Semaglutide
Warnings. Boxed warning for thyroid C-cell tumors in rodents. Do not use with personal/family history of medullary thyroid carcinoma or MEN2. Common GI side effects.
Mechanism
GLP-1 receptor agonist; enhances glucose-dependent insulin secretion, suppresses glucagon, slows gastric emptying, and acts on hypothalamic appetite centers to reduce food intake.
Overview
Semaglutide is a GLP-1 receptor agonist FDA-approved for type 2 diabetes (Ozempic) and chronic weight management (Wegovy). It reduces appetite, slows gastric emptying, and improves glycemic control. Clinical trials demonstrate average weight loss of around 15% of body weight at the 2.4mg dose.
Protocols
Standard Titration (Wegovy Schedule)
Official
BEGINNER
Full FDA-style titration from 0.25mg to 2.4mg weekly, escalating every 4 weeks to minimize GI side effects.
Goal: Weight loss
Step 1 4w
250 mcg · 1×/day
0.25mg once weekly - initiation dose, not intended for glycemic control or weight loss efficacy.
Step 2 4w
500 mcg · 1×/day
0.5mg once weekly.
Step 3 4w
1 mg · 1×/day
1.0mg once weekly.
Step 4 4w
1.7 mg · 1×/day
1.7mg once weekly.
Step 5 4w
2.4 mg · 1×/day
2.4mg once weekly - maintenance dose. Remain at highest tolerated dose.