The escalation schedule
The semaglutide chart at /semaglutide-dosage-chart mirrors the FDA-approved Wegovy weekly escalation: 0.25 mg → 0.5 mg → 1.0 mg → 1.7 mg → 2.4 mg, with each step held for four weeks before advancing. Ozempic shares the first three rungs (0.25 → 0.5 → 1.0 mg) and tops out at 1.0 mg or 2.0 mg weekly depending on glycemic response. The single subcutaneous injection is given on the same day each week, with or without food.
The four-week step interval is not pharmacokinetic. Semaglutide has a half-life of roughly seven days; steady state on any given dose is reached in about five weeks. The label holds each dose for four weeks because the rate-limiting factor for tolerability is gastrointestinal (nausea, vomiting, diarrhea, constipation), and those effects subside as receptors downregulate to a given exposure level. Stepping up before that adaptation completes is what produces the "I quit Ozempic in week three" pattern.
The calculator's two inputs (current week and starting dose) locate you on that schedule. They do not change the schedule itself; they tell you which rung the FDA label assigns to your week number, and what comes next.
Why those specific doses
The five doses on the Wegovy schedule are not arbitrary. Each one is the dose that was carried forward from earlier-phase dose-finding into the STEP 1–8 obesity program and the SUSTAIN diabetes program. The 2.4 mg/week ceiling for Wegovy is the dose at which STEP 1 reported approximately 14.9% body-weight loss at 68 weeks, and is the highest dose for which a favorable benefit-risk ratio has been demonstrated in chronic weight management. Going above 2.4 mg in obesity has not been studied at scale.
The 2.0 mg/week ceiling for Ozempic is the diabetes maximum. SUSTAIN-FORTE compared 1.0 mg and 2.0 mg in adults with type 2 diabetes inadequately controlled on metformin, and the 2.0 mg arm produced an additional ~0.2–0.3% reduction in HbA1c with a similar GI profile. That dose was added to the Ozempic label after the original 1.0 mg approval. It is not interchangeable with Wegovy 2.4 mg; the indication, the label, and the supply chain differ even when the molecule is identical.
The intermediate rungs (0.5, 1.0, 1.7) exist because the trial protocols required them, and the label preserves them because they were the conditioning steps that produced the tolerability profile reported in the registration trials.
Assumptions and limits
The calculator makes specific assumptions that the user is responsible for verifying:
- Weekly subcutaneous dosing via a labeled pen (Ozempic or Wegovy). Compounded semaglutide is not modeled. Concentrations vary across compounding pharmacies, and the FDA has issued multiple warning letters about identity, purity, and salt-form (semaglutide sodium / acetate) issues.
- No FDA-label contraindications. Personal or family history of medullary thyroid carcinoma, MEN-2 syndrome, prior pancreatitis, severe gastroparesis, severe diabetic retinopathy, or pregnancy are absolute or relative contraindications and the chart does not flag them.
- The user is FDA-label-eligible and under prescriber care. The chart is not a prescription, a dose-titration protocol, or a substitute for clinical judgment.
- Individual GI tolerability is not modeled. Some patients tolerate the standard 4-week step; others need a 6–8 week hold at 0.25 or 0.5 mg, or a return to a lower dose mid-titration. That decision belongs to the prescriber, not the chart.
If any of those assumptions does not hold, the schedule the chart shows is not the schedule that applies to you.
Unit conventions
Semaglutide is dosed in milligrams per week, not per month or per day. "0.25 mg" on this chart means 0.25 mg administered once that week, not 0.25 mg/day, not 0.25 mg total over the four-week step. The four-week interval refers to how long each dose is held before advancing, not the dosing frequency.
Pen mechanics complicate the picture. The Ozempic 0.25/0.5 mg pen and the 1.0 mg pen contain semaglutide at 1.34 mg/mL and deliver fixed-volume "clicks": the user does not measure milligrams directly; they advance the dose selector to a marked position. Wegovy ships single-dose pens at the exact prescribed strength (0.25, 0.5, 1.0, 1.7, 2.4 mg), so the milligram value on the pen is the milligram value injected.
Compounded vials reverse this: the user is given a concentration in mg/mL and must compute injection volume themselves. The unit converter on the calculator page handles that conversion against a U-100 insulin syringe; the chart on this methodology page does not.
Why this is documentary, not prescriptive
This page documents what the FDA label says. It does not tell you what to take, when to advance, or when to hold. If you are starting semaglutide, the prescriber writing the script sets the schedule, including whether to hold a step longer for tolerability, whether your indication maps to the Ozempic or Wegovy ceiling, and whether contraindications rule the molecule out entirely.
The research-first framing of this site means the calculator surfaces the published escalation and the trial doses behind it. It does not mean the chart is a treatment plan. The signal we want to be useful, "here is the FDA-approved schedule, here is what the trials measured, here is what the calculator does and does not assume", is documentary by design. Prescriptive dosing is the prescriber's job.