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Peptide Spencer

GLP-1 receptor agonist (FDA-approved for chronic weight management, cardiovascular risk reduction, MASH, and type 2 diabetes depending on product)

Semaglutide

Also known as Wegovy (injection), Ozempic (injection), semaglutide injection

FDA-approved product

FDA-approved as Wegovy, Ozempic, and Rybelsus. Compounded semaglutide is not FDA-approved. Source, Jun 30, 2026

Identity. Semaglutide is the GLP-1 analogue in the FDA-approved products Wegovy and Ozempic (molecular weight 4113.58 g/mol per the Wegovy label). FDA states that some compounders sell semaglutide sodium and semaglutide acetate, which it describes as different active ingredients from those in approved drugs. The formulary entry does not say whether it is the base peptide or a salt. Compounded semaglutide has also been sold combined with cyanocobalamin (PMID 39776038). Approved labels express doses in mg per injection, while compounded vials are labeled by total mg and mg/mL. Unit and concentration confusion is the main dosing hazard. Oral warning: oral semaglutide (Rybelsus; Wegovy and Ozempic tablets) is dosed in mg that are NOT interchangeable with subcutaneous mg. Label oral absolute bioavailability is about 0.4% to 1% (Rybelsus 3, 7, 14 mg) and 1% to 2% (Ozempic tablets 1.5, 4, 9 mg). Never carry an oral mg number into an injection or onto a formulary vial. Semaglutide/cyanocobalamin combinations are a different product from plain semaglutide. Keep their doses separate.

At a glance

These dosages are a helpful guide, not a prescription. Every clinician is expected to do their own due diligence before prescribing.

  1. Start

    0.25 mg subcutaneously once weekly for 4 weeks1

    Approved label

  2. Typical

    1.7 or 2.4 mg subcutaneously once weekly (2.4 mg recommended)1

    Approved label

  3. Ceiling

    7.2 mg SC once weekly, adult weight reduction, after at least 4 weeks on 2.4 mg1

    Approved label
Frequency
once weekly1
Route
subcutaneous (abdomen, thigh, or upper arm)1
Course
16 weeks of escalation, then maintenance from week 171

Oral and subcutaneous semaglutide mg doses are not equivalent, so never convert a tablet dose to an injection mg for mg.

Calculate this dose

Dosing detail

Approved label

Approved label

  • Wegovy injection, adults and pediatric patients 12 years and older, all approved indications: starting dosage and escalation (Table 1)

    0.25 (weeks 1-4); 0.5 (weeks 5-8); 1 (weeks 9-12); 1.7 (weeks 13-16) mg1

    Route
    subcutaneous (abdomen, thigh, or upper arm)
    Frequency
    once weekly
    Duration
    16 weeks of escalation, then maintenance from week 17
    n
    n/a (labeled dosing)
    Design
    FDA-approved labeling (Wegovy PI, section 2.2)
    Source quote
    Starting Dosage 1 through 4 0.25 mg Dosage Escalation 5 through 8 0.5 mg 9 through 12 1 mg 13 through 16 1.7 mg

    Finding. The label says to follow the escalation table to reduce GI adverse reactions. It advises considering a 4-week delay in escalation if a dose is not tolerated.

  • Wegovy injection, weight reduction in adults: maintenance dosage

    1.7 or 2.4 (2.4 recommended) mg1

    Route
    subcutaneous
    Frequency
    once weekly
    Duration
    maintenance from week 17 onward
    n
    n/a (labeled dosing)
    Design
    FDA-approved labeling (Wegovy PI, section 2.2)
    Source quote
    The maintenance dosage of WEGOVY for weight reduction in adults is either 1.7 mg or 2.4 mg (recommended) injected subcutaneously once weekly.

    Finding. Maintenance is 1.7 mg or 2.4 mg weekly, with 2.4 mg the recommended dose.

  • Wegovy injection, weight reduction in adults: maximum dosage after tolerating 2.4 mg

    7.2 mg1

    Route
    subcutaneous
    Frequency
    once weekly
    Duration
    after at least 4 weeks on 2.4 mg
    n
    n/a (labeled dosing)
    Design
    FDA-approved labeling (Wegovy PI, section 2.2)
    Source quote
    For patients who tolerate the 2.4 mg dosage for at least 4 weeks and additional weight reduction is clinically indicated, the dosage may be increased to a maximum dosage of 7.2 mg subcutaneously once weekly.

