Semaglutide is sold under three brand names, and each label sets its own dose ladder. The weekly weight-loss injection, the daily tablet and the diabetes pen share a molecule but not a schedule.
What follows is what each label states and what the trials behind it measured. It is a record of the documents, not a dosing plan, and the dose any one person uses is set with a prescriber.
The Wegovy injection ladder
The label starts everyone at 0.25 mg once a week for 4 weeks [1]. The dose then rises every 4 weeks: 0.5 mg, then 1 mg, then 1.7 mg. From week 17 the patient is on a maintenance dose.
The stated reason for the slow climb is to reduce the risk of stomach and bowel side effects. If a step is not tolerated, the label says to consider delaying the next increase by 4 weeks.
| Weeks | Weekly dose | Role |
|---|---|---|
| 1 to 4 | 0.25 mg | Starting dose |
| 5 to 8 | 0.5 mg | Escalation |
| 9 to 12 | 1 mg | Escalation |
| 13 to 16 | 1.7 mg | Escalation |
| 17 onward | 2.4 mg (recommended) or 1.7 mg | Maintenance for weight reduction |
| After at least 4 weeks on 2.4 mg | Up to 7.2 mg | Optional, if more weight loss is clinically indicated |
For weight reduction in adults, the maintenance dose is 1.7 mg or 2.4 mg, with 2.4 mg recommended [1]. The same two doses apply to lowering heart-attack and stroke risk. For the liver disease MASH, 2.4 mg is the dose, with 1.7 mg as the fallback.
What 2.4 mg did in STEP 1
The 2.4 mg dose rests on the STEP program. STEP 1 randomized 1,961 adults with obesity or overweight, without diabetes, to weekly semaglutide or placebo for 68 weeks [3].
Mean body weight fell 14.9% on semaglutide and 2.4% on placebo. That is a difference of 12.4 percentage points (95% CI 11.5 to 13.4). Half the semaglutide group, 50.5%, lost 15% or more.
The label’s trial with 1.7 and 2.4 mg side by side ran in East Asian adults [1]. How quickly each step shows up on the scale is a separate question, covered in how long it takes for semaglutide to work.
The 7.2 mg step
The current label adds a higher ceiling. Adults who have tolerated 2.4 mg for at least 4 weeks, and for whom more weight loss is clinically indicated, may go up to 7.2 mg once a week [1].
Study 8 randomized 1,407 adults with obesity and no diabetes, 5:1:1, to 7.2 mg, 2.4 mg or placebo for 72 weeks [1]. Doses were escalated over 20 weeks, then held for 52.
−18.8%
Mean weight change on 7.2 mg at week 72 (Study 8, n = 1,005)
Wegovy label
−15.5%
Mean weight change on 2.4 mg in the same trial (n = 201)
Wegovy label
−3.9%
Mean weight change on placebo (n = 201)
Wegovy label
The label puts the extra loss from 7.2 mg over 2.4 mg at 3.3 percentage points (95% CI 1.6 to 4.9) [1]. In adults with type 2 diabetes (Study 9), the figures were 13.2% on 7.2 mg and 10.4% on 2.4 mg.
The higher dose came with more side effects. Nausea was reported by 39% on 7.2 mg, 35% on 2.4 mg and 13% on placebo [1]. Dysesthesia, a group of skin sensations such as burning, tingling or sensitivity, was reported by 22%, 6% and 0%.
Hair loss rose too, to 6% on 7.2 mg against 3% on 2.4 mg. The full list for the usual dose is in semaglutide side effects.
The Wegovy tablet ladder
The tablet runs on 30-day steps rather than 4-week ones [1]. It starts at 1.5 mg daily, then 4 mg, then 9 mg, and reaches the 25 mg maintenance dose on day 91.
It is taken on an empty stomach with up to 4 ounces of water, and nothing else is eaten or drunk for 30 minutes. What the tablet trials measured is laid out in the Wegovy pill article.
Switching is written into the label. One week after the last 2.4 mg injection, the 25 mg tablet can start [1]. Going the other way, 2.4 mg injections start the day after the last 25 mg tablet.
Ozempic doses are different
Ozempic is the same molecule in a diabetes pen. Its label covers blood-sugar control, heart risk and kidney outcomes in adults with type 2 diabetes, and lists no weight-loss indication. [2]
It starts at 0.25 mg weekly for 4 weeks, then 0.5 mg [2]. If more glucose control is needed after at least 4 weeks, the dose can go to 1 mg, then to 2 mg. The maximum is 2 mg a week.
| Wegovy injection | Wegovy tablet | Ozempic | |
|---|---|---|---|
| How often | Once a week | Once a day | Once a week |
| Starting dose | 0.25 mg | 1.5 mg | 0.25 mg |
| Step length | 4 weeks | 30 days | At least 4 weeks |
| Usual top dose | 2.4 mg | 25 mg | 2 mg |
| Label maximum | 7.2 mg | 25 mg | 2 mg |
Missed doses
The rules follow from how long semaglutide lasts. Its elimination half-life is about 1 week, and the label says it stays in the circulation for 5 to 7 weeks after the last dose [1].
For Wegovy injection, a missed dose is taken if the next one is more than 2 days away. If it is less than 2 days away, the missed dose is skipped. After 2 or more missed doses in a row, the label says to restart the ladder at a lower dose.
Ozempic allows a missed dose within 5 days [2]. A missed Wegovy tablet is simply skipped, and the next one is taken the following day [1].
What about lower doses?
No label sets a maintenance dose below 1.7 mg for weight. The 0.25 mg to 1 mg steps are there to build tolerance [1]. Staying on a low dose on purpose is a separate practice, and its evidence is reviewed in microdosing semaglutide.
Reading your own prescription
A prescription should state the drug, the dose in milligrams and the weeks for each step. For a vial, it should also state the concentration, so milligrams can be converted to a volume [4].
For the dual-agonist alternative and its 2.5 mg steps, see tirzepatide dosage. To compare online prescribers who write semaglutide, see the weight-loss peptide rankings.