Ozempic Starting Dose: Complete Beginner Guide

The starting dose of Ozempic is 0.25 mg injected once weekly for the first four weeks. Like other GLP-1 medications, this introductory dose is designed to help your body adjust to semaglutide before moving to higher, more therapeutic levels. Most people won’t experience significant weight loss or appetite changes at 0.25 mg, and that’s expected. The dose exists to build tolerance so that the increases that follow are manageable rather than miserable.

Ozempic’s Full Dose Schedule

Ozempic (semaglutide) follows a straightforward escalation:

• Weeks 1 through 4: 0.25 mg weekly (starting dose)
• Weeks 5 through 8: 0.5 mg weekly
• Week 9 and beyond: 1 mg weekly (if needed)
• Optional: 2 mg weekly (for patients who need additional glycemic or weight control)

It’s worth noting that Ozempic was originally approved for type 2 diabetes management, not specifically for weight loss. Its FDA-approved doses max out at 2 mg. Wegovy, which contains the same semaglutide molecule, goes up to 2.4 mg and is specifically approved for chronic weight management. Many providers prescribe Ozempic off-label for weight loss, and it’s effective for that purpose, but the dosing structure reflects its diabetes-first origins.

The escalation from 0.25 mg to 0.5 mg is mandatory. Novo Nordisk, the manufacturer, specifically designed the Ozempic pen so that your first pen delivers 0.25 mg doses for four weeks before you move to the 0.5 mg pen. Your provider will then determine whether you stay at 0.5 mg or advance to 1 mg based on your response and goals.

What 0.25 mg Actually Does in Your Body

Even though 0.25 mg is a low dose, semaglutide is already at work from your first injection. Here’s what’s happening under the surface.

Semaglutide binds to GLP-1 receptors in your gut, pancreas, and brain. In the gut, it begins slowing gastric emptying, which means food moves through your stomach more gradually. In the pancreas, it enhances glucose-dependent insulin secretion, helping stabilize blood sugar. In the brain, it starts influencing the hypothalamic circuits that regulate hunger and satiety.

At 0.25 mg, these effects are subtle. You might notice that meals keep you satisfied a bit longer, or that you’re slightly less interested in snacking. Some people report a mild reduction in “food noise,” that constant background hum of thinking about what to eat next. Others don’t notice much at all. Both experiences are normal.

The real purpose of this phase is physiological priming. Your GI tract is adapting to a new pace of digestion. Your GLP-1 receptors are being activated at levels they’re not used to. Four weeks of this low-level exposure prepares your system for the jump to 0.5 mg, where the effects become more noticeable and the weight loss typically begins.

What to Expect: Week by Week at the Starting Dose

Week one. Your first injection is the big unknown. Most people are pleasantly surprised that the injection itself is nearly painless (the needle is very thin). In the hours and days following, you might feel mild nausea, a slight decrease in appetite, or nothing at all. If you’re going to have GI side effects at this dose, they usually show up within the first 48 hours after injection. Some people experience a brief headache or fatigue. These are your body’s initial responses to a new medication and typically resolve within a few days.

Week two. Your body has had one week to process semaglutide, and you’re getting your second injection. Many people find that any first-week side effects are milder this time around. You may start to notice subtle appetite changes, like leaving food on your plate without consciously trying to. Or you may notice nothing different. At this dose, both reactions are common.

Weeks three and four. By now, semaglutide has reached a steady state in your body at the 0.25 mg level. Whatever side effects you were experiencing have usually leveled off. This is when the medication feels like part of your routine rather than something new. You’re likely comfortable with the injection process, and you have a sense of how your body responds to this dose.

Don’t be discouraged if you haven’t lost weight during these four weeks. The early period of semaglutide treatment is about building tolerance, not hitting targets. Weight loss typically picks up at 0.5 mg and accelerates further at 1 mg.

