Semaglutide Starting Dose: How to Begin

The standard starting dose of semaglutide for weight loss is 0.25 mg injected once weekly. This applies whether you’re using brand-name Ozempic, brand-name Wegovy, or compounded semaglutide. The introductory dose isn’t meant to produce significant weight loss on its own. It’s a four-week adjustment period that lets your body acclimate to the medication before your provider increases the amount. Where things get interesting is that compounded semaglutide offers more dosing flexibility than the brand-name options, which can matter quite a bit depending on your situation.

Brand-Name vs. Compounded: How Starting Doses Differ

The active molecule is the same across all semaglutide products. What differs is the delivery format and how much control you have over dosing.

Ozempic comes in pre-filled, multi-dose pens with fixed dial settings. You start at 0.25 mg for four weeks, then move to 0.5 mg. The pen literally clicks into preset doses. You can advance to 1 mg and eventually 2 mg, but you can’t easily dose at, say, 0.375 mg. The increments are fixed by the pen design.

Wegovy comes in single-dose, pre-filled auto-injectors at five specific strengths: 0.25 mg, 0.5 mg, 1 mg, 1.7 mg, and 2.4 mg. Each pen contains one injection at one dose. The escalation schedule is predetermined, and there’s no way to adjust between those five levels.

Compounded semaglutide is typically supplied as a multi-dose vial with a concentration measured in mg/mL. You draw your dose using an insulin syringe, which means you can measure virtually any amount within the vial’s range. Want to start at 0.125 mg because you’re concerned about sensitivity? You can. Want to step from 0.25 mg to 0.4 mg instead of jumping straight to 0.5 mg? That’s possible too. This flexibility is one of the main reasons providers and patients choose compounded semaglutide over brand-name versions.

Regardless of which version you use, the starting principle is the same: begin low and escalate gradually.

Why 0.25 mg Is the Universal Starting Point

Semaglutide is a GLP-1 receptor agonist that affects multiple systems in your body simultaneously. It slows gastric emptying, modifies appetite signaling in the brain, enhances insulin secretion, and changes how your body processes hunger cues. Turning all of those dials at once with a high dose would overwhelm your system.

The 0.25 mg starting dose is backed by data from the STEP and SUSTAIN clinical trial programs. Researchers tested various escalation speeds and found that the gradual four-week steps produced the best balance of tolerability and long-term adherence. Patients who titrated slowly were significantly more likely to stay on treatment and reach therapeutic doses compared to those who escalated faster.

The GI tract is particularly sensitive to semaglutide’s effects. Your stomach and intestines need time to adjust to the new pace of digestion. Rushing this process leads to nausea, vomiting, and diarrhea that can be severe enough to land people in urgent care. Four weeks at 0.25 mg is a small time investment that prevents a much worse experience down the road.

The Standard Escalation Path

After your initial four weeks at 0.25 mg, the typical path depends on which product you’re using and what your treatment goals are.

For weight loss (Wegovy dosing schedule): 0.25 mg for four weeks, then 0.5 mg for four weeks, then 1 mg for four weeks, then 1.7 mg for four weeks, then 2.4 mg as the maintenance dose. Total time to reach full dose: about 16 weeks.

For diabetes or off-label weight loss (Ozempic dosing schedule): 0.25 mg for four weeks, then 0.5 mg ongoing. Your provider may advance to 1 mg and eventually 2 mg based on your glycemic and weight response. The timeline is more flexible here since there’s no fixed escalation beyond 0.5 mg.

For compounded semaglutide: The schedule often mirrors one of the above, but your provider has the freedom to customize. Some providers use a slower escalation (six weeks per step instead of four) for patients who are more GI-sensitive. Others create intermediate steps, moving from 0.25 mg to 0.5 mg to 0.75 mg to 1 mg, rather than making larger jumps. This tailored approach is a genuine advantage of compounded formulations.

What Your First Month on Semaglutide Looks Like

The first weeks on semaglutide follow a fairly consistent pattern for most people, though individual experiences vary.

