Semaglutide Dosage Chart (2026): Wegovy & Ozempic Titration Ladder + Maintenance Doses

Semaglutide is titrated slowly and on a fixed schedule, and the schedule is different for each product. Wegovy injection (semaglutide for chronic weight management, cardiovascular risk reduction and MASH) escalates once weekly over five steps — 0.25 mg → 0.5 mg → 1 mg → 1.7 mg → 2.4 mg — spending four weeks at each dose, so the earliest you reach the usual 2.4 mg maintenance dose is week 17. The current label also allows adults on Wegovy for weight reduction who have tolerated 2.4 mg for at least four weeks to go up to a maximum of 7.2 mg once weekly (sold as Wegovy HD).^[1] Ozempic injection (semaglutide for type 2 diabetes, often used off-label for weight loss) follows a different, lower ladder: 0.25 mg → 0.5 mg → 1 mg → 2 mg maximum, where the 0.25 mg starting dose exists to reduce gastrointestinal side effects and is not one of the label's maintenance doses.^[2] The injections are given once weekly under the skin; semaglutide also now comes as once-daily tablets — Wegovy tablets for weight, and Rybelsus and Ozempic tablets for diabetes — each with its own milligram ladder.^[1][5] This guide reproduces every ladder, explains why the four-week steps exist, covers how compounded semaglutide dosing can diverge from the brand schedule, and walks through missed doses and titration pauses. All dosing here is illustrative of the FDA labels — your prescriber sets your actual schedule. See our Wegovy drug page and Ozempic drug page for the live data, and the GLP-1 titration planner to map your own dates.

The full injectable semaglutide dose ladder (Wegovy + Ozempic)

Here is the complete once-weekly subcutaneous titration for both FDA-approved injectable semaglutide brands, side by side. The defining rule for both: you stay at each dose for at least four weeks before stepping up, and you start at 0.25 mg — a starting dose whose job is to let your gut adjust, not one of either label's maintenance doses.^[1][2]

Read the table by brand, not just by row. Wegovy is a five-rung ladder (0.25 → 0.5 → 1 → 1.7 → 2.4 mg) with an optional sixth step to 7.2 mg for adult weight reduction, because it targets weight loss. Ozempic is a four-rung ladder (0.25 → 0.5 → 1 → 2 mg) with a lower ceiling because its job is glycemic control and kidney/heart risk reduction in type 2 diabetes. The 1.7 mg and 7.2 mg doses exist only on the Wegovy label.^[1][2]

The Wegovy injection dose ladder (weight loss, heart, MASH)

Wegovy injection (semaglutide, Novo Nordisk) is FDA-approved, alongside a reduced-calorie diet and more physical activity, to reduce excess body weight and keep it off in adults with obesity or with overweight plus a weight-related condition and in adolescents 12 and older with obesity; to reduce the risk of heart attack, stroke and cardiovascular death in adults with established cardiovascular disease and obesity or overweight; and, under accelerated approval, to treat noncirrhotic MASH with moderate-to-advanced (F2-F3) liver fibrosis in adults. Every indication uses the same starting escalation (label §2.2, Table 1):^[1]

• Weeks 1-4: 0.25 mg once weekly
• 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: the maintenance dose for your indication — 2.4 mg (recommended) or 1.7 mg once weekly for weight reduction and cardiovascular risk reduction; 2.4 mg for MASH, dropping to 1.7 mg if 2.4 mg is not tolerated
• Optional (adults, weight reduction only): after at least 4 weeks tolerating 2.4 mg, the dose may be increased to a maximum of 7.2 mg once weekly if more weight loss is clinically indicated

So the standard 16-week escalation means the earliest a patient reaches the 2.4 mg dose is week 17. If a dose is not tolerated during escalation, the label says to consider delaying the next step for four weeks, and prescribers choose between 1.7 mg and 2.4 mg for maintenance based on response and tolerability.^[1] In the pivotal STEP 1 trial, adults on semaglutide 2.4 mg lost a mean of 14.9% of body weight at 68 weeks versus 2.4% on placebo.^[3] In STEP UP, adults with obesity (without diabetes) on 7.2 mg lost a mean of 18.7% at 72 weeks, versus 15.6% on 2.4 mg and 3.9% on placebo — but gastrointestinal side effects were more common at 7.2 mg (70.8% vs 61.2% on 2.4 mg), and dysesthesia (abnormal skin sensations) was reported by 22.9% vs 6.0%.^[6] You can map your own escalation dates with the GLP-1 titration planner and visualize the climb with the GLP-1 dose plotter.

