How to Start Semaglutide

A medical evaluation happens first, and a prescriber decides from it whether semaglutide is appropriate for you. The same holds if you are reading on behalf of a parent, a partner, or an adult child.

The evaluation covers your health history, your current medications, and what you are hoping to change. The Wegovy prescribing information adds specific items for the prescriber to check. Thyroid cancer history in you or your family is one. Pregnancy plans are another, since the label says to stop Wegovy at least 2 months ahead of a planned pregnancy. People with diabetes need their blood glucose monitored from the start, and doses of insulin or a sulfonylurea may need to come down.

Body mass index and weight-related conditions decide who qualifies for semaglutide, and the evaluation confirms those in person. Semaglutide is not appropriate for everyone, and a good evaluation sometimes ends with a different plan.

Who should not start semaglutide?

Semaglutide is contraindicated for anyone with a personal or family history of medullary thyroid carcinoma, for anyone with multiple endocrine neoplasia syndrome type 2, and for anyone who has had a serious allergic reaction to it. The Wegovy label also advises against use in severe gastroparesis and says to stop when a pregnancy is recognized.

The starting dose of semaglutide is 0.25 mg once weekly for the first 4 weeks, according to the Wegovy prescribing information. Ozempic starts at the same 0.25 mg.

The label gives the reason plainly. Following the step-up schedule reduces the risk of gastrointestinal reactions, which are the side effects most patients ask us about.

Wading into a cold lake works the same way. You go in from the shallow end and let your body catch up at each depth. Jumping off the dock gets you wet sooner, and it feels far worse.

Stomach side effects are reported most often while the dose is rising, and our post on the first week on semaglutide covers what patients tell us about that stretch.

Can you start semaglutide at a higher dose?

A higher starting dose is not on the label. The Wegovy prescribing information gives one starting dose, 0.25 mg once weekly, with no faster option. The step-up schedule exists to reduce the risk of nausea, vomiting, and diarrhea, so skipping a step removes the protection that step provides. Any change belongs to the prescriber who knows your history.

The semaglutide titration schedule raises the dose in 4-week steps until a maintenance dose is reached at week 17. The table below shows the schedule in the Wegovy prescribing information, revised June 2026, for the once-weekly injection.

Semaglutide has a half-life of about 1 week, according to both labels. The Ozempic label reports that steady exposure is reached after 4 to 5 weeks of weekly dosing, which lines up closely with the 4-week length of each step.

The schedule tells you when the dose changes. How long semaglutide takes to work is a different question with its own timeline.

How long does it take to reach the full dose?

Reaching a maintenance dose takes at least 16 weeks on the Wegovy label, with maintenance beginning at week 17. That timeline assumes every step is tolerated on schedule. Each delayed step adds 4 weeks, so a patient whose prescriber holds twice reaches maintenance around week 25.

Do you have to go up every 4 weeks?

Moving up every 4 weeks is the default, and the label builds in a pause. When a dose is not tolerated, the prescribing information tells the prescriber to consider delaying the next increase by 4 weeks. Holding a step is a clinical decision made with your prescriber, and it is a normal part of treatment.

Semaglutide dosing differs between Wegovy and Ozempic, even though both contain the same drug.

Ozempic is approved for adults with type 2 diabetes. The Ozempic label starts at 0.25 mg once weekly for 4 weeks and then moves to 0.5 mg. From there the dose may be increased to 1 mg and then 2 mg, each after at least 4 weeks, when more blood sugar control is needed. The maximum is 2 mg once weekly.

Wegovy is the semaglutide product approved for weight reduction, and its schedule runs through 1 mg and 1.7 mg on the way to maintenance. A patient moving from one brand to the other cannot assume the numbers carry over.

Wegovy tablets follow a third schedule. The tablet is taken once daily, starting at 1.5 mg for 30 days and reaching 25 mg from day 91.

The difference between Wegovy and Ozempic comes down to what each is approved to treat, and the dose schedules follow from that.

Starting semaglutide at our Salem clinic begins with a free consultation, and a prescription is one possible outcome of it.