    Finding. The label sets 7.2 mg weekly as the maximum dosage when additional weight reduction is clinically indicated.

  • Wegovy injection, cardiovascular risk reduction in adults: maintenance dosage

    2.4 (recommended) or 1.7 mg1

    Route
    subcutaneous
    Frequency
    once weekly
    Duration
    maintenance
    n
    n/a (labeled dosing)
    Design
    FDA-approved labeling (Wegovy PI, section 2.2)
    Source quote
    The maintenance dosage of WEGOVY injection for cardiovascular risk reduction in adults is either 2.4 mg (recommended) or 1.7 mg once weekly.

    Finding. CV risk reduction maintenance is 2.4 mg (recommended) or 1.7 mg weekly.

  • Wegovy injection, weight reduction in pediatric patients aged 12 years and older: maintenance dosage

    2.4 (recommended) or 1.7 mg1

    Route
    subcutaneous
    Frequency
    once weekly
    Duration
    maintenance
    n
    n/a (labeled dosing)
    Design
    FDA-approved labeling (Wegovy PI, section 2.2)
    Source quote
    The maintenance dosage of WEGOVY injection for weight reduction in pediatric patients aged 12 years and older is either 2.4 mg (recommended), or 1.7 mg once weekly.

    Finding. Pediatric maintenance is 2.4 mg (recommended) or 1.7 mg weekly, after the same escalation table.

  • Wegovy injection, noncirrhotic MASH with moderate to advanced liver fibrosis in adults: maintenance dosage

    2.4 (may decrease to 1.7 if not tolerated) mg1

    Route
    subcutaneous
    Frequency
    once weekly
    Duration
    maintenance
    n
    n/a (labeled dosing)
    Design
    FDA-approved labeling (Wegovy PI, section 2.2); accelerated approval
    Source quote
    The recommended maintenance dosage of WEGOVY injection for the treatment of noncirrhotic MASH with moderate to advanced liver fibrosis in adults is 2.4 mg injected subcutaneously once weekly.

    Finding. MASH maintenance is 2.4 mg weekly; reduce to 1.7 mg if 2.4 mg is not tolerated.

  • Ozempic injection, type 2 diabetes: initiation dosage

    0.25 for 4 weeks, then 0.5 mg2

    Route
    subcutaneous (abdomen, thigh, or upper arm)
    Frequency
    once weekly
    Duration
    0.25 mg for 4 weeks, then 0.5 mg
    n
    n/a (labeled dosing)
    Design
    FDA-approved labeling (Ozempic PI, section 2.2)
    Source quote
    Initiate OZEMPIC with a dosage of 0.25 mg injected subcutaneously once weekly for 4 weeks.

    Finding. Ozempic starts at 0.25 mg weekly for 4 weeks, then 0.5 mg weekly.

  • Ozempic injection, type 2 diabetes: maintenance dosage

    0.5, 1, or 2 mg2

    Route
    subcutaneous
    Frequency
    once weekly
    Duration
    increase only after at least 4 weeks on the prior dose
    n
    n/a (labeled dosing)
    Design
    FDA-approved labeling (Ozempic PI, section 2.2)
    Source quote
    The recommended maintenance dosage is 0.5 mg, 1 mg, or 2 mg, injected subcutaneously once weekly, based on glycemic control.

    Finding. Maintenance 0.5, 1 or 2 mg weekly based on glycemic control.

  • Ozempic injection, type 2 diabetes: maximum dosage

    2 mg2

    Route
    subcutaneous
    Frequency
    once weekly
    Duration
    after at least 4 weeks on 1 mg
    n
    n/a (labeled dosing)
    Design
    FDA-approved labeling (Ozempic PI, section 2.2)
    Source quote
    The maximum recommended dosage is 2 mg once weekly.

    Finding. Maximum recommended Ozempic dosage is 2 mg weekly.

  • Wegovy injection, MISSED DOSE (section 2.4)

    Next dose more than 2 days away: give now. Less than 2 days away: skip and resume on the usual day. 2 or more consecutive missed doses: restart escalation at a lower dose, do not resume the last maintenance dose. mg1

    Route
    subcutaneous
    Frequency
    once weekly
    Duration
    n/a
    n
    n/a (labeled dosing)
    Design
    FDA-approved labeling
    Source quote
    more than 2 days away, administer WEGOVY injection as soon as possible. ... less than 2 days away, do not administer the WEGOVY injection dose. ... If 2 or more consecutive doses of WEGOVY injection are missed, reinitiate dosage escalation at a lower dosage

    Finding. Resuming at 2.4 mg or 7.2 mg after a gap risks severe GI reactions and volume depletion.

