How is semaglutide dosed?

The injectable ladders

Wegovy, authorised for chronic weight management, starts at 0.25 mg once weekly for four weeks and titrates every four weeks to a maintenance dose of 2.4 mg once weekly, via 0.5, 1.0 and 1.7 mg. Ozempic, authorised for glycaemic control in type 2 diabetes, starts at the same 0.25 mg but its recommended maintenance dosages are 0.5 mg, 1 mg or 2 mg once weekly, with 2 mg the ceiling. The two ladders share a starting dose and diverge at the top.

Both labels increase only after at least four weeks at the current step, so remaining at a step longer is within the labelled schedule rather than a departure from it.

The oral labels run on a different scale entirely

Rybelsus, the oral tablet authorised for type 2 diabetes, is dosed at 3 mg, 7 mg or 14 mg once daily — milligram figures that look larger than the injectable ones because oral bioavailability is far lower, not because the exposure is larger. A more recent oral label for weight management escalates by day rather than by week: 1.5 mg for days 1–30, 4 mg for days 31–60, 9 mg for days 61–90, and 25 mg from day 91 onward. Reading an oral milligram figure as though it were an injectable one is the single most consequential mistake available on this subject.

Four labels, four missed-dose rules

What titration is doing

The escalation is a tolerability mechanism, not an efficacy one. The published rationale across these labels is that starting at a maintenance dose raises gastrointestinal adverse-event rates without improving outcomes, which is why every one of the four ladders begins well below its ceiling. Semaglutide’s half-life of roughly a week is what makes a weekly interval coherent in the first place, and what makes each step take several weeks to reach steady state.

To convert any of these milligram figures into syringe units for a given vial and volume, use the dosage calculator.