Semaglutide dosage chart

Titration schedule

Step	Dose	Duration	Notes
1	0.25 mg	Weeks 1-4	Starter dose; expect mild GI symptoms
2	0.5 mg	Weeks 5-8	Minimum 4 weeks at this dose
3	1.0 mg	Weeks 9-12	Peak GI symptom window; hold if needed
4	1.7 mg	Weeks 13-16	Some patients hold here long-term
5	2.4 mg	Week 17 onward	Maintenance dose; continue indefinitely if tolerated

FDA-approved Wegovy titration (matches compounded semaglutide protocols).

Reconstitution & vial math

Compounded semaglutide is typically dispensed as either pre-mixed solution (2.5 mg/mL or 5 mg/mL) or lyophilized powder requiring reconstitution with bacteriostatic water (BAC water).

Example: 5 mg vial reconstituted with 2 mL BAC water (concentration 2.5 mg/mL)

Dose	Volume (mL)	Units on U-100 syringe
0.25 mg	0.10 mL	10 units
0.5 mg	0.20 mL	20 units
1.0 mg	0.40 mL	40 units
1.7 mg	0.68 mL	68 units
2.4 mg	0.96 mL	96 units

Always confirm reconstitution math with the prescribing pharmacy. Some pharmacies use different concentrations; volume per dose differs accordingly.

Side effects by dose

Dose	Common side effects	Management
0.25-0.5 mg	Mild nausea (20-30%), constipation, fatigue	Smaller meals, hydration
1.0 mg	Moderate nausea (peak), diarrhea/constipation	Consider 8-week step
1.7-2.4 mg	GI symptoms plateau; appetite suppression peak	Protein-first eating; resistance training

Missed doses

• ≤5 days late: take missed dose immediately; resume normal weekly schedule
• >5 days late: skip missed dose; next scheduled dose on regular day
• 2+ weeks missed: consult prescriber — may need to restart at lower dose

Storage

• Refrigerate (2-8°C / 36-46°F)
• Compounded BUD: 28 days reconstituted per USP <797>
• Do not freeze; protect from light

Clinical trial reference

STEP-1 (Wilding JP et al., NEJM 2021, PMID 33567185): semaglutide 2.4 mg + lifestyle vs placebo in 1,961 adults with obesity. -14.9% mean change in body weight at 68 weeks. 86.4%, 69.1%, and 50.5% achieved ≥5%, ≥10%, and ≥15% weight loss respectively.