If you've looked up semaglutide dosing, you've probably found a dozen charts that disagree with each other — some in milligrams, some in "units," some describing the branded pens and some describing compounded vials, usually without saying which. This article lays out how semaglutide dosing actually works, why the schedule is stepped, and why the right dose for you is a clinical decision rather than a number you pick off a chart.

One thing to be clear about up front: this is educational information, not medical advice. If you're prescribed semaglutide, your schedule comes from your prescribing provider and the label of the specific product you're taking — and it may legitimately differ from what's below.

Why semaglutide dosing is a ladder, not a number

Semaglutide isn't started at its full dose. Every approved version of the medication uses gradual titration — beginning at a low dose and stepping up over several months. The reason is tolerability: the most common side effects are gastrointestinal (nausea, and less often vomiting or diarrhea), they're most likely when a dose is new or newly increased, and they're substantially easier to manage when the body is given weeks to adapt at each step. [1]

The starting dose isn't really a treatment dose at all — it exists to acclimate your body. That's worth knowing, because the early weeks can feel underwhelming, and people sometimes conclude the medication "isn't working" at a stage when it isn't yet expected to.

The standard weekly schedule (Wegovy)

Wegovy, the FDA-approved semaglutide product for weight management, uses a five-step schedule of once-weekly injections, with each step lasting at least four weeks: [1]

  • Weeks 1–4: 0.25 mg once weekly (acclimation dose)
  • Weeks 5–8: 0.5 mg once weekly
  • Weeks 9–12: 1 mg once weekly
  • Weeks 13–16: 1.7 mg once weekly
  • Week 17 onward: 2.4 mg once weekly (full maintenance dose)

Two flexibilities in the label are worth knowing about. If a step-up isn't tolerated, the escalation can be delayed — four weeks at a step is a minimum, not a maximum. And if the full 2.4 mg maintenance dose isn't tolerated, 1.7 mg weekly is a recognized maintenance dose in its own right. [1] Slower is not failing; it's how the schedule is designed to flex.

Ozempic uses a different ladder

Ozempic — the same molecule, FDA-approved for type 2 diabetes — titrates 0.25 mg → 0.5 mg → 1 mg → 2 mg weekly, stepping up based on blood-sugar response. [2] This is one of the main reasons dosage charts online disagree: they're describing different products with different targets. A chart topping out at 2 mg is describing diabetes dosing; one topping out at 2.4 mg is describing weight-management dosing.

Compounded semaglutide: mg, "units," and why charts get confusing

Compounded semaglutide is typically dispensed as a vial of solution you draw into a syringe, rather than a pre-set pen. That introduces the single most confusing thing about compounded dosing: syringes measure volume ("units" on an insulin syringe), while doses are prescribed in milligrams — and how many units equal your milligram dose depends entirely on the concentration of your specific vial, which varies by pharmacy. A "40 units" instruction from one pharmacy can be a different milligram dose than "40 units" from another. This is why reputable providers give you instructions specific to your vial, and why copying an internet chart — or a friend's instructions — is genuinely unsafe.

It's also important to say plainly: compounded semaglutide is not FDA-approved. The active ingredient is the same molecule, but the compounded product hasn't been through the FDA's review for safety, effectiveness, and quality. We've written honestly about what that distinction means in our article on compounded vs. brand GLP-1.

What dose "works"?

The major clinical trial behind semaglutide for weight management (STEP 1) tested the full 2.4 mg weekly dose alongside lifestyle changes over 68 weeks, with participants averaging 14.9% body-weight loss. [3] That number describes a trial population at the full dose over more than a year — not a promise about any individual, and not a timeline. Individual results vary widely, and some people do well at lower maintenance doses. What the trial design does usefully illustrate: semaglutide is a months-long treatment whose benefit builds gradually, not a fast-acting one.

Why your schedule may differ — and why that's the point

A licensed medical provider may run your titration slower than the label's minimum, hold you at a middle dose that's working, or decide semaglutide isn't appropriate for you at all. Dose changes should always go through your provider — the schedule above is how the medication is designed to be used, not an invitation to self-adjust, split doses, or stack a missed week. If you miss a dose, the right move depends on how long it's been; contact your provider rather than guessing.

Where care fits

The dosing ladder is the easy part to publish. The judgment — where you start, how fast you climb, where you stop — is the part that requires a clinician who has reviewed your history, your medications, and your goals. That's the model Cypress is built around: a licensed medical provider reviews your assessment first, and if semaglutide is appropriate, your plan comes with dosing instructions specific to what you're prescribed. If you want to see what that looks like, you can learn how provider-reviewed care works.