Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist marketed under three brand names with distinct formulations, indications, and dosing schedules. This chart consolidates dosing data across all approved indications.
| Brand | Route | Frequency | Indication | Manufacturer |
|---|
| Ozempic | SC injection | Weekly | Type 2 diabetes | Novo Nordisk |
| Wegovy | SC injection | Weekly | Obesity/weight management | Novo Nordisk |
| Rybelsus | Oral | Daily | Type 2 diabetes | Novo Nordisk |
| Week | Dose | Frequency | Purpose |
|---|
| 1–4 | 0.25 mg | Once weekly | Initiation/titration |
| 5–8 | 0.5 mg | Once weekly | First maintenance dose |
| 9+ | 1.0 mg | Once weekly | If additional glycemic control needed |
| 9+ | 2.0 mg | Once weekly | Maximum dose |
- Starting dose: 0.25 mg weekly (not therapeutic — for GI tolerability)
- Minimum effective dose: 0.5 mg weekly
- Maximum dose: 2.0 mg weekly
- Dose interval: Minimum 4 weeks between dose increases
| Dose | HbA1c Reduction | Body Weight Change | SUSTAIN Trial |
|---|
| 0.5 mg | −1.0% to −1.3% | −3.5 kg | SUSTAIN-1 |
| 1.0 mg | −1.3% to −1.6% | −4.5 kg | SUSTAIN-2 |
| 2.0 mg | −1.5% to −1.8% | −6.0 kg | SUSTAIN-3 |
| Month | Dose | Frequency | Purpose |
|---|
| 1 | 0.25 mg | Once weekly | Initiation |
| 2 | 0.5 mg | Once weekly | Titration |
| 3 | 1.0 mg | Once weekly | Titration |
| 4 | 1.7 mg | Once weekly | Maintenance initiation |
| 5+ | 2.4 mg | Once weekly | Full maintenance dose |
- Target maintenance dose: 2.4 mg weekly
- Minimum maintenance dose: 1.7 mg weekly (if 2.4 mg not tolerated)
- Dose interval: Minimum 4 weeks between increases
| Trial | Population | Dose | Mean Weight Loss | Placebo |
|---|
| STEP 1 | Non-diabetic obese | 2.4 mg | −14.9% | −2.4% |
| STEP 2 | Diabetic obese | 2.4 mg | −9.6% | −3.4% |
| STEP 3 | Intensive behavioral therapy | 2.4 mg | −16.0% | −5.7% |
| STEP 5 | Extended treatment (104 weeks) | 2.4 mg | −15.2% | −2.6% |
| Period | Dose | Frequency |
|---|
| Days 1–30 | 3 mg | Once daily |
| Days 31–60 | 7 mg | Once daily |
| Day 61+ | 14 mg | Once daily (if needed) |
- Take on an empty stomach
- Swallow with ≤120 mL (4 oz) of water
- Wait ≥30 minutes before eating, drinking, or taking other oral medications
- Do not split, crush, or chew tablets
| Dose | HbA1c Reduction | Body Weight Change |
|---|
| 3 mg | −0.4% | −0.1 kg |
| 7 mg | −0.8% | −0.7 kg |
| 14 mg | −1.2% | −1.5 kg |
| eGFR (mL/min/1.73m²) | Ozempic/Wegovy | Rybelsus |
|---|
| ≥30 | No adjustment | No adjustment |
| 15–29 | No adjustment | No adjustment |
| <15 or dialysis | Limited data | Limited data |
- No dose adjustment required for mild or moderate impairment
- Not studied in severe hepatic impairment (Child-Pugh C)
| Medication | Interaction | Management |
|---|
| Insulin | Additive hypoglycemia risk | Reduce insulin dose |
| Sulfonylureas | Additive hypoglycemia risk | Reduce sulfonylurea dose |
| Oral contraceptives | May reduce exposure slightly | No adjustment typically needed |
| Warfarin | Monitor INR | Increased monitoring |
| Brand | Missed Dose Rule |
|---|
| Ozempic | If <2 days late, take when remembered. If ≥2 days, skip and resume schedule |
| Wegovy | If <2 days late, take when remembered. If ≥2 days, skip and resume schedule |
| Rybelsus | If missed, take with food next day. Do not double dose |
| Adverse Event | Incidence (0.5 mg) | Incidence (1.0 mg) | Incidence (2.4 mg) |
|---|
| Nausea | 15–20% | 18–24% | 30–44% |
| Diarrhea | 8–12% | 10–15% | 15–20% |
| Vomiting | 5–8% | 8–12% | 15–20% |
| Constipation | 5–8% | 5–10% | 10–15% |
| Abdominal pain | 5–8% | 5–8% | 8–12% |
- Novo Nordisk. “Ozempic Prescribing Information.” FDA 2024.
- Wilding JPH, et al. “Once-Weekly Semaglutide in Adults with Overweight or Obesity (STEP 1).” NEJM 2021;384:989-1002.