  • Ozempic injection, MISSED DOSE and changing the dosing day (section 2.1)

    Give as soon as possible within 5 days after the missed dose; if more than 5 days have passed, skip and give the next dose on the regular day. The dosing day may change if at least 2 days (more than 48 hours) separate two doses. mg2

    Route
    subcutaneous
    Frequency
    once weekly
    Duration
    n/a
    n
    n/a (labeled dosing)
    Design
    FDA-approved labeling
    Source quote
    If a dose is missed, administer OZEMPIC as soon as possible within 5 days after the missed dose. ... The day of weekly administration can be changed if necessary as long as the time between two doses is at least 2 days

    Finding. The Ozempic window (5 days) differs from the Wegovy window (2 days). The Ozempic label text reviewed does not give a restart rule after prolonged gaps.

  • Wegovy, switching from 25 mg tablets to injection (section 2.5): shows oral and SC mg are not equivalent

    Day after stopping Wegovy tablets 25 mg once daily: start Wegovy 2.4 mg SC once weekly mg1

    Route
    subcutaneous
    Frequency
    once weekly
    Duration
    n/a
    n
    n/a (labeled dosing)
    Design
    FDA-approved labeling
    Source quote
    The day after discontinuing WEGOVY tablets 25 mg once daily, initiate WEGOVY 2.4 mg subcutaneous injection once weekly.

    Finding. Oral 25 mg daily maps to 2.4 mg weekly injection; no mg-for-mg conversion.

  • Wegovy approved presentations (section 3), for concentration context

    2.4 mg in 0.75 mL and 7.2 mg in 0.75 mL (Wegovy HD); arithmetic: 3.2 mg/mL and 9.6 mg/mL mg1

    Route
    subcutaneous
    Frequency
    once weekly
    Duration
    n/a
    n
    n/a
    Design
    FDA-approved labeling
    Source quote
    7.2 mg (WEGOVY HD) 7.2 mg/0.75 mL

    Finding. Approved pens deliver 7.2 mg in 0.75 mL. At common compounded strengths of 2.5 and 5 mg/mL, 7.2 mg is 2.88 mL and 1.44 mL (calculated). That is more than one injection's usual volume and more than a whole 1, 2, 2.5 or 5 mg vial.

Human studies

Human study

  • STEP 1: adults with BMI 30 or greater (27 or greater with a weight-related condition), without diabetes; semaglutide vs placebo plus lifestyle intervention

    2.4 mg3

    Route
    subcutaneous
    Frequency
    once-weekly
    Duration
    68 weeks
    n
    1961 enrolled
    Design
    Double-blind randomized placebo-controlled trial, 2:1
    Source quote
    In this double-blind trial, we enrolled 1961 adults with a body-mass index [...] and randomly assigned them, in a 2:1 ratio, to 68 weeks of treatment with once-weekly subcutaneous semaglutide (at a dose of 2.4 mg) or placebo, plus lifestyle intervention.

    Finding. Mean body weight change -14.9% with semaglutide vs -2.4% with placebo at week 68 (difference -12.4 percentage points).

  • STEP UP: adults with obesity (BMI 30 or greater) without diabetes; semaglutide 7.2 mg vs 2.4 mg vs placebo plus lifestyle intervention

    7.2 (source prints 7·2) mg4

    Route
    subcutaneous
    Frequency
    once-weekly
    Duration
    72 weeks
    n
    1407 randomized (7.2 mg n=1005; 2.4 mg n=201; placebo n=201)
    Design
    Phase 3b randomized, double-blind, placebo- and active-controlled, 5:1:1
    Source quote
    Participants were randomly assigned (5:1:1) to receive once-weekly subcutaneous semaglutide 7·2 mg, 2·4 mg, or placebo, with a lifestyle intervention, for 72 weeks. [...] 1407 participants were randomly assigned to semaglutide 7·2 mg (n=1005), semaglutide 2·4 mg (n=201), or placebo (n=201).

