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Semaglutide (Ozempic / Wegovy / Rybelsus)
The most studied GLP-1 agonist — proven 15% average body weight reduction in clinical trials.
📍 GLP-1 / Weight Loss
⏱ Once weekly
💉 SubQ (abdomen, thigh, or upper arm)
🔄 Cycle: Ongoing / long-term
⏳ Half-life: ~7 days
❄️ Storage: 28 days refrigerated
💉 Dosing Reference Table
| Week | Dose | Notes |
|---|
| 1–4 | 0.25 mg/week | Starting dose — tolerance building |
| 5–8 | 0.5 mg/week | First escalation |
| 9–12 | 1.0 mg/week | Therapeutic dose for many |
| 13–16 | 1.7 mg/week | Escalation toward max |
| 17+ | 2.4 mg/week | Maximum approved dose (Wegovy) |
| Maintenance | 1.0–2.4 mg/week | Stay at lowest effective dose |
Semaglutide must be titrated slowly to minimize GI side effects (nausea, vomiting). The titration schedule above is the FDA-approved Wegovy protocol. Many clinicians extend each step to 6–8 weeks rather than 4 to improve tolerability. Take on the same day each week. Injection can be in abdomen, front of thigh, or upper arm. Rotate sites.
🔀 Common Stacks
+ Tirzepatide (switch, not stack)
Many patients switch from semaglutide to tirzepatide for greater weight loss (~21% vs ~15%). Not typically combined — they act on overlapping pathways.
+ BPC-157
Some practitioners add BPC-157 to help with GI side effects during GLP-1 titration, leveraging BPC-157's gut-healing properties.
❓ Frequently Asked Questions
What's the difference between Ozempic and Wegovy?
Same molecule (semaglutide), different doses and approvals. Ozempic is approved for type 2 diabetes at up to 2 mg/week. Wegovy is approved for chronic weight management at 2.4 mg/week. Rybelsus is an oral form at 14 mg/day (lower bioavailability). The 2.4 mg/week dose produces more weight loss but also more side effects.
Why do I need to titrate slowly?
GLP-1 slows gastric motility. Too high a dose too quickly causes significant nausea, vomiting, and rarely, gastroparesis. The titration protocol allows GI adaptation. Most side effects occur in the first 4–8 weeks and improve substantially after. Eating smaller, lower-fat meals helps during titration.
What happens if I stop taking it?
Weight regain begins within weeks of stopping semaglutide. The STEP 4 withdrawal trial showed ~2/3 of weight lost returned within 1 year after stopping. This suggests semaglutide manages obesity chronically, similar to how antihypertensives manage blood pressure — it works while you take it.
Can I use compounded semaglutide?
Compounded semaglutide became widely available due to FDA shortage listings. Quality varies significantly between compounders. Avoid formulations containing 'semaglutide sodium' — this is not bioequivalent to the approved molecule. Acetate form is the correct salt. FDA shortage status and regulations change — verify current status.
What are the main side effects?
Nausea (44% of patients), diarrhea (30%), vomiting (24%), constipation (24%). Usually worst during titration, improve over time. Rare but serious: pancreatitis, gallbladder disease, increased heart rate. Contraindicated with personal or family history of medullary thyroid carcinoma or MEN2.