Starting semaglutide begins with a low dose of 0.25 mg once per week, injected under the skin, and gradually increases over about 16 to 20 weeks until you reach the full maintenance dose. The slow ramp-up is intentional: it gives your body time to adjust and reduces the odds of intense nausea, which is the most common side effect. Here’s what the full process looks like, from qualifying for a prescription to managing your first few months.
Who Qualifies for a Prescription
Semaglutide for weight management (sold as Wegovy) is FDA-approved for adults with a BMI of 30 or higher. If your BMI is 27 or higher, you can still qualify as long as you have at least one weight-related health condition such as high blood pressure, type 2 diabetes, or high cholesterol. It’s also approved for patients aged 12 and older whose BMI is at or above the 95th percentile for their age and sex.
Semaglutide is not safe for everyone. The FDA’s strongest warning applies to people with a personal or family history of medullary thyroid carcinoma, a rare type of thyroid cancer, or a condition called Multiple Endocrine Neoplasia syndrome type 2. If either runs in your family, this medication is off the table. Your prescriber will ask about your thyroid history before writing a prescription.
What Happens Before Your First Dose
Most providers order baseline bloodwork before prescribing semaglutide. This typically includes kidney and liver function markers to confirm your body can process the medication safely, along with a metabolic panel, cholesterol levels, and blood counts. Pancreatic and thyroid markers are also checked because of rare but serious potential side effects involving pancreatitis and thyroid disorders. These labs give your provider a reference point to compare against as treatment progresses.
The Dose Titration Schedule
Semaglutide uses a stepped schedule, with each dose level lasting four weeks before you move up:
- Weeks 1 through 4: 0.25 mg per week (this dose is purely for adjustment and produces minimal weight loss on its own)
- Weeks 5 through 8: 0.5 mg per week
- Weeks 9 through 12: 1 mg per week
- Weeks 13 through 16: 1.7 mg per week
- Week 17 onward: 2.4 mg per week (maintenance dose)
If you hit a dose level that causes persistent nausea or vomiting, your provider can pause the escalation for an extra four weeks before trying again. If you reach the 2.4 mg maintenance dose and can’t tolerate it, the typical approach is to drop back to 1.7 mg for four weeks, then try ramping up again. If you still can’t tolerate the full dose after repeated attempts, the medication is generally discontinued.
How to Give Yourself the Injection
Semaglutide is injected subcutaneously, meaning just under the skin rather than into a muscle. You have three site options: your lower abdomen (avoiding the two-inch area around your navel), the front of your thigh, or your upper arm. Rotate between these sites each week to avoid irritation.
Before injecting, wash your hands thoroughly and clean the injection site with an alcohol swab. If you’re using a prefilled pen, attach a new needle each time. Pinch a fold of skin, insert the needle at a slight angle, and press the injection button. Hold for the time specified in your pen’s instructions (usually several seconds) to ensure the full dose is delivered. You can inject at any time of day, with or without food, as long as you keep a consistent weekly schedule. Pick a day of the week that’s easy to remember.
Managing Side Effects in the First Months
Gastrointestinal side effects are extremely common, especially during dose increases. In clinical trials, about 44% of people on semaglutide experienced nausea compared to 16% on placebo. Roughly 30% had diarrhea, 25% had vomiting, and 24% dealt with constipation. These numbers sound high, but the severity is usually mild to moderate, and symptoms tend to improve as your body adjusts to each new dose level.
A few practical strategies make a real difference. Eat smaller meals and stop eating when you feel full rather than finishing what’s on your plate. Your appetite will decrease noticeably, and pushing past that signal is one of the fastest routes to nausea. Avoid high-fat and greasy foods, which slow digestion and worsen discomfort. Stay well hydrated, especially if you’re experiencing diarrhea or vomiting.
What to Eat While on Semaglutide
Because semaglutide significantly reduces appetite, many people simply eat less of everything, including protein. That’s a problem. During rapid weight loss, your body can break down muscle along with fat. To help preserve lean mass, aim for 1.2 to 2.0 grams of protein per kilogram of body weight each day. For a 200-pound person, that works out to roughly 110 to 180 grams of protein daily. Prioritizing protein at every meal (eggs, chicken, fish, Greek yogurt, legumes) becomes more important when your total food intake drops.
Fiber is the other nutrient that deserves attention. Constipation is a top complaint among people on semaglutide, and most users fall well short of the recommended 28 grams of fiber per day. One study found average intake was just 14.5 grams. Adding vegetables, beans, whole grains, and fruit can help keep things moving and manage that particular side effect without medication.
Storing Your Medication
Unopened semaglutide pens should be kept refrigerated between 36°F and 46°F and are good until their printed expiration date. Once you start using a pen (Ozempic), it can be stored at room temperature, between 59°F and 86°F, for up to 56 days. Wegovy pens have a shorter window of 28 days at room temperature. If a pen accidentally gets warm, the clock starts ticking on that room-temperature window whether you’ve used it or not. Never freeze semaglutide, and don’t use it if the liquid looks cloudy or contains particles. The oral tablet form (Rybelsus) is simpler: store at room temperature until the expiration date.
What It Costs
Semaglutide is expensive at list price. Wegovy’s list price is about $1,349 per month, and Ozempic runs around $1,028 per month. Insurance coverage varies widely. Some commercial plans cover Wegovy for weight management if you meet BMI criteria, while many others exclude weight-loss medications entirely. Medicare Part D currently does not cover Wegovy for weight loss, though coverage rules are evolving. Cash-pay options through telehealth platforms and compounding pharmacies can bring costs down to roughly $150 to $350 per month depending on your dose, though compounded versions are not FDA-approved and carry additional quality considerations. Check with your insurance first, and ask your prescriber’s office about manufacturer savings programs, which can significantly reduce copays for eligible patients.
What to Expect in the First Three Months
The first four weeks at 0.25 mg are really a warm-up period. You may notice a slight decrease in appetite, but significant weight loss typically doesn’t start until you reach the 0.5 mg or 1 mg dose levels. Most people begin to see meaningful changes on the scale between weeks 8 and 12, as the dose climbs and the drug’s appetite-suppressing effects strengthen. The full maintenance dose isn’t reached until around week 17, and weight loss continues to accumulate for months after that. In clinical trials, participants lost an average of about 15% of their starting body weight over 68 weeks, though individual results vary considerably.
Patience during the early weeks matters. The titration schedule exists to protect you from side effects, not to delay results. Skipping doses to “catch up” or jumping to a higher dose before your body is ready almost always backfires with severe nausea. Stick to the schedule, focus on protein intake and hydration, and let the medication build in your system as designed.