    Finding. Weight change -18.7% on 7.2 mg vs -15.6% on 2.4 mg vs -3.9% placebo; GI events 70.8% vs 61.2% vs 42.8%; dysaesthesia 22.9% vs 6.0% vs 0.5%.

  • STEP UP T2D: adults with obesity and type 2 diabetes; semaglutide 7.2 mg vs 2.4 mg vs placebo plus lifestyle intervention

    7.2 (source prints 7·2) mg5

    Route
    subcutaneous
    Frequency
    once-weekly
    Duration
    72 weeks
    n
    512 randomized (7.2 mg n=307; 2.4 mg n=103; placebo n=102)
    Design
    Phase 3b randomized, double-blind controlled, three-arm, 3:1:1
    Source quote
    randomly assigned (3:1:1) to receive once-weekly subcutaneous semaglutide 7·2 mg, 2·4 mg, or placebo, alongside a lifestyle intervention, for 72 weeks [...] 512 participants were randomly assigned to receive semaglutide 7·2 mg (n=307), semaglutide 2·4 mg (n=103), or placebo (n=102).

    Finding. Weight change -13.2% on 7.2 mg vs -3.9% placebo; dysaesthesia 18.9% on 7.2 mg vs 4.9% on 2.4 mg and none on placebo.

  • SUSTAIN FORTE: adults with inadequately controlled type 2 diabetes on metformin with or without sulfonylurea; 2.0 mg vs 1.0 mg

    2.0 vs 1.0 (source prints 2·0 and 1·0) mg6

    Route
    not stated in the abstract (Ozempic label route is subcutaneous)
    Frequency
    once-weekly
    Duration
    40 weeks
    n
    961 (2.0 mg n=480; 1.0 mg n=481)
    Design
    Randomized, active-controlled, double-blind phase 3B, 1:1
    Source quote
    Participants were randomly assigned to once-weekly semaglutide 2·0 mg (n=480 [50%]) or 1·0 mg (n=481 [50%])

    Finding. HbA1c change -2.2 vs -1.9 percentage points (trial product estimand); body weight -6.9 kg vs -6.0 kg.

  • Retrospective real-world cohort at a commercial wellness studio: compounded semaglutide/cyanocobalamin injections

    start 0.25 mg/0.125 mg; maximum 2.4 mg/0.24 mg (semaglutide/cyanocobalamin) mg/mg (semaglutide/cyanocobalamin)7

    Route
    subcutaneous
    Frequency
    once-weekly
    Duration
    primary endpoint at 3 months
    n
    94 analysed
    Design
    Retrospective cohort, no control group
    Source quote
    Once-weekly semaglutide/cyanocobalamin injected subcutaneously starting at 0.25 mg/0.125 mg and titrated to a maximum dose of 2.4 mg/0.24 mg. [...] A total of 94 individuals were analysed (81F/13M)

    Finding. Average weight loss was 4.57% (SD 2.96%) at 3 months. The cohort used a semaglutide/cyanocobalamin combination, not semaglutide alone.

  • Retrospective real-world primary-care cohort in Denmark: adults prescribed semaglutide injections for weight management (brand product)

    at or below 1.0 (40%); 1.7 (30%); 2.4 (30%) among those still on treatment at 12 months mg/week8

    Route
    injection (subcutaneous not stated in the abstract)
    Frequency
    weekly
    Duration
    12-month follow-up
    n
    206 included; about 48% (n=98) remained on treatment
    Design
    Retrospective observational study, one general practice
    Source quote
    Amongst these, 40% were treated with ≤ 1.0 mg/week, 30% with 1.7 mg/week and 30% with 2.4 mg/week.

    Finding. Mean weight change was -13.6% at 12 months among those not discontinued. 38% permanently discontinued. Titration was slower and maintenance doses lower than the label.

Clinical practice

Clinical practice

Compounded-product practice rests on one medically reviewed patient-education page from a lab-testing information site (no author or clinic protocol named), one retrospective cohort of a semaglutide/cyanocobalamin combination, and one Danish cohort using brand product. No prescriber protocol or society guidance for compounded semaglutide titration is established, and no compounded dose ceiling is established. Vial concentration (mg/mL) varies by compounder. Check units against the dispensing pharmacy label to avoid the dosing errors FDA describes.