The Ozempic injection dose ladder (type 2 diabetes, used off-label)

Ozempic injection (semaglutide, Novo Nordisk) is FDA-approved for adults with type 2 diabetes — to improve blood sugar control, to reduce the risk of major cardiovascular events in those with established cardiovascular disease, and to reduce the risk of kidney function decline, kidney failure and cardiovascular death in those with chronic kidney disease. It is not approved for weight loss, though it is widely prescribed off-label for weight management. Per the Ozempic label §2.2, the escalation is:^[2]

• Weeks 1-4: 0.25 mg once weekly — a starting dose to reduce the risk of GI side effects, not one of the labeled maintenance doses
• Weeks 5-8: increase to 0.5 mg once weekly
• After ≥4 weeks at 0.5 mg: if more glycemic control is needed, increase to 1 mg once weekly (for type 2 diabetes with chronic kidney disease, 1 mg is the recommended maintenance dose)
• After ≥4 weeks at 1 mg: if more glycemic control is needed, increase to the maximum 2 mg once weekly

Two structural differences from Wegovy: Ozempic injection's maximum dose is 2 mg (not 2.4 mg or 7.2 mg), and Ozempic has no 1.7 mg step — it goes 1 mg straight to 2 mg. The label lists 0.5 mg, 1 mg and 2 mg as the maintenance doses, chosen by glycemic control.^[2] Because Ozempic and Wegovy are the same molecule (semaglutide), people sometimes assume the doses are interchangeable; they are not — the brands have different approved ladders and ceilings. Note also that the Ozempic name now covers a separate oral tablet (1.5, 4 and 9 mg) that is dosed completely differently from the injection (see below).^[5] See the Ozempic drug page for full details, and our ranking of the best semaglutide providers for where to get a legitimate prescription.

Oral semaglutide: Wegovy tablets, Rybelsus and Ozempic tablets

Semaglutide also comes as a once-daily tablet, and the tablet milligrams are much larger than the injection milligrams because very little of an oral dose is absorbed. The tablet ladders step up every 30 days, not every four weeks, and none of the tablet doses converts milligram-for-milligram to an injection dose — or even to another tablet brand: the label states that Rybelsus and Ozempic tablets are not substitutable on a mg-to-mg basis.^[1][5]

All three tablets are taken the same way: one tablet on an empty stomach in the morning with up to 4 ounces of plain water, swallowed whole, then wait at least 30 minutes before eating, drinking or taking other oral medicines.^[1][5] Wegovy tablets 25 mg is the oral counterpart of Wegovy 2.4 mg injection: the label lets patients switch from 2.4 mg injection to 25 mg tablets one week after the last injection, or from 25 mg tablets back to the 2.4 mg injection the day after the last tablet.^[1] In the OASIS 4 trial, adults with obesity or overweight (without diabetes) on oral semaglutide 25 mg lost a mean of 13.6% of body weight at 64 weeks versus 2.2% on placebo.^[7] For the full Rybelsus schedule and timing rules, see our Rybelsus dosage chart.

