A long-acting GLP-1 receptor agonist with extensive human trial data and regulated indications for type 2 diabetes, chronic weight management, and selected cardiovascular-risk reduction.
Established human evidencePeptide research profile
Also known as: GLP-1 analogue, Ozempic, Wegovy, Rybelsus
Semaglutide has indication-specific clinical titration schedules. The ladder below describes the subcutaneous obesity regimen studied in STEP and reflected in regulated labeling; it is not individualized prescribing advice. This is educational source context, not a protocol or recommendation.
How sourced amounts are organized
Initiation0.25 mg / weekWeeks 1-4
A tolerability step, not the maintenance exposure used for obesity outcomes.
Human dosing is well studied, but the correct regimen is product- and indication-specific.
Storage, handling and interpretation
Lyophilized material
Keep cold, dry, and protected from light according to the manufacturer certificate or validated lab SOP.
After reconstitution
Use sterile technique, refrigerate as validated, and avoid repeated freeze-thaw cycles.
Traceability
Record lot, concentration, preparation date, and the identity/purity documentation used by the lab.
Reported protocols for Semaglutide
What published studies and recent community write-ups report about amounts, timing and course length. 9 clinical and 3 community-reported rows, each linked to its source. These are descriptions of what others report, not instructions, and nothing here is medical advice.
Context
Dose
Frequency
Route
Course
Source
Clinical9 rows
FDA label, Wegovy injectionAdults and adolescents aged 12 and over for weight reduction; adults with established cardiovascular disease for risk reduction
0.25 mg start, then 0.5 mg, 1 mg, 1.7 mg, maintenance 2.4 mg (1.7 mg accepted); up to 7.2 mg for adults needing further weight reduction
Once weekly, same day each week, with or without food
Subcutaneous, abdomen, thigh or upper arm
16 weeks of escalation, then open-ended maintenanceNone; the label instead advises delaying an escalation step by 4 weeks if a dose is not tolerated
The 7.2 mg dose is only reached after at least 4 weeks of tolerating 2.4 mg and when further weight reduction is clinically indicated. A missed dose can be taken if the next scheduled dose is more than 2 days away, otherwise it is skipped.
FDA label, Wegovy tabletsAdults with obesity or overweight with a weight-related condition, or with established cardiovascular disease
1.5 mg days 1 to 30, 4 mg days 31 to 60, 9 mg days 61 to 90, then 25 mg maintenance
Once daily, on an empty stomach in the morning with no more than 4 ounces of plain water, then nothing by mouth for at least 30 minutes
Oral tablet, swallowed whole
90 days of escalation, then open-ended maintenance at 25 mgNone; a missed dose is skipped and the next taken the following day
The oral product escalates every 30 days rather than every 4 weeks and uses a salcaprozate sodium absorption enhancer, which is why the water volume and fasting window are part of the dosing instruction. The label directs switching to 1.7 mg weekly injection for patients who cannot tolerate the 25 mg tablet.
FDA label, Ozempic injectionAdults with type 2 diabetes, including those with chronic kidney disease
0.25 mg for 4 weeks, then 0.5 mg; 1 mg and then 2 mg if more glycemic control is needed
Once weekly at any time of day, with or without meals
Subcutaneous, abdomen, thigh or upper arm
Continuous while treatment is appropriateNone; each step requires at least 4 weeks at the previous dose
The label states that 0.25 mg is for initiation only and is not effective for glycemic control, and caps the product at 2 mg weekly, well below the Wegovy ceiling. A missed dose can be given within 5 days, and the dosing day can be changed provided doses stay more than 48 hours apart.
FDA label, Rybelsus tabletsAdults with type 2 diabetes
3 mg for days 1 to 30, 7 mg for days 31 to 60, then 14 mg if more glycemic control is needed
Once daily on an empty stomach in the morning with up to 4 ounces of water, then at least 30 minutes before food, other drinks or other medicines
The label warns that Rybelsus and the newer Ozempic tablets, which use 1.5, 4 and 9 mg strengths, are not interchangeable milligram for milligram. The 3 mg starting dose is described as an initiation dose that is not effective for glycemic control on its own.
STEP 1 phase 3 obesity trial1,961 adults with a BMI of 30 or more, or 27 or more with a weight-related condition, without diabetes
2.4 mg maintenance, reached over 16 weeks of escalation
Mean weight change was 14.9% against 2.4% on placebo, and 86.4% of the semaglutide group lost at least 5% of body weight against 31.5% on placebo. Nausea and diarrhea were the most common adverse events, usually transient and mild to moderate, and 4.5% stopped for gastrointestinal events against 0.8% on placebo.