Start
0.25 mg once weekly for 4 weeks, the same as the Wegovy label. Compounded semaglutide is also described as typically starting at 0.25 mg injected once weekly.
Titration
Escalate no faster than every 4 weeks (Wegovy label). In a Danish cohort, real-world titration was slower than the label. Compounded steps may differ from brand steps and are set by the prescriber. After 2 or more missed weekly doses (Wegovy label), re-titrate from a lower dose rather than resuming the last maintenance dose. See the missed-dose rows in label_dosing.
Typical
No single typical dose is established for compounded product. Among Danish primary-care patients still on treatment at 12 months, 40% were at or below 1.0 mg/week, 30% at 1.7 mg/week and 30% at 2.4 mg/week. A patient-education page says compounded semaglutide is increased every four weeks up to 1.0 to 2.4 mg based on response and prescriber guidance.
Ceiling
No source gives a ceiling specific to compounded product. The current Wegovy label permits up to 7.2 mg weekly in adults who tolerate 2.4 mg for at least 4 weeks. Volume check (calculated): the label delivers 7.2 mg as 9.6 mg/mL (0.75 mL). At 2.5 or 5 mg/mL a 7.2 mg dose is 2.88 or 1.44 mL, above a whole 1, 2, 2.5 or 5 mg vial. A 2.4 mg dose is 0.96 mL at 2.5 mg/mL, so 1, 2 and 2.5 mg vials cannot supply a 2.4 mg maintenance course. A calculator should flag any single dose over 1 mL or over one vial.
Frequency
Once weekly, on the same day each week.
Route
Subcutaneous injection. Compounded product reaches patients as vials with syringes for self-administration (FDA alert and poison-center case series).
Timing
Per the approved labels: same day each week, any time of day, with or without meals; injection site and time of day can change without dose adjustment.
Cycle
Continuous weekly use. No cycling schedule is established. The Wegovy label frames use as long-term maintenance of weight reduction.

Sources

  • Clinical practiceRegulator1
    Initiate at 0.25 mg once weekly for 4 weeks. Then follow the dosage escalation schedule in Table 1, titrating every 4 weeks to achieve the maintenance dosage.
  • Clinical practiceRegulator1
    For patients who tolerate the 2.4 mg dosage for at least 4 weeks and additional weight reduction is clinically indicated, the dosage may be increased to a maximum dosage of 7.2 mg subcutaneously once weekly.
  • Clinical practiceRegulator10
    provide patients with the appropriate syringe size for the intended dose

What clinics and vendors publish

These ranges come from clinic and vendor publications, not studies.

Community-reported
  • Community-reportedOther web source9
    Compounded semaglutide typically starts at 0.25 mg injected once weekly, increasing every four weeks up to 1.0 to 2.4 mg based on your response and your prescriber’s guidance.
  • Community-reportedOther web source9
    Your prescriber controls the schedule.
  • Community-reportedOther web source9
    The number of units depends entirely on your vial’s concentration, which varies by compounder.
  • Community-reportedOther web source8
    semaglutide for weight management is frequently discontinued and titrated slower and to lower maintenance doses in real-world clinical practise than in the approved labelling.
  • Community-reportedOther web source7
    Once-weekly semaglutide/cyanocobalamin injected subcutaneously starting at 0.25 mg/0.125 mg and titrated to a maximum dose of 2.4 mg/0.24 mg.

