for weight loss?
The FDA-approved Wegovy dosage for chronic weight management is 2.4 mg once weekly, reached by titrating through 0.25, 0.5, 1, and 1.7 mg at 4-week intervals. A higher 7.2 mg HD option was added to the label in March 2026 and is now the maximum dose for semaglutide injection. Oral Wegovy tablets reach a 25 mg daily maintenance dose.1
How long does it take to see weight loss on semaglutide?
Some patients see modest weight change in the first 4 weeks at 0.25 mg, though the starter dose is not primarily a treatment dose. In STEP-1, meaningful weight loss accumulated across the 68-week trial, with the full −14.9% mean change measured at week 68 on the 2.4 mg maintenance dose. Four to sixteen weeks is a common window for early response as titration progresses.3
Is 1 mg of semaglutide enough to lose weight?
Some patients lose clinically meaningful weight at 1 mg, but the 1 mg dose was not tested as a standalone maintenance arm in STEP-1, which compared only 2.4 mg against placebo. Ozempic (which caps at 2 mg for diabetes) is sometimes prescribed off-label for weight loss and can produce weight reduction, though the phase 3 weight-loss evidence supports 2.4 mg as the recommended weight-management dose.3
What happens if I miss more than one semaglutide dose?
For Wegovy injection, two or more consecutive missed doses permit either resuming on schedule or reinitiating the full titration ladder, a clinical judgment based on how long the gap has been and whether gastrointestinal tolerance has regressed. Restarting at the prior maintenance dose after a multi-week gap can reintroduce titration-era side effects, which is why some prescribers step patients back down.1
Can I increase my semaglutide dose faster than every 4 weeks?
No. The FDA-approved labels for Wegovy and Ozempic both require at least 4 weeks on each dose before any increase. The 4-week interval aligns with the time required to reach steady-state plasma semaglutide concentrations. Faster titration is not studied, not approved, and not advised, even if a provider offers to accelerate it.12
Is Ozempic dosing the same as Wegovy dosing?
No. Both drugs contain semaglutide and share the 0.25 mg starter dose and 4-week-per-step cadence, but they diverge after week 4. Ozempic ends at 2 mg weekly for type 2 diabetes; Wegovy continues through 1.7 mg to 2.4 mg weekly for weight loss, with an additional 7.2 mg HD option and a 25 mg daily oral tablet.12
Does compounded semaglutide use the same dose schedule?
Most compounded semaglutide providers mirror the Wegovy titration: 0.25 mg weekly for 4 weeks, then 0.5, 1, 1.7, 2.4 mg. Some compress the ladder or use different dose increments. Compounded preparations are not FDA-approved and the STEP-1 efficacy and safety data do not automatically transfer to every compounded vial, purity and fill accuracy vary across 503A and 503B pharmacies.4
The Bottom Line
Semaglutide dosing is structured, not improvised. Every approved injectable ladder starts at 0.25 mg for 4 weeks, climbs in 4-week steps, and lands at a labeled maintenance dose: 2.4 mg for Wegovy (weight loss), 2 mg for Ozempic (diabetes), with an additional 7.2 mg HD option for Wegovy and a 25 mg daily oral tablet added in March 2026. The 4-week-per-step interval exists because gastrointestinal side effects concentrate during escalation and steady-state exposure takes that long to establish at each dose. STEP-1 measured a −14.9% mean weight change at the 2.4 mg dose against −2.4% with placebo, with 86.4% of treated patients reaching the 5% weight-loss threshold.
Before starting, changing, or stopping semaglutide, talk to a licensed prescriber. If cost is part of the decision, our semaglutide cost guide covers what patients pay across insurance, NovoCare self-pay, and compounded pathways in 2026. For the full picture of the drug, see the semaglutide hub.
Written By
Rachel Nguyen, MS, RDN
Rachel is a registered dietitian with over a decade of experience in nutrition policy and the economics of health. Her current editorial focus covers GLP-1 medications, obesity medicine, and the intersection of nutrition and pharmaceutical treatment. She holds a Master of Science in Nutrition from the University of North Carolina.
Expert Reviewer
Dr. Kevin Park, PhD
Dr. Park is a nutrition education researcher focused on federal nutrition programs and dietary outcomes. His work has been published in the Journal of School Health and the Journal of the Academy of Nutrition and Dietetics. He reviewed this article's nutrition and public-health content. Clinical dosing decisions about semaglutide should be made with a licensed prescriber.
Sources
- Novo Nordisk Inc. Wegovy (semaglutide) injection and tablets, for subcutaneous or oral use, Full Prescribing Information. FDA-approved label, sections 2.1 Important Dosage and Administration Instructions, 2.2 Recommended Dosage, 2.3 Recommended Maintenance Dosages Based on Indication, 2.4 Missed Doses, 2.5 Switching Between WEGOVY Injection and WEGOVY Tablets, and 12.3 Pharmacokinetics. Structured Product Label (SPL) revised March 3, 2026. DailyMed SPL setid ee06186f-2aa3-4990-a760-757579d8f77b. dailymed.nlm.nih.gov. Retrieved .
- Novo Nordisk Inc. Ozempic (semaglutide) injection, for subcutaneous use, Full Prescribing Information. FDA-approved label, sections 2.1 Important Administration Instructions, 2.2 Recommended Dosage, and 2.3 Missed Dose. Structured Product Label revised October 2025. DailyMed SPL setid adec4fd2-6858-4c99-91d4-531f5f2a2d79. dailymed.nlm.nih.gov. Retrieved .
- Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity (STEP-1). New England Journal of Medicine. 2021 Mar 18;384(11):989–1002. doi:10.1056/NEJMoa2032183. ClinicalTrials.gov NCT03548935. Abstract verified via pubmed.ncbi.nlm.nih.gov/33567185. Retrieved .
- US Food and Drug Administration. Compounding and the FDA: Questions and Answers; GLP-1 Drug Shortage Status. FDA Drug Shortages Database and Human Drug Compounding guidance. Semaglutide shortage declared resolved February 2025. Compounded semaglutide is dispensed under Section 503A (patient-specific) or 503B (outsourcing facility) of the Federal Food, Drug, and Cosmetic Act, and is not an FDA-approved product. fda.gov/drugs/human-drug-compounding. Retrieved .
- US National Library of Medicine. DailyMed: WEGOVY (SEMAGLUTIDE) INJECTION / TABLETS, Structured Product Label. Novo Nordisk Inc. SPL version published March 3, 2026. dailymed.nlm.nih.gov. Authoritative source for the current FDA-approved Wegovy label, including the Wegovy HD 7.2 mg injection and 25 mg oral tablet added in March 2026. Retrieved .