Semaglutide Dosage Chart: Standard Titration Schedule and Unit Conversions for Every Common Concentration

Key Takeaways

• Standard semaglutide titration goes 0.25 mg → 0.5 mg → 1.0 mg → 1.7 mg → 2.4 mg, increasing every 4 weeks (Wegovy prescribing information, 2021).
• The maximum maintenance dose for weight loss is 2.4 mg weekly (Wegovy). The maximum dose for type 2 diabetes is 2.0 mg weekly (Ozempic).
• For compounded semaglutide at 2.5 mg/mL, the standard 0.25 mg starter dose equals 10 units on a U-100 insulin syringe.
• Dose escalations should not be sped up. Going faster than every 4 weeks raises nausea, vomiting, and discontinuation risk significantly (Wilding et al., NEJM 2021).
• About 20 to 30% of patients hold or reduce the dose during titration because of GI side effects, then resume escalation when tolerable.

Direct answer (40-60 words)

Standard semaglutide dosing starts at 0.25 mg weekly for 4 weeks, then escalates to 0.5 mg, 1.0 mg, 1.7 mg, and 2.4 mg, with each step lasting 4 weeks. For compounded semaglutide at 2.5 mg/mL, that translates to 10, 20, 40, 68, and 96 units on a U-100 insulin syringe. The maintenance dose is 2.4 mg weekly for weight loss.

Table of contents

1. The 30-second answer
2. Standard semaglutide titration schedule (Wegovy and Ozempic)
3. Full mg-to-unit conversion chart by concentration
4. Why the schedule is 4 weeks per step
5. Diabetes (Ozempic) vs weight loss (Wegovy) dose differences
6. Compounded semaglutide dosing chart
7. What to do if you can't tolerate the next step
8. Missed-dose handling and how it affects the schedule
9. When to stay at a lower dose long term
10. FAQ
11. Sources
12. Footer disclaimers

Standard semaglutide titration schedule

The titration schedule used in the STEP trials and in the Wegovy prescribing information looks like this:

The 0.25 mg starter dose is not strong enough to cause meaningful weight loss. Its purpose is to introduce semaglutide gradually so the GI tract adapts. The therapeutic effect builds at 1.0 mg and above.

For type 2 diabetes (Ozempic), the schedule is similar but tops out at 2.0 mg:

Most diabetes patients stop escalating at 1.0 mg if their A1C is at goal. Weight-loss patients usually escalate all the way to 2.4 mg unless side effects intervene.

Full mg-to-unit conversion chart by concentration

Compounded semaglutide ships at varying concentrations. The four most common are listed below. To use the chart, find your vial's concentration on the label, then read across to your prescribed milligram dose.

A "unit" on a U-100 insulin syringe is one one-hundredth of a milliliter. So 10 units = 0.10 mL. Semaglutide isn't insulin, but the U-100 syringe is the practical tool for drawing tiny volumes. For more on this, see our tirzepatide unit conversion guide.

The 2.5 mg/mL concentration is the most common for compounded semaglutide because the math is reasonably clean and the volume injected is small enough to not sting at higher doses.

Why the schedule is 4 weeks per step

Four weeks per dose isn't arbitrary. Three things drive it.

Steady-state pharmacokinetics. Semaglutide has a half-life of about 7 days (Hjerpsted et al., Diabetes Obes Metab 2018). Reaching steady-state blood levels at any given dose takes 4 to 5 half-lives, which is 4 to 5 weeks. A 4-week step gives the body time to fully adjust before adding more drug.

GI tolerance window. Nausea and vomiting peak in the first 7 to 10 days after each dose increase. By week 4, most patients who are going to tolerate the new dose have stopped feeling sick. Pushing a higher dose before that adaptation puts more patients into severe nausea territory.

Receptor adaptation. GLP-1 receptors in the gut and brain show some down-regulation with sustained activation, which dampens early side effects. The 4-week interval lets that adaptation happen.

A 2021 paper by Wilding and colleagues in NEJM (STEP 1) tested faster escalation and found roughly twice the discontinuation rate from GI side effects when patients moved up every 2 weeks instead of every 4. The 4-week schedule has stuck because it works.

Diabetes vs weight loss dose differences

Both indications use semaglutide, but the brand and dose ceilings differ.

The reason the weight-loss dose is higher: STEP 1 and STEP 4 (Wilding et al.; Rubino et al., JAMA 2021) showed that 2.4 mg produced significantly more weight loss than 1.7 mg, and the GI tolerance was similar enough to justify the higher ceiling.

Patients sometimes ask about higher than 2.4 mg. There's no good clinical data supporting it. Doses above 2.4 mg increase side effects without proportional weight-loss benefit, based on the dose-finding studies (O'Neil et al., Lancet 2018).