STEP UP phase 3b high-dose trial1,407 adults with a BMI of 30 or more, without diabetes, across 95 sites in 11 countries
Mean weight loss on 7.2 mg was 18.7% under the treatment policy estimand and 20.7% if all participants had stayed on treatment, against 15.6% and 17.5% for 2.4 mg. Gastrointestinal events affected 70.8% of the 7.2 mg group against 61.2% at 2.4 mg and 42.8% on placebo, and altered skin sensation was reported by 22.9% at the higher dose.
SELECT cardiovascular outcomes trial17,604 adults aged 45 and over with a BMI of 27 or more and existing cardiovascular disease, without diabetes
2.4 mg
Once weekly
Subcutaneous
Mean exposure 34.2 months, mean follow-up 39.8 monthsNone; this was an event-driven trial run to a fixed number of endpoints
The composite of cardiovascular death, non-fatal myocardial infarction and non-fatal stroke occurred in 6.5% on semaglutide against 8.0% on placebo, a 20% relative reduction. Adverse events led to permanent discontinuation in 16.6% of the semaglutide group against 8.2% on placebo, which is the main cost of dosing this long.
OASIS 4 oral semaglutide trial307 adults without diabetes, 205 on oral semaglutide and 102 on placebo, across 22 sites in four countries
25 mg
Once daily
Oral, with a 12-week escalation period
64 weeks of treatment within a 71-week trial, plus 7 weeks off treatmentNone during treatment
Mean weight change at week 64 was 13.6% against 2.2% on placebo, or 16.6% among those who stayed on treatment. Gastrointestinal adverse events affected 74.0% of the oral group against 42.2% on placebo, and this trial supported the December 2025 approval of the Wegovy tablet.
STEP 1 withdrawal extension327 STEP 1 participants followed for a year after treatment stopped
2.4 mg during the 68-week treatment phase, then nothing
Once weekly until week 68, then no drug
Subcutaneous during treatment
68 weeks on, then 52 weeks offAbrupt stop with no taper, and the lifestyle intervention was withdrawn at the same time
Participants had lost 17.3% by week 68 and regained 11.6 percentage points of it by week 120, leaving a net 5.6% below baseline. Most cardiometabolic improvements drifted back toward baseline, and the authors concluded that continued treatment is needed to hold the result.
Community-reported3 rows
Compounded vial titration chart
0.25 mg weeks 1 to 4, 0.5 mg weeks 5 to 8, 1 mg weeks 9 to 12, then up to 2-2.4 mg
Once weekly
Subcutaneous from a multi-dose compounded vial
12 weeks of escalation, then prescriber-set maintenanceNone; holding a dose longer is described instead when side effects are significant
Community resource2026
This 2026 guide mirrors the branded ladder but stresses that compounded semaglutide is not an FDA-approved finished product and has not been reviewed for safety, effectiveness or quality. It highlights a July 2024 FDA alert about dosing errors in which people drew 50 units instead of 5, and gives the conversion of units equal to dose divided by concentration times 100.
Reconstitution and unit math for compounded vials
0.25 mg equals 10 units at 2.5 mg/mL, or 5 units at 5 mg/mL
Once weekly
Subcutaneous from a vial reconstituted with bacteriostatic water
Set by the prescriber; the vial itself is described as usable for about 28 days once mixedNot applicable to the mixing step
Community resource2026
The standard mix described here is 2 mL of bacteriostatic water into a 5 mg vial to give 2.5 mg/mL, at which every titration step lands on a round unit number. The page is explicit that vial size is not concentration and that the same milligram dose needs different unit counts depending on how much water was added.
Microdosing pattern below the labelled start
0.05 mg weeks 1 to 2, 0.075 mg weeks 3 to 4, 0.10 mg weeks 5 to 8, then 0.125-0.15 mg
Once weekly, same day each week
Subcutaneous, 5 to 15 units at a compounded 2.5 mg/mL concentration
16 weeks before reassessmentEach step is held at least 2 weeks rather than scheduled off periods
Community resource2026
This clinic page describes a ladder that sits entirely below the 0.25 mg labelled starting dose, aimed at people who could not tolerate a full dose, and places expected weight loss at 5% to 10% against 12% to 17% for standard dosing. It states clearly that the clinical evidence for microdosing is limited and mostly anecdotal and that the practice requires compounded product.
How a course is commonly described
1
Weeks 1-4: 0.25 mgClinical
Every injectable product opens at 0.25 mg once weekly for four weeks. The labels describe this purely as an initiation dose that reduces gastrointestinal reactions, and the Ozempic label adds that it is not effective for glycemic control on its own.
