GLP-1 & metabolic · Type 2 diabetes and obesity management
Semaglutide
0.25 → 2.4 mg weekly, titrated
A long-acting GLP-1 receptor agonist approved as Ozempic and oral Rybelsus for type 2 diabetes and as Wegovy for weight management. It has driven major gains in obesity treatment, though GI side effects require gradual dose increases.
Reconstitution
| Vial | 1 mL water | 2 mL water |
|---|---|---|
| 5 mg | 5 mg/mL | 2.5 mg/mL |
| 10 mg | 10 mg/mL | 5 mg/mL |
Dosed in small amounts, so a 2 mL fill on a 5 mg vial (2.5 mg/mL) keeps the early micro-doses measurable. Adjust the fill to suit the dose you are running.
- Use bacteriostatic water as the diluent.
- Add the water slowly, letting it run down the inside wall of the vial rather than onto the powder.
- Swirl gently to mix, then leave it to dissolve. Do not shake.
- Give it a few minutes. The finished solution should be clear and colourless.
Protocol
Route: Subcutaneous
Standard titration (once weekly, subcutaneous)
- Weeks 1 to 4: 0.25 mg
- Weeks 5 to 8: 0.5 mg
- Weeks 9 to 12: 1 mg
- Weeks 13 to 16: 1.7 mg
- Week 17 onward: 2.4 mg as the target maintenance dose
- Hold each step a full 4 weeks
If 2.4 mg is too much
- 1.7 mg is a recognised fallback maintenance dose
- If nausea at 2.4 mg does not settle after a few weeks, dropping back to 1.7 mg is normal and still effective
Dosing detail
- Start at 0.25 mg for 4 weeks. This is a tolerance-building dose and is not expected to do much for weight on its own.
- Step up every 4 weeks: 0.25, 0.5, 1.0, 1.7, 2.4 mg, reaching target around week 16.
- 2.4 mg is the standard maintenance dose for weight, with 1.7 mg as a fallback if 2.4 is not tolerated.
- Same day each week. Half-life is about 7 days, so timing is forgiving.
Duration
- Long-run protocol. Titrate over the first ~16 weeks, then maintain. Stopping commonly leads to weight regain, so plan an exit (taper or maintenance dose) with that in mind.
Notes
- Inject subcutaneously, rotating sites.
- Nausea is the most reported early effect and a smaller starting dose helps.
- Protein and hydration matter as appetite falls.
Storage and handling
- Keep the powdered (lyophilized) vial in a cool, dark place. Refrigerate it for longer-term storage before mixing.
- Once reconstituted and refrigerated at 2–8 °C away from light, use the vial within 90 days.
- Do not freeze a reconstituted vial, and keep it away from heat and sunlight.
- If the solution turns cloudy, develops floating particles, or shows any other sign of degradation, stop using that vial.