Semaglutide Dosage: The Chart, and the Units Trap

Wegovy's labeled dosage ladder climbs in five steps: 0.25 mg once weekly for weeks 1 through 4, then 0.5 mg, 1 mg, and 1.7 mg — each held for four weeks — reaching the usual maintenance dose of 2.4 mg at week 17¹⁰. Ozempic, the same molecule labeled for type 2 diabetes, starts at the same 0.25 mg but tops out at 2 mg weekly¹¹. Rybelsus, the daily tablet, steps 3 mg, then 7 mg, then 14 mg¹². Those numbers are printed in FDA labeling, they are not a matter of opinion, and your prescriber sets where you sit on them.

That is the first question inside "semaglutide dosage," and if you arrived here for the chart, it is below in full. But there is a second question the chart cannot answer, and it is the one that actually injures people: a semaglutide dose is written in milligrams, an insulin syringe is marked in units, and nothing connects the two except the concentration of your particular vial. The approved pens and tablets never make you do that arithmetic. A compounded vial does — and semaglutide's weekly doses are small enough that getting it wrong scales the entire dose by multiples, not percentages.

This page covers the chart first and the arithmetic second, and exists mostly for the second.

The Chart: One Molecule, Three Labels

Semaglutide is sold under three brand names, and the ladder differs by label, not by molecule. Wegovy is labeled for weight reduction and cardiovascular risk reduction, Ozempic and Rybelsus for type 2 diabetes — background on the molecule itself is in how does semaglutide work and is Ozempic a peptide.

Three details from the labels that comparison pages usually flatten¹⁰¹¹¹²:

• •The starting dose is not a treatment dose. Rybelsus's label says outright that 3 mg is not effective for glycemic control — it exists to build tolerance¹².
• •Wegovy's ceiling moved. The June 2026 label added a 7.2 mg maximum for adults using it for weight reduction, above the long-standing 2.4 mg — a maximum, not a target¹⁰.
• •Wegovy now comes as a tablet too, on its own ladder: 1.5 mg daily for 30 days, then 4 mg, then 9 mg, to a 25 mg maintenance dose¹⁰. Do not confuse it with Rybelsus's 3-7-14 — same molecule, different label, different numbers. The oral route in general is covered in oral peptides for weight loss.

Rybelsus carries one more rule the chart cannot show: take it on an empty stomach with no more than 4 ounces of water, then wait at least 30 minutes before eating, drinking, or taking other oral medication¹². The tablet's absorption depends on it.

Why Does the Ladder Climb So Slowly?

Gastrointestinal side effects are the dose-limiting problem for this drug class, and the slow ladder is the management strategy. A pooled analysis of the STEP 1-3 trials makes the shape precise: nausea hit 43.9% of participants on semaglutide 2.4 mg versus 16.1% on placebo, events clustered during and shortly after dose escalation, 98.1% were mild to moderate, and only 4.3% of participants stopped the drug over them⁶. Hold each step long enough and most people adapt; that is the entire logic, and it is why the labels tell prescribers to delay escalation when a step is not tolerated rather than push through¹⁰.

The same analysis answers a persistent myth: weight loss was essentially the same in participants who had gastrointestinal side effects and those who did not, so feeling sick is not evidence the drug is working⁶.

Two conclusions worth stating plainly. Reaching 2.4 mg faster does not reproduce the trial results faster — the trials ran the ladder, so their numbers are results of the ladder. And slowing down is the labeled response to poor tolerance, a conversation with your prescriber rather than a failure.

Maintenance Is Not the Maximum

The chart's right-hand columns are the ones people misread. On Wegovy, 1.7 mg is a legitimate labeled maintenance dose for anyone who does not tolerate 2.4 mg¹⁰ — and in STEP 8, participants who could not tolerate 2.4 mg were maintained on 1.7 mg inside the trial itself⁵. On Ozempic, 0.5 mg is a maintenance dose, full stop; the label only escalates when glycemic control requires it¹¹.

The trials also measured what more drug actually buys. SUSTAIN FORTE compared semaglutide 2.0 mg against 1.0 mg head to head in type 2 diabetes: doubling the dose improved HbA1c by an additional 0.23 percentage points and weight by about 0.9 kg — real, but modest⁷. And STEP 4 tested the other direction: after a 20-week run-in in which 89% of participants reached 2.4 mg, those who stayed on the drug lost a further 7.9% of body weight over 48 weeks while those switched to placebo regained 6.9%³. Maintenance, in other words, is doing active work — and what the smallest dose that holds a result looks like is a genuinely open question the trials were not built to answer. That question, and the low-dose practice built around it, is laid out in microdosing tirzepatide; the reasoning transfers to semaglutide directly.