Rick Meyers, FNP-BC, reviews your health history, your current medications, your lifestyle, and your goals. Rick began working with GLP-1 medications in 2015 with liraglutide (Saxenda), years ahead of semaglutide's approval for weight management. He decides whether a GLP-1 medication is medically appropriate for you, and he will tell you when it is the wrong fit.

Follow-up visits happen in person or virtually, and dose changes are made at those check-ins. Take a patient at week 6 who feels queasy most mornings on 0.5 mg. The label lets us hold her at that dose for 4 more weeks, and she moves up once her stomach settles.

Regular check-ins are the core of our medically supervised GLP-1 program in Salem.

The maintenance dose of semaglutide for weight reduction in adults is 1.7 mg or 2.4 mg once weekly on the Wegovy label, with 2.4 mg listed as the recommended dose. The label tells prescribers to weigh treatment response and tolerability when choosing between the two.

The current label also lists a higher option. For adults who tolerate 2.4 mg for at least 4 weeks, and for whom more weight reduction is clinically indicated, the dose may be raised to a maximum of 7.2 mg once weekly.

Trial data show how often patients settle below the top. The Wegovy label describes a cardiovascular outcomes trial of 17,604 adults with established cardiovascular disease and without diabetes. Among patients still on treatment at 1 year, 76% were taking 2.4 mg, 8% were taking 1.7 mg, and 16% were on lower doses. Those figures describe that trial population, and your own dose is set by your prescriber.

A plateau at a stable dose is a different problem from an unfinished schedule, and we cover why weight loss stalls on semaglutide separately.

Stomach-related side effects are the ones that show up while the dose goes up, and the Wegovy label says they were reported most often during dose escalation.

The label pools three trials of 2,116 adults who took Wegovy 2.4 mg for up to 68 weeks. Nausea was reported by 44% of those patients, against 16% on placebo. Diarrhea was reported by 30% against 16%, vomiting by 24% against 6%, and constipation by 24% against 11%. In the same trials, 6.8% of patients on Wegovy stopped treatment permanently because of adverse reactions, compared with 3.2% on placebo.

Serious reactions are less common and matter more. The label carries warnings for pancreatitis, gallbladder disease, kidney injury linked to dehydration, and severe gastrointestinal reactions.

Red flags: call your prescriber the same day for any of these, and call 911 for trouble breathing or swelling of the face or throat.

• Severe stomach pain that will not go away, with or without vomiting, especially pain that spreads to your back
• Vomiting or diarrhea that stops you keeping fluids down
• A lump or swelling in your neck, trouble swallowing, hoarseness, or shortness of breath
• Yellowing of your skin or eyes
• A racing heartbeat while you are at rest

Our guide to semaglutide side effects covers the full list and when each one tends to appear.

A missed dose of semaglutide is handled by rules in the label, and those rules differ by product.

For the Wegovy injection, the answer turns on whether your next scheduled dose is more than 2 days away. The Ozempic label uses a different window of 5 days after the missed dose. Wegovy tablets have the simplest rule: skip the missed tablet and take the next one the following day.

Two or more missed Wegovy injections in a row change the picture. The label tells the prescriber to restart escalation at a lower dose, which reduces the risk of stomach side effects on the way back up.

Call your prescriber or pharmacist instead of guessing, and have the name of your product and the date of your last dose ready. The drug's half-life of about 1 week shapes how long semaglutide stays in your system, and a gap of several weeks lets much of it clear.

"Units" cause semaglutide dosing errors because a unit is a volume marking on a syringe, and the amount of drug in that volume changes with the concentration in the vial.

FDA-approved injectable semaglutide is dosed in milligrams. Compounded semaglutide is often dispensed in multiple-dose vials at concentrations that vary by compounder, sometimes with instructions written in units.

FDA issued an alert on July 26, 2024, after receiving reports of overdoses with compounded semaglutide. In most of those reports, patients had drawn up five to 20 times the intended dose from a vial. Some needed hospital care. Several reports involved providers who miscalculated a dose when converting from milligrams.

Three questions protect you here. Ask which product you are being given, ask what concentration it is, and ask to be shown your dose on the syringe you will use. A provider should answer all three without hesitation.

We cover the regulatory status of compounded semaglutide in our post on how the drug works.