Safety

Serious warnings

  • Boxed warning (Wegovy label): WARNING: RISK OF THYROID C-CELL TUMORS. In rodents, semaglutide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures. It is unknown whether WEGOVY causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as human relevance of semaglutide-induced rodent thyroid C-cell tumors has not been determined. WEGOVY is contraindicated in patients with a personal or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Counsel patients regarding the potential risk for MTC with the use of WEGOVY and inform them of symptoms of thyroid tumors (e.g., a mass in the neck, dysphagia, dyspnea, persistent hoarseness). Routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of MTC in patients treated with WEGOVY.1
  • Acute pancreatitis (label 5.2): acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis, has been observed in patients treated with GLP-1 receptor agonists; if pancreatitis is suspected, discontinue and initiate appropriate management.1
  • Acute gallbladder disease (label 5.3): treatment is associated with an increased occurrence of cholelithiasis and cholecystitis; in adult weight-reduction trials cholelithiasis was reported by 1.6% of injection-treated patients vs 0.7% on placebo. If cholelithiasis is suspected, gallbladder studies and clinical follow-up are indicated.1
  • Hypoglycemia (label 5.4): semaglutide lowers blood glucose; risk is increased with insulin or insulin secretagogues (e.g., sulfonylureas). The label says reducing the dose of the insulin or insulin secretagogue may be necessary.1
  • Acute kidney injury due to volume depletion (label 5.5): postmarketing reports, some requiring hemodialysis, mostly after GI reactions causing dehydration; monitor renal function in patients reporting adverse reactions that could lead to volume depletion, especially during initiation and escalation.1
  • Severe gastrointestinal adverse reactions (label 5.6): severe GI reactions were reported in 4.1% of injection-treated vs 0.9% of placebo-treated adults in weight-reduction trials; not recommended in patients with severe gastroparesis.1
  • Hypersensitivity (label 5.7): serious reactions including anaphylaxis and angioedema have been reported; discontinue if they occur.1
  • Diabetic retinopathy complications in type 2 diabetes (label 5.8): in a 2-year trial of 0.5 mg and 1 mg weekly, complications occurred in 3% on semaglutide vs 1.8% on placebo, with larger absolute increase in patients with baseline retinopathy (8.2% vs 5.2%).1
  • Heart rate increase (label 5.9): mean resting heart rate increases of 1 to 4 bpm vs placebo; monitor heart rate at regular intervals; discontinue if resting heart rate increase is sustained.1
  • Pulmonary aspiration during general anesthesia or deep sedation (label 5.10): rare postmarketing reports in patients on GLP-1 receptor agonists who had residual gastric contents despite fasting; patients should tell providers before planned procedures.1
  • Compounded product and dosing errors (FDA, content current 10/01/2026): FDA reports adverse events, some requiring hospitalization, that 'may be related to dosing errors' with compounded injectable semaglutide, including patients measuring incorrect doses and clinicians miscalculating doses; FDA had 990 reports for compounded semaglutide as of May 31, 2026 and notes underreporting is likely.11
  • Dosing errors with compounded vials are the main practical hazard. FDA says errors involve confusion between milliliters, milligrams and syringe 'units', and different concentrations from different compounders; prescribers should be vigilant, supply a syringe sized for the intended dose, counsel on measuring, and contact the compounder if uncertain. A poison-center case series reports two patients self-administering 10-fold doses from vials with days of nausea, vomiting and abdominal pain, one dosing in mL and units instead of mg. In California poison-center data, 33 of 36 compounded GLP-1 RA exposures (91.7%) were administration errors.10
  • Nonarteritic anterior ischemic optic neuropathy (NAION): the EMA safety committee (PRAC) concluded it is a very rare side effect of semaglutide (up to 1 in 10,000), about a two-fold increase in risk, roughly one additional case per 10,000 person-years. This is an EU conclusion. A US label statement is not established. Sudden vision loss or rapidly worsening eyesight needs prompt evaluation; stop semaglutide if NAION is confirmed.12
  • Never share (label 5.11): Wegovy FlexTouch must never be shared between patients, even if the needle is changed. For vials, the same principle implies one patient per vial and syringe. This is inferred from the pen rule, not from a vial-specific statement.1
  • Hypoglycemia in patients without diabetes: California poison-center data report hypoglycemia in 3.8% of 1,047 GLP-1 RA exposures; the authors say nondiabetic patients should be educated to recognize it.13

Contraindications

  • Personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).1
  • Prior serious hypersensitivity reaction to semaglutide or to any of the excipients in the product.1

Adverse effects

  • Wegovy 2.4 mg weekly vs placebo in adults with obesity or overweight (label Table 3; N=2,116 vs 1,261): nausea 44% vs 16%, diarrhea 30% vs 16%, vomiting 24% vs 6%, constipation 24% vs 11%, abdominal pain 20% vs 10%, headache 14% vs 10%, fatigue 11% vs 5%, dyspepsia 9% vs 3%, dizziness 8% vs 4%, hair loss 3% vs 1%, dysesthesia 2% vs 1%.1
  • Wegovy 7.2 mg weekly (label Table 4; N=1,311) vs 2.4 mg (N=304) vs placebo (N=303): nausea 39% / 35% / 13%, vomiting 22% / 16% / 6%, dysesthesia 22% / 6% / 0%, constipation 20% / 19% / 8%, abdominal pain 12% / 9% / 7%, fatigue 11% / 9% / 5%, hair loss 6% / 3% / 1%. Permanent discontinuation for adverse reactions was 5%, 5% and 2%.1
  • STEP UP (72 weeks, adults without diabetes): gastrointestinal adverse events 70.8% on 7.2 mg vs 61.2% on 2.4 mg vs 42.8% on placebo; dysaesthesia 22.9%, 6.0% and 0.5%; serious adverse events 6.8%, 10.9% and 5.5%.4
  • Compounded GLP-1 receptor agonists in FAERS 2018-2024 (707 of 81,078 reports): higher reporting odds for abdominal pain (ROR 2.84), diarrhea (1.59), nausea (1.27), suicidality (6.34), cholecystitis (3.39), preparation errors (48.92), contamination (19.00) and hospitalization (2.35) than non-compounded products. This is spontaneous-report data and cannot establish causation.14