What Did the STEP Trials Actually Dose?

Every headline semaglutide number came from one regimen: 2.4 mg once weekly, reached by a 16-week escalation, on top of diet and activity changes.

• •STEP 1: 68 weeks, adults without diabetes — 14.9% mean weight loss versus 2.4% on placebo¹.
• •STEP 2: the same dose in adults with type 2 diabetes — 9.6% versus 3.4%, a notably smaller result than in the nondiabetic population².
• •STEP 5: two full years — 15.2% versus 2.6%, so the effect held rather than faded⁴.
• •STEP 8: against liraglutide 3.0 mg daily — 15.8% versus 6.4% at 68 weeks⁵.

For the oral route, PIONEER 1 dosed Rybelsus at exactly the labeled 3, 7, and 14 mg for 26 weeks: every dose improved HbA1c, but meaningful weight change appeared only at 14 mg, and it was about 2.3 kg — the tablet at diabetes doses is not the injection⁸. And the head-to-head that frames the whole category: SURPASS-2 put tirzepatide against semaglutide 1 mg and beat it at every tirzepatide dose⁹ — the comparison is worked through in tirzepatide vs semaglutide and the sibling schedule in tirzepatide dosage. What happens to lean mass on either drug is its own question, covered in semaglutide and muscle loss.

How Do You Convert Semaglutide Milligrams to Units?

The approved pens and tablets hide this problem completely — fixed doses, nothing to calculate. Compounded semaglutide from a telehealth pharmacy usually arrives as a vial, dosed in milligrams, drawn with an insulin syringe marked in units. The bridge between them is one number:

Concentration = milligrams in the vial ÷ milliliters of liquid. On a U-100 insulin syringe, 100 units always span 1 mL. So a 5 mg vial in 2 mL is 2.5 mg/mL, each unit mark carries 0.025 mg, and a 0.25 mg starting dose is 10 units. Put that same 5 mg in 1 mL and the identical dose is 5 units. Same vial, same dose, same syringe — half the marks.

What makes semaglutide less forgiving than most compounds is the size of its doses. Weekly amounts run from 0.25 to 2.4 mg — roughly a tenth of tirzepatide's — so doses land on the first few unit marks of the syringe, where one misread mark is a large fraction of the whole dose, and a unit number copied from someone whose vial was mixed differently can miss by several times, not several percent. A units figure from a forum is not information; it was correct for somebody else's concentration.

Our semaglutide dosage calculator does the milligrams-to-units conversion from your prescribed dose and your vial's concentration. If you are mixing a lyophilized powder yourself, the water volume is what sets the concentration — that is the semaglutide reconstitution calculator plus the bacteriostatic water calculator — and the bare mg-to-units relationship lives in the insulin syringe units converter. Technique itself is in how to reconstitute peptides and how to inject peptides.

What Compounded Semaglutide Actually Costs to Dose

The vial market also prices the ladder differently than the pens do, which is worth knowing before you compare numbers. As of August 2026, SkinnyRx publishes a four-term price ladder — injectable semaglutide is $349 month to month, falling to $199 only on a twelve-month commitment, while its tiles advertise the $199 with no term printed beside it. Semaglutide Online sells compounded semaglutide at $199 a month all-inclusive, and stacks a separate $44 monthly provider fee on its brand-name options. Per-provider rows are on best semaglutide providers, with the methodology in the price transparency index. Whether a compounded vial is a product a pharmacy can lawfully make for you this month is a separate, moving question — see is compounded semaglutide legal and the peptide regulatory tracker.

Bottom Line

The chart is the easy half. Wegovy climbs 0.25, 0.5, 1, 1.7 to a 2.4 mg weekly maintenance dose — 1.7 mg if 2.4 is not tolerated, 7.2 mg as a labeled ceiling for weight reduction, never a target¹⁰. Ozempic runs the same start to a 2 mg maximum¹¹; Rybelsus steps 3, 7, 14 mg daily¹². The ladder is slow because gastrointestinal tolerance is built, not assumed⁶, and every trial result people quote was produced on that schedule¹⁴.

The hard half is arithmetic, and it appears the moment your semaglutide comes as a vial instead of a pen. Milligrams are the dose; units are marks on a barrel; your vial's concentration is the only bridge. Get the dose in milligrams from whoever prescribes it, read the concentration off your own vial, and run the numbers yourself in the semaglutide dosage calculator — never from a number that was true for someone else's vial.

This page is educational and not medical advice. Semaglutide is a prescription drug; your dose, your schedule, and any change to either belong with a licensed clinician who knows your history.