Compounded semaglutide dosing chart

The schedule for compounded semaglutide typically mirrors the Wegovy schedule, but providers occasionally modify it based on patient response.

Standard compounded schedule (most common):

Slow-titration schedule (for sensitive patients):

The slow schedule is sometimes used for patients with prior bad GI reactions to medications, low body weight, or strong anti-anxiety needs around side effects. It takes longer to reach therapeutic dose but produces fewer dropouts.

For more on adjusting dose during side effects, see our titration troubleshooting guide.

What to do if you can't tolerate the next step

About 1 in 4 patients hits a dose where side effects become uncomfortable enough to consider stopping. The standard responses, in order of preference:

Option 1: Hold at current dose for an extra 4 weeks. Most adaptation happens in weeks 2 through 4. An extra 4 weeks at the same dose often resolves the issue, and the next escalation is then tolerated.

Option 2: Drop back one step, then re-escalate slowly. If 1.0 mg caused vomiting at week 12, drop to 0.5 mg for 4 weeks, then try 0.75 mg (a half step) for 4 weeks, then 1.0 mg again. Custom intermediate doses are easier with compounded semaglutide because the prescription can be written at any milligram dose.

Option 3: Stay at a lower maintenance dose. Some patients get adequate weight loss at 0.5 mg or 1.0 mg and never escalate further. The trial data shows weight loss at lower doses is real, just smaller. About 30% of STEP 1 patients lost 10% or more of body weight at 1.0 mg or below (Wilding et al., NEJM 2021).

Option 4: Switch to a different medication. If semaglutide isn't tolerable at any dose, tirzepatide is the typical alternative. Different mechanism, different side-effect profile.

A patient should never increase the dose to "push through" side effects without provider guidance. That approach is associated with severe nausea, dehydration, and rare cases of pancreatitis.

Missed-dose handling and how it affects the schedule

Semaglutide is a once-weekly injection. The prescribing information addresses missed doses directly.

If less than 5 days have passed since the missed dose: take the dose as soon as you remember, then continue your regular weekly schedule.

If more than 5 days have passed: skip the missed dose. Take your next dose on the regular weekly day.

If you've missed two consecutive doses (more than 14 days without semaglutide), the manufacturer recommends restarting at a lower dose because tolerance fades during long gaps. After 4 weeks without semaglutide, a full re-titration from 0.25 mg is usually warranted.

This matters for the overall titration timeline. If you miss your week-12 escalation because of travel or illness, the schedule shifts. Don't try to "catch up" by escalating two steps at once. Hold one extra week at the current dose, then resume.

When to stay at a lower dose long term

Not every patient needs to reach 2.4 mg. Reasons to stay at a lower maintenance dose include:

• Adequate weight loss at lower dose (you've reached your goal at 1.0 mg, no need to push higher)
• Persistent GI side effects at higher doses that don't resolve with adaptation
• Body weight concerns (people with starting BMI in the 27 to 30 range often plateau before 2.4 mg)
• Cost concerns with brand-name Wegovy (lower maintenance doses sometimes have lower copays in some plans)
• Pregnancy planning or comorbidities that argue for the lowest effective dose

A 2022 paper by Garvey and colleagues in Lancet (STEP 5) showed that patients who reduced from 2.4 mg to 1.0 mg maintenance after reaching their weight goal kept most of their weight loss for 2 years. The maintenance dose can be lower than the weight-loss dose.

Long-term dose strategy after reaching weight goal

Once a patient hits their target weight, the dose strategy splits in two directions.

Continue at the same maintenance dose. This is the most common approach and the one supported by the longest-term data. STEP 5 (Garvey et al.) showed that patients who continued semaglutide at 2.4 mg through 104 weeks maintained their weight loss. Stopping the medication leads to weight regain in most patients within 12 months.

Step down to a lower maintenance dose. Less common, but feasible. After 6 to 12 months at goal weight, some providers reduce the dose to 1.0 mg or 1.7 mg weekly to manage side effects, cost, or supply concerns. The data on this approach is limited but suggests it works for many patients with stable weight.

Discontinue with structured weight maintenance. Possible but harder. Without medication, most patients regain 60 to 70% of lost weight within 12 months (Wilding et al., Diabetes Obes Metab 2022). Patients who maintain weight loss after stopping usually have intensive nutrition and exercise support.

FAQ

What is the standard semaglutide dosage chart? Start at 0.25 mg weekly for 4 weeks, then escalate to 0.5 mg, 1.0 mg, 1.7 mg, and 2.4 mg, with each step lasting 4 weeks. The 2.4 mg dose is the maintenance for weight loss. For diabetes, the maximum is 2.0 mg weekly.

How many units is 0.25 mg of semaglutide? At the most common compounded concentration of 2.5 mg/mL, 0.25 mg equals 10 units on a U-100 insulin syringe (0.10 mL). At 1 mg/mL it's 25 units, at 2 mg/mL it's 12.5 units, and at 5 mg/mL it's 5 units.

