How to start dosing with semaglutide (Ozempic®)

Semaglutide’s only significant side-effect is nausea which is usually mild and settles with time, particularly if the dose is started low and increased slowly. The usual starting dose for Ozempic is 0.25 mg weekly (19 clicks on the pen, counting clicks is useful, see below). If after 4 weeks nausea is minimal the dose should be increased to 0.5 mg (38 clicks) and this dose continued for another 4 weeks. If target weight or sugar has not been achieved and nausea is absent or minimal, the dose is increased to 1.0 mg weekly (76 clicks), the usual maintenance dose. Ozempic is often prescribed off-label (not Health Canada approved) in doses higher than 1.0 mg per week. At BCDiabetes we do so by giving 1.0 mg more frequently than weekly. Common doses we use are 1 mg every 5 days and 1 mg every 3 days (equivalent to 2.4 mg per week, an obesity dose approved for use in the USA). Higher doses provide for more weight loss with a slightly higher rate of nausea.

If persistent nausea or vomiting occurs with Ozempic, the dose should be held until the nausea disappears and then reintroduced at no more than 50% of the previous dose. At BCDiabetes we employ in-between or micro doses of semaglutide measured in clicks, not milligrams. For instance, if we have a client who tolerates 0.25 mg per week (19 clicks) but not 0.5 mg per week (38 clicks) we might try 28 or 29 clicks weekly (0.125 mg). For those who do not tolerate 0.25 mg weekly (19 clicks, the usual starting dose) we may try them on 5 or 10 clicks weekly.

If Ozempic is stopped for more than two weeks and planned for reintroduction, your physician may recommend restarting at the usual starting dose of 0.25 mg weekly, not the previously tolerated dose.