Moving to 0.5 mg: The First Real Step

The increase from 0.25 mg to 0.5 mg is where most people start feeling like the medication is “working.” This doubling of the dose brings a more noticeable reduction in appetite, stronger satiety after meals, and for many people, the beginning of consistent weight loss.

It’s also when side effects can flare up again. Each dose increase is essentially another adjustment period for your body. The nausea that resolved at 0.25 mg might return for a few days at 0.5 mg. Constipation sometimes becomes more pronounced. These effects usually settle within one to two weeks as your body catches up to the new dose level.

Some practical advice for the transition: eat smaller portions in the days immediately following your first 0.5 mg injection. Your stomach is now emptying more slowly than it was at 0.25 mg, and large meals are the fastest trigger for nausea at a new dose. Lean proteins, vegetables, and moderate portions are your friends during any dose increase.

Should You Stay at 0.5 mg or Go to 1 mg?

This is a conversation between you and your provider, and the right answer depends on several factors.

Staying at 0.5 mg makes sense if you’re seeing good weight loss results, your appetite is well controlled, and you’re tolerating the dose without significant side effects. Some people do very well at 0.5 mg and don’t need to go higher. There’s no rule that says you must escalate to 1 mg.

Moving to 1 mg makes sense if your weight loss has plateaued at 0.5 mg, your appetite suppression is fading, or you and your provider agree that a higher dose would help you reach your goals. The 1 mg dose produces more substantial weight loss on average, but it also comes with a higher likelihood of side effects.

The 2 mg dose is relatively newer and is typically reserved for patients who need additional glycemic control or who haven’t achieved adequate results at 1 mg. Not everyone needs it, and your provider will help determine whether it’s worth considering.

The important thing is that dosing should be individualized. The right maintenance dose is the lowest dose that gives you the results you need with side effects you can manage. More isn’t always better.

Managing Side Effects at Any Dose Level

The side effect profile of Ozempic is well studied, and GI symptoms are by far the most common. Here are strategies that work across all dose levels.

Time your meals around your injection. Many people inject on the same day each week and find that the first 24 to 48 hours after injection are when side effects peak. Eating lighter on injection day and the following day can reduce nausea.

Prioritize protein. Protein is the most satiating macronutrient and also helps preserve lean muscle mass during weight loss. Aiming for 25 to 30 grams per meal becomes especially important as your overall food intake decreases on Ozempic.

Don’t skip meals. It might seem logical to skip meals when you’re not hungry, but going too long without eating can make nausea worse and lead to blood sugar fluctuations. Even if you’re eating less, try to maintain regular meal timing with smaller portions.

Watch for constipation. Slowed gastric emptying means slower transit throughout your entire digestive system. Adequate water intake (at least 64 ounces daily), fiber-rich foods, and regular physical activity all help. If constipation becomes persistent, your provider can recommend additional interventions.

Report anything unusual. Mild nausea and some digestive changes are expected. Severe abdominal pain, persistent vomiting, signs of pancreatitis (intense pain radiating to the back), or allergic reactions are not expected and require medical attention.

Getting Started With Ozempic

If you’re ready to begin Ozempic, the first step is connecting with a provider who can evaluate whether you’re a good candidate. Ozempic is typically prescribed for people with type 2 diabetes, but it’s widely used off-label for weight management in patients with a BMI of 30 or higher (or 27 with weight-related health conditions).

TrimRx offers compounded semaglutide as an affordable alternative to brand-name Ozempic, with the same active ingredient at a fraction of the cost. You can check your eligibility quickly online and have a provider review your information to determine the right starting approach.

The 0.25 mg starting dose might not feel like much, but it’s the foundation for everything that follows. Give it the four weeks it deserves, manage side effects proactively, and know that the results are coming. The patients who approach the starting phase with patience and realistic expectations are the ones who stay on treatment long enough to see transformative results.

This information is for educational purposes and is not medical advice. Consult with a healthcare provider before starting any medication. Individual results may vary.