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Metabolic & weight

Semaglutide

Also called Wegovy, Ozempic, Rybelsus, Wegovy HD, Wegovy pill, NN9535

Semaglutide is a long-acting copy of the gut hormone GLP-1. It lowers appetite and blood sugar, and it is one of the most widely used weight-loss and diabetes medicines in the world. It comes as a weekly shot and as a daily pill.

FDA-approvedApproved by the FDA for at least one use after large human trials.

All printable flashcards

Drawn from its published sequence: 31 residues, one bead each. The gold tail marks the fatty-acid chain.

Overview

Semaglutide is a long-acting copy of the gut hormone GLP-1. It lowers appetite and blood sugar, and it is one of the most widely used weight-loss and diabetes medicines in the world. It comes as a weekly shot and as a daily pill.

How it works

Established: semaglutide activates the GLP-1 receptor. In the pancreas this boosts insulin release and lowers glucagon when blood sugar is high. In the brain it reduces hunger and food intake, and it slows stomach emptying. Albumin binding gives it a half-life of about one week, which allows once-weekly injection. The oral tablet is co-formulated with an absorption enhancer and must be taken on an empty stomach.

What research shows

  • STEP 1 (human RCT, n=1,961, 68 weeks): semaglutide 2.4 mg weekly lowered body weight by about 14.9% vs 2.4% with placebo.
  • SELECT (human cardiovascular outcomes RCT, n=17,604, adults with heart disease and overweight or obesity, no diabetes): major cardiovascular events occurred in 6.5% on semaglutide 2.4 mg vs 8.0% on placebo, roughly a one-fifth relative reduction.
  • STEP UP (human RCT, n=1,407, 72 weeks): 7.2 mg weekly produced 18.7% mean weight loss vs 3.9% with placebo; about 31% lost at least 25% of body weight.
  • OASIS 4 (human RCT, n=307, 64 weeks): oral semaglutide 25 mg daily produced 16.6% weight loss vs 2.7% with placebo (on-treatment).
  • Pediatric trial (human RCT, n=201, ages 12+, 68 weeks) supported approval for adolescents with obesity.

Doses studied in people

Study or labelDose usedSource
FDA label, Wegovy injection (adults and ages 12+): escalation0.25 mg weekly weeks 1–4, 0.5 mg weeks 5–8, 1 mg weeks 9–12, 1.7 mg weeks 13–16, subcutaneous1
FDA label, Wegovy injection: maintenance2.4 mg (recommended) or 1.7 mg once weekly from week 17; adults may go up to 7.2 mg weekly after at least 4 weeks on 2.4 mg if more weight loss is needed. MASH maintenance 2.4 mg (may reduce to 1.7 mg).1
FDA label, Wegovy tablets: escalation and maintenance1.5 mg daily days 1–30, 4 mg days 31–60, 9 mg days 61–90, then 25 mg once daily, by mouth1
STEP 1 RCT in adults with obesity (n=1,961)2.4 mg once weekly, subcutaneous, 68 weeks2
STEP UP RCT (n=1,407)7.2 mg vs 2.4 mg once weekly, subcutaneous, 72 weeks4
OASIS 4 RCT (n=307)25 mg oral once daily, 64 weeks5

Doses above come from the FDA label and pivotal trials; Ozempic and Rybelsus (diabetes brands) use separate, lower dose schedules.

Read this first: these are the amounts given to participants in published studies or written on official prescribing labels, reported for reference. They are not recommendations. Trial doses were chosen for specific patients under medical supervision, and a dose that is safe in one person can be harmful in another.

Weekly protocol

How the schedule looks week by week. Each chart says where it comes from: a prescribing label, a clinical trial, or a protocol commonly reported online.

Wegovy label titration

Prescribing label

One week

D1D2D3D4D5D6D7

Once weekly · Subcutaneous injection

Dose by week

0.25 mgwk 1–4
0.5 mgwk 5–8
1 mgwk 9–12
1.7 mgwk 13–16
2.4 mgMaintenance · wk 17+
Course
Ongoing (maintenance)
Note
If a dose is not tolerated, escalation can be delayed 4 weeks; 1.7 mg is an alternative maintenance dose. Adults on 2.4 mg for at least 4 weeks may go up to a maximum of 7.2 mg weekly if more weight loss is needed.
Source
WEGOVY prescribing information (FDA, revised 05/2026)

Ozempic label titration

Prescribing label

One week

D1D2D3D4D5D6D7

Once weekly · Subcutaneous injection

Dose by week

0.25 mgStarting · wk 1–4
0.5 mgwk 5–8
1 mg (if more glucose control is needed)wk 9–12
2 mg (if more glucose control is needed)Maintenance · wk 13+
Course
Ongoing (maintenance)
Note
Maintenance is 0.5 mg, 1 mg or 2 mg weekly based on glucose control; each increase needs at least 4 weeks on the current dose. Maximum 2 mg weekly.
Source
OZEMPIC prescribing information (FDA, revised 01/2025)

Reference only, not a recommendation. Label and trial schedules were set for specific patients under medical supervision. Use the calculator only to understand the arithmetic.

