Semaglutide dosage chart: Wegovy and Ozempic titration in units

Wegovy and Ozempic are the same molecule at different doses for different indications. Both start at 0.25 mg once weekly for 4 weeks and move to 0.5 mg. From there, Wegovy continues to 1.0 mg, then 1.7 mg, then the 2.4 mg maintenance dose, holding each for at least 4 weeks, which means the full climb takes a minimum of 16 weeks. Ozempic moves from 0.5 mg to 1 mg and then to 2 mg only if more glucose control is needed, and 2 mg is its ceiling.

The 2.4 mg Wegovy dose is the one studied in STEP 1, where adults without diabetes lost about 15 percent of body weight over 68 weeks against roughly 2.5 percent on placebo. Ozempic's 1 and 2 mg doses were studied for HbA1c in the SUSTAIN program, and the weight loss at those doses is real but smaller. People using Ozempic off-label for weight tend to find that out when they plateau at 1 mg.

Not everyone needs the top step. The compound page notes that many people stop escalating at whatever dose controls appetite, and the label's as-tolerated language allows holding at 1.0 or 1.7 mg indefinitely. A 7 day half-life means each step takes about a month to settle, which is why the label refuses to move faster than 4 weeks.

The 0.25 mg step has almost no weight loss effect and is not meant to. It is there so the stomach can adapt to slower emptying before the drug reaches a level that suppresses appetite hard. In the STEP trials, GI side effects were most common during escalation and most people who quit did so in that window. A month at 0.25 mg lowers the chance of a bad start.

Skipping it is the most common mistake on the grey market, where nobody dispenses a starter pen. People who begin at 0.5 or 1 mg report the nausea that the schedule was designed to avoid, and some of them conclude the drug does not suit them when it was the ramp that failed. The side effects by dose step article walks through what each step tends to produce.

The same logic applies to every later increase. The compound page's protocol note is explicit: do not step up while still nauseous on the current dose. Holding a step for 8 weeks instead of 4 costs nothing except time.

The answer is the dose divided by the concentration, times 100. At 2.5 mg/mL, 0.25 mg is 0.1 mL, or 10 units on a U-100 insulin syringe. At 5 mg/mL it is 5 units. At 1 mg/mL it is 25 units. The live chart above does this for every step at all three concentrations.

The pattern to notice is that the low steps are tiny at high concentrations. At 5 mg/mL, the 0.25 mg start is a 5 unit draw and 0.5 mg is 10 units, both small enough that a half-unit error is a 10 percent dose error. At 1 mg/mL the top step is 240 units, which does not fit a 1 mL syringe. The middle concentration, 2.5 mg/mL, keeps every step between 10 and 96 units, which is why it is the most common choice for the early months.

Drawing units from a vial at a different concentration than the one you calculated for is the error that causes overdoses. Ten units is 0.25 mg at 2.5 mg/mL and 1 mg at 10 mg/mL, four times the starting dose. The calculator takes the vial size and water volume and returns the units for any dose; the insulin syringe units chart covers the syringe sizes.

Concentration is the vial amount divided by the water you add. A 5 mg vial with 1 mL of bacteriostatic water is 5 mg/mL; with 2 mL it is 2.5 mg/mL. A 10 mg vial with 2 mL is 5 mg/mL and with 4 mL is 2.5 mg/mL. The compound page lists 5 mg with 1 mL, 10 mg with 1 mL and 20 mg with 2 mL as the standard amounts; the 10 mg with 1 mL option gives 10 mg/mL, where 0.25 mg is a 2.5 unit draw that is too small to measure reliably on most syringes.

For someone starting at 0.25 mg, the practical choice is more water. A 5 mg vial at 2.5 mg/mL gives twenty 0.25 mg doses of 10 units each, or ten 0.5 mg doses. The compound page gives a 4 week refrigerated window for reconstituted semaglutide, and at 0.25 mg a 5 mg vial would last 20 weeks, so it will expire first. Smaller vials or accepting the waste are the two ways around that.

At maintenance, higher concentration makes sense. A 10 mg vial with 2 mL at 5 mg/mL gives 2.4 mg as a 48 unit draw, and the vial lasts about four weeks, matching the storage window. Keep reconstituted vials refrigerated at 2 to 8 C and do not freeze them. The reconstitution guide covers the mixing itself.

The 2.4 mg maintenance dose produced about 15 percent average loss in STEP 1, with roughly a third of participants losing 20 percent or more and some losing very little. The STEP 1 extension found that most of the lost weight returned within a year of stopping. That is the case for treating semaglutide as a long-term drug rather than a course, and the compound page's cycle note says the same: ongoing, with a slow taper if stopping.

Head to head, tirzepatide 15 mg beat semaglutide 2.4 mg in SURMOUNT-5 at about 20 versus 14 percent over 72 weeks. Semaglutide's advantage is the SELECT cardiovascular outcomes trial, which showed a 20 percent reduction in major cardiovascular events in people with obesity and existing heart disease, something no other weight management peptide has yet. The semaglutide vs tirzepatide comparison weighs those against each other.

Reduced maintenance doses, sometimes called microdosing, are a popular idea without trial support. Our GLP-1 microdosing article explains what people describe doing and why no controlled study backs it for weight loss.

The Wegovy label says that if a dose is missed and the next scheduled dose is more than 2 days away, take the missed dose as soon as possible. If the next dose is less than 2 days away, skip the missed one and resume on the usual day. In practice this gives a window of about 5 days after the scheduled time. Two doses should never be taken within 2 days of each other.

The injection day can be changed as long as at least 2 days separate the doses. Because the half-life is about 7 days, a single late dose has little effect on blood levels. Missing two or more weeks in a row is different: the label says that after more than 2 weeks without a dose, restarting at the previous dose risks GI side effects and a lower restart should be considered. Clinicians commonly drop back one or two steps.

Wegovy pens deliver a fixed dose with no math. Compounded semaglutide is a multi-dose vial at a pharmacy-chosen concentration, often 2.5 mg/mL, and the prescription gives a volume or a units number specific to that concentration. Grey-market vials are lyophilized powder you reconstitute yourself. The mg schedule is the same across all three; the number on the syringe is not.

The FDA has reported dosing errors with compounded semaglutide where patients drew the units intended for one concentration from a vial at another, or confused mL with units, and took many times the intended dose. The fix is mechanical: find the concentration on the label, calculate the units for the current step, and recalculate with every new vial. Carrying a units number from one vial to the next is how the errors happen.

The supply side is also changing. On April 30, 2026 the FDA proposed removing semaglutide, tirzepatide and liraglutide from the 503B bulks list; the Federal Register notice ran May 1 and the comment period closed June 29. As of October 2026 no final decision has been reported. If finalized, outsourcing facilities could no longer compound from bulk powder outside a shortage. Our buying guide covers what that means for compounded supply.