2
Weeks 5-16: escalationClinical
The weight-management ladder steps through 0.5 mg, 1 mg and 1.7 mg at four-week intervals. If a step is not tolerated, the label directs delaying the next increase by four weeks rather than stopping, which is why reaching maintenance can take longer than 16 weeks in practice.
3
Week 17 to week 68: maintenance at 2.4 mgClinical
STEP 1 held 2.4 mg weekly to week 68 and recorded a mean 14.9% weight reduction, with the curve still falling slowly at the end of treatment. This is the exposure that the 2.4 mg maintenance dose is built on.
4
Beyond 2.4 mgClinical
Adults who tolerate 2.4 mg for at least four weeks and need further weight reduction may move to 7.2 mg weekly. STEP UP found an extra 3 percentage points of weight loss at 72 weeks against 2.4 mg, at the cost of more gastrointestinal events and markedly more altered skin sensation.
5
Years on treatmentClinical
SELECT kept participants on 2.4 mg for a mean of 34 months with cardiovascular benefit emerging early, so the labels describe treatment as ongoing rather than cycled. Permanent discontinuation for adverse events was twice as common as on placebo over that period.
6
After stoppingClinical
In the STEP 1 extension, participants regained about two-thirds of their lost weight within a year of stopping, and cardiometabolic measures drifted back with it. No label or trial describes a taper, and none has tested a scheduled break.
The four approved products are not interchangeable. Ozempic stops at 2 mg weekly, Wegovy injection runs to 2.4 mg and then 7.2 mg, Rybelsus uses 3, 7 and 14 mg tablets and Wegovy tablets use 1.5, 4, 9 and 25 mg, and the labels state that the tablet lines are not substitutable milligram for milligram.
Nothing in the labels or the trials describes cycling, breaks or tapers. The escalation ladder exists to limit gastrointestinal effects, and withdrawal data show most of the weight returns within a year of stopping.
Compounded vials carry a dosing-error risk that pens do not, because the same milligram dose corresponds to different unit counts at different concentrations. The FDA declared the semaglutide injection shortage resolved in 2025 and has since narrowed the conditions under which pharmacies may compound copies.
Plus 4 community resources (dosing guides, forum threads and vendor write-ups), reported above but not linked.
Overview
Semaglutide is a long-acting analog of the gut hormone glucagon-like peptide-1, developed by Novo Nordisk, in which an aminoisobutyric acid substitution blocks DPP-4 cleavage and a C18 fatty diacid side chain binds albumin to give a half-life of about a week. The FDA has approved it in four distinct products: Ozempic injection and Rybelsus tablets for type 2 diabetes, Wegovy injection for chronic weight management and cardiovascular risk reduction, and Wegovy tablets, approved in December 2025 as the first oral GLP-1 for obesity. Each product has its own escalation schedule and ceiling, from 2 mg weekly for Ozempic to 7.2 mg weekly for the high-dose Wegovy injection and 25 mg daily for Wegovy tablets. A large compounded and grey market also exists; the FDA declared the semaglutide injection shortage resolved in February 2025 and has since restricted the conditions under which pharmacies may compound copies.
What researchers are exploring
These themes describe recurring questions in published research. They are not claims of effectiveness or recommendations for use.
1
Glucose regulation
Large phase 3 programs evaluate HbA1c and other glycaemic endpoints in type 2 diabetes.
2
Weight management
The STEP program studies once-weekly 2.4 mg alongside lifestyle intervention.
3
Cardiovascular outcomes
Outcome trials examine major cardiovascular events in high-risk populations.
4
Dose escalation
Clinical regimens escalate gradually to improve gastrointestinal tolerability.
What the current evidence can support
Study models remain visible so laboratory and animal findings are not mistaken for established human outcomes.
Human
Large randomized trial programs
Multiple phase 3 trials establish efficacy and characterize common gastrointestinal adverse effects for regulated products.
Human
STEP 1 obesity trial
In 1,961 adults without diabetes, 2.4 mg once weekly plus lifestyle intervention was compared with placebo for 68 weeks.
Review
Indication-specific interpretation matters
Diabetes, obesity, cardiovascular, and oral-formulation evidence use different doses, populations, and product instructions.
Amounts recorded for Semaglutide
These amount records are independent from vial strength, reconstitution volume and measuring device. A recorded source is not the same as study backing, and these values are not recommendations.
1
STEP 1 initiation stepSign in for schedule, duration and source context.
0.25 mg
2
STEP 1 escalation stepSign in for schedule, duration and source context.
1 mg
3
STEP 1 target armSign in for schedule, duration and source context.
2.4 mg
Chemistry identifiers
Sequence, synonyms and registry identifiers as recorded in PubChem, the National Library of Medicine's open chemistry database. Formula, mass and CAS number are summarized at the top of the page.