Why the 4-week escalation matters (tolerability and GI side effects)

The four-week step schedule is not arbitrary, and it is not optional padding — it is the mechanism that makes semaglutide tolerable. Semaglutide's most common side effects are gastrointestinal: nausea, vomiting, diarrhea, and constipation. These are dose-related and most intense when the dose increases. Both injection labels say the escalation schedule exists to reduce the risk of gastrointestinal adverse reactions: starting at 0.25 mg and holding each rung for four weeks lets the gut adapt before the next increase.^[1][2]

The practical consequence: skipping a rung or rushing the schedule predictably worsens nausea and vomiting and is a documented source of dosing errors, especially with non-standardized compounded product. If a dose is not tolerated, the correct move under the label is to delay the next step up — staying longer at the current dose — rather than push through. The same logic applies at the top of the Wegovy ladder: in STEP UP, GI side effects were more frequent at 7.2 mg than at 2.4 mg.^[6] Persistent severe GI symptoms also warrant a check for dehydration-related complications such as acute kidney injury. None of this is a reason to fear the drug; it is the reason the ladder is shaped the way it is.

Compounded semaglutide dosing differs (mg may not map 1:1)

A critical caveat for anyone on compounded semaglutide: the mg numbers in this chart describe the FDA-approved Wegovy and Ozempic products, and they do not necessarily map 1:1 to a compounded prescription. Compounded semaglutide is not an FDA-approved drug — it is prepared by a compounding pharmacy under a separate regulatory pathway, and its concentration, vial sizing, and titration schedule are set by the prescribing clinician and pharmacy, not by the brand label.

• Units vs milligrams. Compounded semaglutide is frequently dosed in units on an insulin syringe or in mL drawn from a vial of a specific concentration. A "20-unit" dose means nothing without knowing the vial concentration — the same volume can deliver very different milligram amounts.
• Non-standard escalation. A compounding clinic's titration may not match the 0.25 → 0.5 → 1 → 1.7 → 2.4 mg Wegovy steps. Some use different increments or hold points.
• Salt-form differences. The FDA has warned about compounded products using salt forms (semaglutide sodium/acetate) that differ from the base molecule in the approved drugs — another reason a milligram on a compounded label may not behave like a milligram of Wegovy.^[4]

Missed dose and titration pauses

The missed-dose rules are different for each product, so check which one you use:^[1][2][5]

• Wegovy injection: if the next scheduled dose is more than 2 days away, take the missed dose as soon as possible; if it is less than 2 days away, skip the missed dose and resume on your regular day. Do not double up.
• Wegovy injection, 2 or more doses in a row missed: the label says to restart the escalation at a lower dose to reduce the risk of GI side effects — contact your prescriber rather than jumping back in at your previous dose.
• Ozempic injection: take the missed dose as soon as possible within 5 days of the missed dose; if more than 5 days have passed, skip it and take the next dose on your regular day.
• Wegovy tablets, Rybelsus and Ozempic tablets: skip the missed tablet and take the next dose the following day. Never take more than one tablet a day.

Titration pauses are normal and expected. Staying longer at a given rung — or stepping back down — because of side effects is a label-sanctioned strategy, not a failure. A pause simply pushes your timeline to the maintenance dose later; it does not mean the medication is not working. The GLP-1 titration planner can re-map your dates if you hold or repeat a dose.

When you reach maintenance

For Wegovy injection, the usual maintenance dose is 2.4 mg once weekly, reached at week 17, with 1.7 mg also a labeled maintenance dose based on response and tolerability; adults using it for weight reduction may later step up to the 7.2 mg maximum.^[1] For Wegovy tablets, maintenance is 25 mg once daily from day 91.^[1] For Ozempic injection, there isn't a single "maintenance" dose in the weight-loss sense — the prescriber stops escalating once glycemic targets are met, which may be at 0.5 mg, 1 mg, or the 2 mg maximum (1 mg for type 2 diabetes with chronic kidney disease).^[2]

Maintenance is not a finish line you graduate from — semaglutide is a chronic therapy. The Wegovy label frames weight management as reducing excess weight and maintaining that reduction long term, and trial follow-up shows weight tends to come back when semaglutide is stopped.^[1][3] Once at maintenance, the cadence is simply your weekly injection (or daily tablet) at the same dose, with periodic prescriber follow-up to monitor tolerability, weight or glycemic response, and any need to adjust. To find a provider for ongoing prescriptions, compare the best semaglutide providers, or read our reviews of Found and Ro.