Monitoring

  • In patients with diabetes, monitor blood glucose before starting and during treatment.1
  • Monitor renal function in patients with GI reactions that could cause volume depletion, especially during initiation and escalation.1
  • Monitor heart rate at regular intervals consistent with usual clinical practice; routine calcitonin or thyroid ultrasound monitoring is of uncertain value for early MTC detection.1
  • Monitor the effects of concomitant oral medications, particularly those with a narrow therapeutic index, because semaglutide delays gastric emptying.1
  • Pregnancy planning (label, Use in Specific Populations; not a contraindication): discontinue when pregnancy is recognized (weight reduction and CV indications) and at least 2 months before a planned pregnancy because of the long half-life. For MASH, use during pregnancy only if the potential benefit justifies the potential risk to the fetus.1
  • Patients with a history of diabetic retinopathy should be monitored for progression (label 5.8).1
  • Counsel on dehydration, hypoglycemia and GI warning signs, especially in the first weeks and after any dose change or restart, and with compounded vials.1
  • Sudden vision loss or rapidly worsening eyesight: urgent evaluation (NAION, EU conclusion).12

Interactions

  • Insulin or insulin secretagogues (e.g., sulfonylureas): increased risk of hypoglycemia; reducing the dose of the insulin or secretagogue may be necessary.1
  • Oral medications: delayed gastric emptying may affect absorption. In clinical pharmacology trials with semaglutide 1 mg weekly injection, absorption of orally administered medications was not affected; in a study with the semaglutide tablet, levothyroxine exposure increased 33%.1
  • Concomitant use with other semaglutide-containing products or any other GLP-1 receptor agonist is not recommended (Wegovy label Limitations of Use).1

Handling

Reconstitution

No reconstitution protocol for compounded semaglutide is established. Approved Wegovy and Ozempic injections are supplied as ready-to-use solution (clear, colorless). Follow the dispensing 503A pharmacy's labeling for any vial that requires reconstitution or dilution.

Storage before mixing

Approved Wegovy single-dose pen or syringe: refrigerate at 2C to 8C (36F to 46F). It may be kept at 8C to 30C (46F to 86F) for up to 28 days before cap removal. Protect from light. Do not freeze. Wegovy FlexTouch before first use: 2C to 8C. After first use: 56 days at 15C to 30C or in a refrigerator. Compounded vial storage and beyond-use dating are set by the dispensing pharmacy and are not established here.

Storage after mixing

Not established for compounded semaglutide.11015

Evidence

FDA-approved injectable (Wegovy, Ozempic). Randomized trials support 2.4 mg weekly (STEP 1, n=1961: -14.9% vs -2.4% body weight at 68 weeks) and 7.2 mg weekly (STEP UP: -18.7% vs -15.6% on 2.4 mg at 72 weeks). Evidence on compounded product is limited to a retrospective cohort (n=94) and pharmacovigilance data. Practice titration rests on one patient-education page and one primary-care cohort. No compounded-specific ceiling is established. The FDA-label evidence tier applies to the approved injections only. It does not carry to compounded vials, which FDA states are not approved. The compounded practice steps are practice-tier.

Mechanism

A GLP-1 analogue with 94% sequence homology to human GLP-1. It selectively binds and activates the GLP-1 receptor, a physiological regulator of appetite and caloric intake found in appetite-regulating brain areas. Albumin binding is the main protraction mechanism, giving a half-life of approximately 1 week.1

Availability

Amounts offered

  • 1 mg
  • 2 mg
  • 2.5 mg
  • 5 mg
  • 7.5 mg
  • 10 mg
  • 12.5 mg
  • 15 mg
  • 25 mg

Custom strengths on request.