Safety

  • Boxed warning (label): thyroid C-cell tumors in rodents; human relevance unknown. Contraindicated with personal or family history of medullary thyroid carcinoma or MEN 2.
  • Most common side effects (label, 2.4 mg vs placebo): nausea 44% vs 16%, diarrhea 30% vs 16%, vomiting 24% vs 6%, constipation 24% vs 11%, abdominal pain 20% vs 10%.
  • Label warnings include pancreatitis, gallbladder disease, low blood sugar with insulin or sulfonylureas, kidney injury from dehydration, allergic reactions, diabetic retinopathy complications, and aspiration risk during anesthesia or deep sedation.
  • Higher 7.2 mg dose caused more gastrointestinal effects and dysesthesia (abnormal skin sensations) than 2.4 mg in STEP UP.
  • Compounded and unapproved versions (including salt forms such as semaglutide sodium or acetate) have been linked by FDA to dosing errors and adverse events.

Report side effects of any drug or product to the FDA through MedWatch. For a possible poisoning in the US, call Poison Control at 1-800-222-1222.

Storage and stability

Per label: injection pens refrigerated before first use; tablets stored at room temperature in original packaging.

General lab handling, not instructions for personal use. See Storage and stability.

History

Developed by Novo Nordisk as a longer-acting successor to liraglutide. Approved for type 2 diabetes as Ozempic (2017) and as the oral tablet Rybelsus (2019). Approved for chronic weight management as Wegovy injection in 2021, then for cardiovascular risk reduction based on the SELECT trial. Wegovy gained accelerated approval for MASH with fibrosis. The oral Wegovy 25 mg tablet was approved on December 22, 2025, and a higher-dose 7.2 mg injection (Wegovy HD) was approved on March 19, 2026, under FDA's Commissioner's National Priority Voucher program.

Common questions

Is semaglutide FDA-approved?

Yes. It is approved as Ozempic and Rybelsus tablets for type 2 diabetes, and as Wegovy for weight management, heart risk reduction and the liver disease MASH with fibrosis 1. A Wegovy pill was approved on December 22, 2025, and a higher 7.2 mg Wegovy injection on March 19, 2026 64.

What does the research show?

In STEP 1 (1,961 adults, 68 weeks), 2.4 mg weekly lowered weight by about 14.9% vs 2.4% on placebo 2. In SELECT, adults with heart disease and excess weight had major heart events in 6.5% on semaglutide vs 8.0% on placebo 3.

What doses are on the label?

The Wegovy injection label starts at 0.25 mg weekly and steps up every 4 weeks to a 2.4 mg or 1.7 mg weekly maintenance dose, with adults allowed up to 7.2 mg in some cases 1. The Wegovy pill steps up to 25 mg once daily, and the diabetes brands use separate, lower schedules 1. These are label figures, not personal guidance.

What are the side effects?

Stomach effects are most common; on the label, nausea affected 44% vs 16% on placebo and diarrhea 30% vs 16% 1. It carries a boxed warning about thyroid tumors seen in rodents and is not for people with a personal or family history of medullary thyroid cancer or MEN 2 1.

Are compounded versions still allowed?

FDA declared the shortage over on February 21, 2025, and the grace periods for compounders ended in April and May 2025 7. Copies are now allowed only for documented patient-specific medical differences, and FDA has linked compounded and salt-form versions to dosing errors and adverse events 711.

Is semaglutide banned in sport?

No. It is not prohibited, but WADA tracks it in its Monitoring Program and said in 2026 there is not yet enough evidence to list GLP-1 drugs 910.

Sold in blends and stacks

CagriSema (cagrilintide + semaglutide)

Related compounds

Metabolic & weightFDA-approvedFlashcard

Liraglutide

Saxenda · Victoza

Liraglutide is an older, once-daily GLP-1 medicine.

Metabolic & weightFDA-approvedFlashcard

Tirzepatide

Zepbound · Mounjaro

Tirzepatide is a weekly shot that acts on two gut-hormone receptors, GIP and GLP-1, at once.

Metabolic & weightLate-stage trialsFlashcard

Cagrilintide (and CagriSema)

NN9838 · CagriSema (cagrilintide + semaglutide)

Cagrilintide is an experimental weekly shot that mimics amylin, a fullness hormone made by the pancreas.

Metabolic & weightFDA-approvedFlashcard

Orforglipron

Foundayo · LY3502970

Orforglipron is a once-daily pill that activates the GLP-1 receptor, but it is a small molecule, not a peptide.

Sources

  1. Wegovy (semaglutide) Prescribing Information, revised 6/2026 (Drugs.com mirror of FDA label) FDA label
  2. Wilding JPH et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity (STEP 1). N Engl J Med 2021 Journal
  3. Lincoff AM et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes (SELECT). N Engl J Med 2023 Journal
  4. Higher-dose semaglutide approved under new FDA accelerated review process (AJMC, Mar 20, 2026) Regulatory
  5. FDA approves Wegovy pill, the first oral GLP-1 to treat obesity (Healio) Regulatory
  6. FDA approval letter, Wegovy tablets NDA 218316 (Dec 22, 2025) Regulatory
  7. FDA winds down GLP-1 compounding policies (TechTarget) Regulatory
  8. FDA issues warning letters to 30 telehealth companies over misleading compounded GLP-1 RA marketing (Mar 2026) Regulatory
  9. WADA publishes Prohibited List 2026 (NADA Germany) Regulatory
  10. WADA publishes 2027 Prohibited List (World Rugby summary) Regulatory
  11. Navigating the 2026 peptide regulatory landscape (D.J. Holt Law, Jul 2026) Regulatory

Last reviewed 2026-10-25 · How we research · Found an error? See our corrections policy.