Semaglutide dosing is straightforward. All patients start out at the lowest dose with gradual titration.
TITRATION
Here is the standard titration schedule
- Weeks 1-4: Semaglutide 5mg/mL – 0.05 mL (5 units) SQ weekly for 4 weeks
- Weeks 5-8: Semaglutide 5 mg/mL – 0.10 ml (10 units) SQ weekly for 4 weeks
- Weeks 9-12: Semaglutide 5mg/mL – 0.20 ml (20 units) SQ weekly for 4 weeks
- Weeks 13 and onward: Semaglutide 5 mg/mL – 0.35 ml (35 units) SQ weekly for 4 weeks THEN 0.50 ml (50 units) SQ weekly thereafter
While this is the recommended dosing schedule, the majority of patients do not need to titrate to the maximum dose. In fact, some patients reach a therapeutic dose as low as 10 units.
The goal is to have patients reach a therapeutic dose that reduces both nutritional hunger and emotional hunger such that they are able to (1) effectively lose weight (2) make the required behavioral changes without the burden of excessive nutritional and/or emotional hunger
We do not recommend dosing that completely negates hunger. Hunger is normal and patients need the context of some hungry in order connect the type of hunger they are experiencing with their eating behavior.
In many cases, it is reward-based (emotional) hunger that tends to be problematic for patients and often requires a higher dosage than nutritional hunger. However, there is a lot of individual variability.
As patients go through the program, episodic dosage adjustments may be necessary. It is important to monitor patients success in the program (metabolic health improvements, weight loss), their goals, and the degree of hunger that they are having to manage. Patients should understand that the dose is not related to the severity of obesity or the pathology of eating behavior. It is more dependent on pharmacology and how individual patients metabolize the medication.
TAPERING
Tapering SG is more art than science. A few patients are able to titrate off quite quickly (a few weeks); however, most patients benefit from a much longer titration schedule. In general, the provider should review the patient’s goals and confidence with maintaining their health behaviors before titrating.
In general, a titration of 3-5 units every 2 weeks is a reasonable option. However, some patients require a much longer schedule along with occasional ‘pauses’ at a given dose before resuming titration. As noted, some patients will require long-term treatment and should be encouraged as to the safety of the medication and importance of maintaining their weight loss and metabolic health.
There is some evidence that biweekly dosing is reasonable for some patients once they are at the lower dosage–for example 10 units every 2 weeks.