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References

According to PubMed

  1. 1WEGOVY (semaglutide) injection and tablets, prescribing informationNovo Nordisk Pharmaceutical Industries, LP via DailyMed; set ID ee06186f-2aa3-4990-a760-757579d8f77b, SPL version 19, published Jun 30, 2026, 2026
  2. 2OZEMPIC (semaglutide) injection, prescribing informationNovo Nordisk Pharmaceutical Industries, LP via DailyMed; set ID adec4fd2-6858-4c99-91d4-531f5f2a2d79, SPL version 20, published Jun 10, 2026, 2026
  3. 3Once-Weekly Semaglutide in Adults with Overweight or Obesity.N Engl J Med 2021;384:989 (Wilding et al., STEP 1), 2021
  4. 4Once-weekly semaglutide 7.2 mg in adults with obesity (STEP UP): a randomised, controlled, phase 3b trial.Lancet Diabetes Endocrinol 2025;13(11):949-963 (Wharton et al.), 2025
  5. 5Once-weekly semaglutide 7.2 mg in adults with obesity and type 2 diabetes (STEP UP T2D): a randomised, controlled, phase 3b trial.Lancet Diabetes Endocrinol 2025;13(11):935-948 (Lingvay et al.), 2025
  6. 6Efficacy and safety of once-weekly semaglutide 2.0 mg versus 1.0 mg in patients with type 2 diabetes (SUSTAIN FORTE): a double-blind, randomised, phase 3B trial.Lancet Diabetes Endocrinol 2021;9(9):563-574 (Frias et al.), 2021
  7. 7Weight loss and body composition after compounded semaglutide treatment in a real world setting.Diabetes Obes Metab 2025;27(3):1536-1543 (Chun et al.), 2025
  8. 8Real-World Use of Semaglutide for Weight Management: Dose Titration, Discontinuation Patterns and Weight Changes.Diabetes Obes Metab 2026;28(10):8905-8912 (Skandov et al.), 2026
  9. 9Compounded Semaglutide Dosage Chart: Week-by-Week Titration GuideTesting.com (patient-education page; medically reviewed by Soma Mandal, MD); updated June 30, 2026, 2026
  10. 10FDA alerts health care providers, compounders and patients of dosing errors associated with compounded injectable semaglutide productsFDA; content current as of 07/26/2024, 2024
  11. 11FDA's Concerns with Unapproved GLP-1 Drugs Used for Weight LossU.S. Food and Drug Administration; content current as of 10/01/2026; adverse event counts as of May 31, 2026, 2026
  12. 12PRAC concludes eye condition NAION is a very rare side effect of semaglutide medicines Ozempic, Rybelsus and WegovyEuropean Medicines Agency, 6 June 2025 (revised 13 June 2025); EU conclusion, not in the US label, 2025
  13. 13Changes in GLP-1 RA Exposures Following Recent Demand for Weight Management: California Poison Control System dataJ Pharm Technol 2025;41(4):165-173 (Ho et al.), 2025
  14. 14Safety analysis of compounded GLP-1 receptor agonists: a pharmacovigilance study using the FDA adverse event reporting system.Expert Opin Drug Saf 2025;25(3):581-588 (McCall et al.), 2025
  15. 15Administration errors of compounded semaglutide reported to a poison control center-Case seriesJ Am Pharm Assoc 2023;63(5):1643-1645 (Lambson et al.), 2023
  16. 16Navigating compounded semaglutide: what health care providers need to know.Am J Manag Care 2025;31(9):480-484 (Liu et al.); narrative review, abstract only reviewed, 2025
  17. 17FDA clarifies policies for compounders as national GLP-1 supply begins to stabilizeU.S. Food and Drug Administration; updated 4/1/2026, 2026
  18. 18Bulk Drug Substances Used in Compounding Under Section 503A of the FDCAU.S. Food and Drug Administration; content current as of 05/14/2026; semaglutide not mentioned in the retrieved text, 2026
  19. 19RYBELSUS / OZEMPIC tablets (oral semaglutide), prescribing informationNovo Nordisk via DailyMed; set ID 27f15fac-7d98-4114-a2ec-92494a91da98, 2026

Last reviewed 2026-10-14. 33 figures checked against their sources. How this works