Days one through three after your first injection. This is when side effects are most likely to appear if they’re going to. Mild nausea is the most common complaint, usually described as a queasy feeling rather than active vomiting. Some people feel slightly fatigued or notice a headache. Others feel nothing at all. There’s no way to predict your response before your first dose, which is exactly why starting low matters.

The rest of week one. Any initial side effects usually begin to improve. You might notice subtle appetite changes, perhaps finding that you’re less interested in a late-night snack or that lunch keeps you satisfied longer than usual. These changes are mild at 0.25 mg, and many people don’t notice them at all until they’re specifically paying attention.

Weeks two through four. Your body settles into a rhythm with the medication. Side effects that appeared in week one have typically resolved or become very manageable. You’ve established your injection routine (same day each week, same general time, same injection site rotation). By the end of week four, semaglutide has reached a steady state at this dose, meaning your body has fully adjusted.

Weight loss during this month is typically minimal. The first month of semaglutide averages somewhere between zero and five pounds of loss, with many people falling in the one-to-three-pound range. The real results begin accumulating once you reach 0.5 mg and higher.

Handling Common Early Side Effects

GI symptoms are the hallmark of early semaglutide treatment. Here’s how to manage them effectively.

Nausea. Eat smaller, more frequent meals rather than two or three large ones. Avoid lying down immediately after eating. Bland, easily digestible foods (toast, rice, bananas, plain chicken) tend to sit better than rich or fatty foods during the first couple of weeks. Ginger tea or ginger supplements can help with mild nausea. If nausea is persistent enough to affect your daily life, let your provider know.

Constipation. This is the second most common complaint and can persist across dose levels. Semaglutide slows the entire GI tract, not just the stomach. Drink plenty of water (aim for at least 64 ounces daily), include fiber-rich foods in your diet, and stay physically active. A gentle over-the-counter stool softener can help if dietary measures aren’t enough.

Reduced appetite leading to undereating. This sounds like a benefit, and it is, up to a point. But some people on semaglutide find they can go an entire day barely eating, which leads to fatigue, nutrient deficiencies, and muscle loss over time. Even if you’re not hungry, aim for at least two balanced meals daily with adequate protein. Your body still needs fuel, especially during weight loss.

Injection site reactions. Mild redness, itching, or a small bump at the injection site is normal and usually resolves within a day or two. Rotate between your abdomen, thigh, and upper arm to minimize irritation at any one spot.

Factors That Might Change Your Starting Dose

While 0.25 mg is the standard starting point, certain situations may lead your provider to modify the approach.

Prior GLP-1 experience. If you’ve recently been on tirzepatide, liraglutide, or another GLP-1 medication, your body is already adapted to the drug class. Your provider might start you at 0.5 mg or adjust the escalation timeline. The transition between GLP-1 medications doesn’t always require going back to square one.

Kidney or liver impairment. Semaglutide is processed differently in patients with significant organ impairment. While mild kidney or liver issues typically don’t require dose adjustments, moderate to severe cases may warrant a more cautious approach with extended time at lower doses.

Older adults. Age alone isn’t a reason to change the starting dose, but older adults tend to have more GI sensitivity and may benefit from a slower escalation. Some providers extend the 0.25 mg phase to six or eight weeks for patients over 65.

Concurrent medications. Certain medications, particularly those that also affect gastric motility or blood sugar, may interact with semaglutide in ways that influence dosing decisions. Always share your complete medication list with your provider before starting.

Taking the First Step

Starting semaglutide is simpler than most people expect. The medication, the injection process, and the early side effects are all very manageable when you know what’s coming and have a provider guiding the process.

If you’re considering semaglutide for weight loss, checking your eligibility takes just a few minutes. TrimRx offers compounded semaglutide with the dosing flexibility that brand-name pens can’t match, along with provider consultations and home delivery that make getting started straightforward.

The 0.25 mg dose is just the beginning. It won’t change your life in four weeks. But it sets your body up to tolerate the doses that will, and that makes it one of the most important steps in the entire process.

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