GLP-1 Medications
Ozempic Dose Chart: Titration Schedule From 0.25mg to 2mg
Ozempic (semaglutide) dose chart and titration schedule — 0.25mg to the 2mg max, pen strengths, missed-dose rules, and how the weekly escalation works.
On this page
Ozempic (semaglutide) follows a fixed escalation schedule that starts low and steps up every four weeks. The ramp isn't optional — it's built into the prescribing protocol because semaglutide slows gastric emptying, and your GI system needs time to adapt at each level before the dose climbs. Rushing it doesn't get you results faster; it gets you nausea.
This is a reference page. The chart is first; the reasoning follows.
Ozempic Dose Chart
| Step | Dose | When | Purpose |
|---|---|---|---|
| 1 | 0.25 mg | Weeks 1-4 | Initiation — GI acclimation only, not therapeutic |
| 2 | 0.5 mg | Weeks 5-8 (min) | First maintenance dose |
| 3 | 1 mg | Week 9 onward (min 4 wks at 0.5 mg first) | Higher maintenance dose |
| 4 | 2 mg | Week 13 onward (min 4 wks at 1 mg first) | Maximum dose |
Every step requires at least 4 weeks at the current dose before moving up. The weeks above assume the fastest possible schedule with no delays — in practice your prescriber may hold you at a dose longer if it's working or if side effects need more time to settle.
What Each Dose Is For
0.25 mg (Weeks 1-4): Not a therapeutic dose. The Ozempic prescribing information is explicit that 0.25 mg "is not a maintenance dose" and isn't intended for blood-sugar control. Its only job is to let your body adjust to semaglutide's GI effects before the dose reaches a level that does clinical work. Mild nausea here is common and expected.
0.5 mg (Weeks 5-8): The first dose with real clinical effect. Most people notice appetite suppression and improved glucose control begin here. Some patients stay at 0.5 mg long-term if it meets their goals.
1 mg (Week 9+): A common maintenance dose. In the SUSTAIN trials, 1 mg produced substantially greater HbA1c and weight reduction than 0.5 mg. Your prescriber moves you here if you need more effect after at least four weeks at 0.5 mg.
2 mg (Week 13+): The maximum approved dose, added by the FDA in 2022. The SUSTAIN FORTE trial showed 2 mg delivered a modest additional HbA1c and weight reduction over 1 mg, with a similar side-effect profile. Not everyone needs it — it exists for people who need more glycemic effect and tolerate 1 mg well.
Pen Strengths and How Dialing Works
Unlike Mounjaro, which uses fixed single-dose pens, Ozempic uses multi-dose pens with a dose selector you dial. One pen holds four weekly doses. There are three pen types, matched to where you are in the schedule:
| Pen | Doses it delivers | Lasts |
|---|---|---|
| 0.25 / 0.5 mg pen | 0.25 mg or 0.5 mg per dose | 4 weekly doses |
| 1 mg pen | 1 mg per dose | 4 weekly doses |
| 2 mg pen | 2 mg per dose | 4 weekly doses |
When you titrate up, you get a new prescription for the pen that matches your new dose. You don't combine smaller doses to make a bigger one. For the actual injection mechanics — priming, dialing, holding the count — see how to inject Ozempic, and for where to place it and how to rotate, Ozempic injection sites.
Timing Your Weekly Injection
Ozempic is injected once weekly, on the same day each week, with or without food, any time of day. Pick a day that fits your routine.
Changing your injection day: You can move it as long as at least 48 hours (2 days) have passed since your last injection. Semaglutide's long half-life (about a week) makes the weekly schedule forgiving, but don't inject two doses closer than two days apart.
What Happens If You Miss a Dose
The rule keys off how late you are:
- 5 days or less since the dose was due: Take it as soon as you remember, then resume your normal weekly schedule.
- More than 5 days late: Skip the missed dose entirely. Take your next dose on your regular day. Do not double up.
If you miss two or more consecutive doses, contact your prescriber before restarting — especially if you were at 1 mg or 2 mg. After a gap, semaglutide's appetite and GI effects can hit harder on re-exposure, and your provider may want to restart you at a lower dose and re-titrate. This is the same principle that applies across GLP-1s; the Mounjaro dosage guide covers the tirzepatide version of the same situation.
Ozempic vs Wegovy: Same Drug, Different Ceiling
A frequent source of confusion: Ozempic and Wegovy are both semaglutide, but they're not interchangeable doses. Ozempic is approved for type 2 diabetes and cardiovascular risk reduction, and it tops out at 2 mg weekly. Wegovy is approved for weight management and goes up to 2.4 mg weekly on its own titration schedule. If your goal is weight loss specifically, the 2 mg Ozempic ceiling is not the same as the Wegovy protocol — that's a conversation for your prescriber, not a dose you self-adjust. The mechanism behind both is the same; the semaglutide guide covers it in depth.
Managing Side Effects During Titration
GI side effects are the main challenge while escalating, and they tend to flare for a week or two at each new dose, then settle:
- Nausea is the most common, usually worst right after a dose increase. Smaller meals, less fat, and staying hydrated help. If it hasn't eased after two to three weeks at a dose, tell your prescriber — they can extend your time at that step before going up.
- Diarrhea and constipation both occur; hydration and fiber help, and persistent diarrhea warrants a call because of dehydration risk.
- Decreased appetite is partly the point — but if you can't eat enough protein or fluids, the dose may be climbing faster than you tolerate.
For a fuller breakdown by frequency and the signals that mean "call your provider," see semaglutide side effects.
A Note on Compounded Semaglutide
If you're using compounded semaglutide from a vial rather than an Ozempic pen, the dose is drawn in units on an insulin syringe, and the concentration varies by pharmacy. The milligram targets in the chart above still describe the escalation logic, but your unit markings depend on how your vial was mixed — confirm the conversion with your prescriber or pharmacy so your units match your intended milligrams. Don't assume a pen schedule maps one-to-one onto a vial.
Why Tracking Titration Matters
Titration is exactly the kind of thing that's hard to hold in your head: your dose changes on a schedule, your side-effect profile shifts at each level, and the decision to step up or hold depends on data you only have if you recorded it. Worth logging at each step:
- Injection date and dose — confirms you're on schedule and how long you've been at the current level
- Injection site — supports rotation (see Ozempic injection sites)
- GI symptoms and severity — shows your prescriber the adaptation curve at each dose
- Appetite and weight trend — the signal you're actually titrating toward
Done Dose tracks all of this in one place, including your dose-level history, so when it's time to decide whether to escalate from 0.5 mg to 1 mg you're looking at a record instead of a hazy memory of "I think week 6 was rough." Set it up in under a minute.
