Semaglutide Dosing Schedule: Week by Week
The standard semaglutide titration: 0.25 to 2.4 mg over 17+ weeks. Here's the full week-by-week schedule, why it ramps slowly, and what to do if a step is too aggressive.
Updated May 6, 2026 · 5 min read
Semaglutide is one of the most-titrated drugs in modern medicine. You don't start at the dose that produces the headline weight-loss results — you ramp into it slowly over four months, with the goal of letting your gut adjust before the appetite signal gets loud.
The slow ramp is the whole game. People who try to skip steps almost always pay for it in nausea and reflux.
The standard Wegovy titration
This is the FDA-approved schedule for semaglutide as a weight-management drug. Five steps, 4 weeks per step, ending at the 2.4 mg maintenance dose.
| Weeks | Weekly dose | Notes |
|---|---|---|
| 1–4 | 0.25 mg | Sub-therapeutic. Goal is gut adaptation, not weight loss. |
| 5–8 | 0.5 mg | First "real" dose. Appetite suppression typically noticeable. |
| 9–12 | 1.0 mg | Many users see meaningful weight loss starting here. |
| 13–16 | 1.7 mg | The newest pen strength (added 2021). |
| 17+ | 2.4 mg | Maintenance dose. STEP-1 trial dose. |
You inject once per week, on the same day each week, into the abdomen, thigh, or upper arm. See injection sites and rotation for technique.
The Ozempic variant
Ozempic uses the same starting dose but stops earlier:
| Weeks | Weekly dose |
|---|---|
| 1–4 | 0.25 mg |
| 5–8 | 0.5 mg |
| 9–12 | 1.0 mg |
| 13+ | 1.0 or 2.0 mg (provider's call) |
The 2.0 mg Ozempic strength was added in 2022, partly because patients were plateauing at 1.0 mg. There's no 1.7 mg or 2.4 mg Ozempic pen — those strengths only exist for Wegovy.
For why the same molecule has two different ceilings, see Ozempic vs Wegovy.
Why titrate at all?
Three reasons, in order of how much they matter:
- GI tolerance. Semaglutide slows gastric emptying. If you start at the maintenance dose, your stomach empties so slowly that nausea, reflux, and vomiting become unbearable. Slow ramp = gut adapts.
- Appetite calibration. Going from a normal eating pattern to "barely interested in food" overnight is psychologically jarring and often leads to under-eating, fatigue, and electrolyte issues.
- Identifying side effects early. A slow ramp gives you time to notice problems at a lower dose and adjust before you've committed to maintenance.
What "4 weeks per step" actually means
The protocol is the minimum time at each step before increasing. It is not the maximum. If you reach week 4 of a step and you're still nauseated, fatigued, or barely tolerating it — stay at the current dose for another 2–4 weeks before stepping up.
This is one of the most common mistakes. People treat the schedule like a checklist to complete rather than a guideline based on how their body is actually responding.
What to do if a step is too aggressive
The classic scenario: you bumped up to 1.0 mg on schedule, and now four days in you can't keep food down and you're losing sleep over reflux. Options, from least to most aggressive:
- Wait it out 5–7 days. Most dose-increase symptoms peak 2–4 days after the injection and improve significantly by day 7. If you're approaching your next injection still feeling rough, that's the signal to act.
- Hold the dose. Repeat the current step for another 4 weeks before considering another increase. This is the most common adjustment.
- Step back down. Go back to the previous dose for 4 weeks, then attempt the higher dose again. There's no medical harm in this — semaglutide doesn't lose effectiveness from a temporary step-down.
- Try a half-step. If you're using compounded semaglutide and have flexibility on dose, an intermediate dose (e.g., 0.75 mg between the 0.5 and 1.0 steps) can bridge a difficult transition. This isn't an option with the brand pens, which deliver fixed strengths.
The full week-by-week symptom map is in semaglutide side effects timeline.
Compounded semaglutide and the math
Compounded semaglutide comes as a powder you reconstitute with bacteriostatic water. The dosing target is the same milligram amount as the brand titration — 0.25, 0.5, 1.0, 1.7, 2.4 mg — but you draw it from a vial in syringe units rather than dialing a pen.
The math depends on three variables:
- Total mg in the vial (typically 2 mg, 5 mg, or 10 mg)
- Volume of bacteriostatic water you add
- Syringe units per dose
Our calculator handles this conversion, but the key principle: the schedule is the same. Compounded users follow the same 0.25 → 2.4 ramp; only the mechanics of drawing the dose change.
For more on what to know before ordering compounded, see is compounded semaglutide safe?.
When you reach maintenance
The "maintenance dose" is the dose you stay at indefinitely while you're on the drug — typically 2.4 mg for Wegovy or 1.0–2.0 mg for Ozempic. Reaching maintenance does not mean weight loss accelerates; it means you've hit the dose where the drug's effect plateaus.
A few maintenance-dose realities:
- Maximum benefit emerges around 5 months in. STEP-1 showed weight loss continuing through week 68, but the steepest losses happen in months 3–9.
- Some users dose down at maintenance. A 2.4 mg user who plateaus or experiences too-aggressive appetite suppression may settle at 1.7 mg long-term.
- You don't need to stay at 2.4 mg forever. Maintenance dose is a starting point for long-term use, not a destination.
For what to expect along the way, see how long does semaglutide take to work.
Missed doses during titration
If you miss a dose during the ramp, the rule depends on how long it's been:
- Less than 5 days: Take the missed dose, continue the schedule.
- More than 5 days: Skip it. Take the next scheduled dose on your normal injection day.
- More than 2 weeks off: Most providers recommend stepping back one or two doses before resuming the planned schedule.
Full details in missed dose of semaglutide.