How do I titrate semaglutide?
The standard semaglutide titration schedule starts at 0.25 mg weekly and increases every 4 weeks. Here's why the ramp matters and what to do if side effects derail you.
Updated April 18, 2026 · 2 min read
The standard titration schedule for semaglutide (Ozempic, Wegovy, or compounded) is designed to let your gut adjust gradually. Skipping ahead almost always backfires.
The standard schedule
| Weeks | Weekly dose |
|---|---|
| 1–4 | 0.25 mg |
| 5–8 | 0.5 mg |
| 9–12 | 1.0 mg |
| 13–16 | 1.7 mg |
| 17+ | 2.4 mg (Wegovy max) |
You inject once per week, on the same day, into the abdomen, thigh, or upper arm. Rotate the site each week.
Why titrate at all?
The receptors GLP-1 binds to live on your stomach, your pancreas, and your brain. When activated suddenly at a high dose, the most common result is severe nausea — bad enough that many people quit in the first month. The 4-week ramp gives those receptors time to desensitize slightly so you can tolerate the therapeutic dose.
What if a step is too much?
Two options, both fine:
- Stay at the current dose for an extra 2–4 weeks before stepping up. There's no medal for hitting 2.4 mg on schedule.
- Step down half a level, hold for 2 weeks, then try the increase again.
What you should not do is push through severe nausea, vomiting, or dehydration — those are signals to slow down, not reasons to "tough it out."
What about compounded semaglutide?
Compounded versions are dosed identically by milligram, but reconstitution math gets in the way. If you have a 5 mg vial reconstituted with 2.5 mL of bacteriostatic water, your concentration is 2 mg/mL — so a 0.25 mg dose is 0.125 mL, which lands at 12.5 units on a U-100 syringe. Use our reconstitution calculator rather than doing this math at 7 a.m. on a Sunday.
Common questions
Can I split doses across the week? Semaglutide's half-life is ~7 days, so a single weekly injection produces a steady level. Splitting offers no benefit and adds injection burden.
What if I miss a dose? If it's been less than 5 days, take it as soon as you remember. If more than 5 days, skip and resume your normal schedule next week. Don't double up.
Can I drink alcohol? Pharmacologically yes, but practically: nausea + alcohol is rough, and GLP-1s tend to dampen alcohol's reward signal anyway. Many users find they simply lose interest.