Ozempic dosing schedule: what the label says at each step

Ozempic is semaglutide for adults with type 2 diabetes. Its label (revised January 2025) gives three indications: glycemic control as an adjunct to diet and exercise, reduction of major adverse cardiovascular events in adults with type 2 diabetes and established cardiovascular disease, and reduction of the risk of sustained eGFR decline, end-stage kidney disease and cardiovascular death in adults with type 2 diabetes and chronic kidney disease. Weight is not on the list. The schedule below is the label's, step by step.

The schedule as written

Weeks 1 to 4: 0.25 mg once weekly. The label calls this the initiation dosage and states that it is not intended for glycemic control. It exists to reduce gastrointestinal reactions.

Week 5 onward: 0.5 mg once weekly. The first maintenance dose.

1 mg. "If additional glycemic control is needed, increase the dosage to 1 mg once weekly after at least 4 weeks on the 0.5 mg dosage." For the kidney indication, the label directs the increase to 1 mg after 4 weeks at 0.5 mg.

2 mg. "If additional glycemic control is needed, increase the dosage to 2 mg once weekly after at least 4 weeks on the 1 mg dosage." This is the maximum. The 2 mg dose was added March 28, 2022 (Drugs@FDA supplement 9).

Three things follow. Every increase after 0.5 mg is conditional, so there is no default destination. "At least 4 weeks" is a floor, not a schedule; a prescriber can hold a step for months. And the label never says what "additional glycemic control is needed" means in numbers; that is the prescriber's judgment against your A1c.

The pens

Ozempic comes in three prefilled multi-dose pens, all 3 mL, distinguished by concentration:

The pen dials the dose. You never count syringe units with Ozempic, which is one of the practical differences from a compounded vial. The label notes a 2 mg per 1.5 mL strength that is not currently marketed. Each pen is for one patient only, even with a new needle. The pens guide covers storage, the 56-day in-use limit and needle handling.

Timing rules

Same day each week, any time of day, with or without food. Abdomen, thigh or upper arm, rotating sites within a region. The weekly day can be changed as long as two doses are at least 2 days (more than 48 hours) apart; see changing your injection day. A missed dose can be taken within 5 days; after that, skip it. The missed-dose helper applies that rule.

The evidence behind the two extra indications

The cardiovascular indication (approved January 16, 2020) rests on SUSTAIN-6: 3,297 people with type 2 diabetes at high cardiovascular risk, a primary outcome of cardiovascular death, non-fatal heart attack or non-fatal stroke in 6.6% on semaglutide versus 8.9% on placebo, hazard ratio 0.74 (95% CI 0.58 to 0.95). The same trial found more retinopathy complications on semaglutide, hazard ratio 1.76 (95% CI 1.11 to 2.78), which is why the label carries a diabetic retinopathy warning (PubMed 27633186).

The kidney indication (approved January 28, 2025) rests on FLOW: 3,533 people with type 2 diabetes and chronic kidney disease, a composite kidney outcome 24% lower on semaglutide 1 mg, hazard ratio 0.76 (95% CI 0.66 to 0.88), with death from any cause 20% lower, hazard ratio 0.80 (95% CI 0.67 to 0.95), over a median 3.4 years (PubMed 38785209). The outcomes trials guide has the details.

What the label does not say

It does not give a weight-loss dose, because weight is not an Ozempic indication; the 2.4 mg weight-management dose belongs to Wegovy. It does not describe compounded semaglutide, which is not FDA approved and not interchangeable with Ozempic. And it does not tell you what to do if you were started on a compounded product at an Ozempic-like schedule; that is a conversation with the prescriber who wrote it. Use the titration planner to date whichever schedule you were given.