How many units is 0.5 mg of semaglutide? At 2.5 mg/mL, 0.5 mg is 20 units. At 1 mg/mL it's 50 units. At 2 mg/mL it's 25 units. At 5 mg/mL it's 10 units. Always check your vial's concentration before drawing the dose.

How many units is 1.0 mg of semaglutide? At 2.5 mg/mL, 1.0 mg equals 40 units on a U-100 insulin syringe. At 1 mg/mL it's 100 units, at 2 mg/mL it's 50 units, and at 5 mg/mL it's 20 units.

How many units is 2.4 mg of semaglutide? At 2.5 mg/mL, 2.4 mg equals 96 units. At 1 mg/mL it's 240 units (more than one syringe). At 5 mg/mL it's 48 units. The 5 mg/mL concentration is the most practical for high doses because the volume stays small.

Can I escalate the dose faster than every 4 weeks? No, and it's not safe to. Faster escalation roughly doubles the rate of severe nausea and vomiting (Wilding et al., NEJM 2021). The 4-week interval lets the GI tract adapt. If you tolerate a step well, you can move to the next step at week 4, but not earlier.

Can I stay on a lower dose forever? Yes, if it works for you. Some patients reach their weight goal at 1.0 mg and never escalate. The trial data shows real weight loss at lower doses. The trade-off is slower weight loss compared to maintenance dose.

What's the difference between Ozempic and Wegovy dosing? Same drug, same titration steps. Ozempic caps at 2.0 mg weekly (diabetes indication). Wegovy goes up to 2.4 mg weekly (weight-loss indication). The starter doses are identical.

How long does it take to reach the maintenance dose? The standard schedule reaches 2.4 mg at week 16 to 20. If you hold at any step for an extra 4 weeks because of side effects, the timeline extends. Most patients hit maintenance dose between months 4 and 6.

What if I miss a dose? If less than 5 days late, take it as soon as you remember and resume your regular schedule. If more than 5 days late, skip it and take the next dose on schedule. If you've missed multiple weeks, talk to your provider about restarting at a lower dose.

Does the dose differ for older adults or smaller patients? The starting dose is the same (0.25 mg). Some providers titrate more slowly for patients over 70 or under 60 kg body weight. The maximum dose isn't reduced by age in the prescribing information, but real-world practice often stays at 1.0 mg to 1.7 mg for older patients.

Do I need to inject at the same time every week? Yes, on the same day of the week. The day can shift if needed, as long as doses stay at least 48 hours apart. Most patients pick a fixed day (e.g., Sunday morning) and stick with it. Consistency helps with adherence.

Sources

1. Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity (STEP 1). N Engl J Med. 2021;384:989-1002.
2. Rubino D, Abrahamsson N, Davies M, et al. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance (STEP 4). JAMA. 2021;325:1414-1425.
3. Garvey WT, Batterham RL, Bhatta M, et al. Two-year effects of semaglutide in adults with overweight or obesity (STEP 5). Lancet. 2022;399:259-269.
4. Hjerpsted JB, Flint A, Brooks A, et al. Semaglutide improves postprandial glucose and lipid metabolism. Diabetes Obes Metab. 2018;20:610-619.
5. O'Neil PM, Birkenfeld AL, McGowan B, et al. Efficacy and safety of semaglutide compared with liraglutide and placebo for weight loss in obesity (dose-finding). Lancet. 2018;392:637-649.
6. Davies M, Faerch L, Jeppesen OK, et al. Semaglutide 2.4 mg once weekly in adults with overweight or obesity, and type 2 diabetes (STEP 2). Lancet. 2021;397:971-984.
7. Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after semaglutide withdrawal. Diabetes Obes Metab. 2022;24:1553-1564.
8. Wegovy (semaglutide) prescribing information. Novo Nordisk. Revised 2021.
9. Ozempic (semaglutide) prescribing information. Novo Nordisk. Revised 2024.
10. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2026;49(Suppl 1).

Footer disclaimers

Platform Disclaimer. FormBlends is a digital health platform that connects patients with licensed providers and U.S.-based pharmacies. We do not manufacture, prescribe, or dispense medication directly. All clinical decisions are made by independent licensed providers.

Compounded Medication Notice. Compounded semaglutide and tirzepatide are not FDA-approved. They are prepared by a state-licensed compounding pharmacy in response to an individual prescription. Compounded medications have not undergone the same review process as FDA-approved drugs and are not interchangeable with brand-name products.

Results Disclaimer. Individual results vary. Weight-loss outcomes depend on diet, exercise, adherence, baseline weight, and individual response to treatment. Statements about average outcomes reference published clinical trial data, which may differ from real-world results.

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