Semaglutide
Ozempic, Wegovy and Rybelsus — the same molecule
Experimental material. Read before using anything from here.
Nothing on this page is a medical recommendation, prescription or treatment plan. It is an organized translation of protocols circulating in research communities and, where it exists, of what published trials tested. The two are marked differently — and they are not equivalent.
Most of the compounds here have no FDA approval for human use. Several are sold labeled "research use only", which means they have not gone through purity, sterility or dosage controls for human consumption. A community-reported dose is not a validated dose: it is what someone reported having done.
Talk to a licensed health professional before considering any of these compounds. If you already use one and feel anything unexpected, seek care — do not wait for the next routine test.
Black box warning in the US, caution in Brazil — and the two package inserts disagree
Semaglutide carries the strongest warning the FDA applies to a medicine. In rodents it causes thyroid C-cell tumors in a dose- and treatment-duration-dependent manner, at clinically relevant exposures. Whether it causes them in humans is unknown.
In the United States this is an absolute contraindication in anyone with a personal or family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia type 2 (MEN 2). In Brazil, it is not. The package inserts of Ozempic, Wegovy and Rybelsus contraindicate only hypersensitivity; on MTC, they say to use with caution and classify human relevance as considered low. Here, the prescriber decides — not the package insert.
There are reports of anaphylaxis and angioedema with semaglutide, and that is a contraindication in both countries.
This warning was not on this page until September 4, 2026, and the failure was this site's, not the source's. The audit of the dose tables against the FDA package inserts is in The GLP-1s against the package insert.
Summary
One of the most studied weight-loss and diabetes drugs in the world. It appears as Ozempic (type 2 diabetes), Wegovy (weight management) and Rybelsus (daily oral tablet). They are the same molecule in different presentations and doses. Here it is the compound with the most solid clinical base in the entire reference.
Quick reference
- Two pathways
- Injectable (1×/week) and oral tablet (1×/day). The dosing schedules are different.
- Slow start
- Doses start very low and rise every 4 weeks, so the stomach can adjust.
- Measure
- Most research vials come out well at 2.5 mg/mL. In that mix, 0.25 mg = 10 units on the U-100.
- Half-life
- About 7 days. Steady state takes 4 to 5 weeks at each step.
Injectable Titration Schedule
| Phase | Weeks | Weekly dose | What to expect |
|---|---|---|---|
| Phase 1 - Initiation | Weeks 1–4 | 0.25 mg | Starting dose for tolerability only. Not a therapeutic dose. Minimal metabolic effect expected. |
| Phase 2 - Early escalation | Weeks 5-8 | 0.5 mg | First meaningful dose. Stomach side effects (nausea) most likely to show up here. |
| Phase 3 - Mid escalation | Weeks 9-12 | 1.0 mg | Therapeutic range for type 2 diabetes (Ozempic). Appetite suppression often becomes noticeable. |
| Phase 4 - High escalation | Weeks 13-16 | 1.7 mg | Approaching the weight-management dose. Weight loss often clearly underway. |
| Phase 5 - Maintenance | Weeks 17+ | 2.4 mg | FDA-approved maintenance dose for weight management (Wegovy). 14.9% mean weight loss at 68 weeks in STEP 1. |
Oral Tablet Titration
| Phase | Weeks | Daily dose | Notes |
|---|---|---|---|
| Phase 1 | Weeks 1–4 | 1.5 mg | Starting dose. Tolerability only. |
| Phase 2 | Weeks 5-8 | 4 mg | First step up. |
| Phase 3 | Weeks 9-12 | 9 mg | Mid-range dose. |
| Phase 4 | Week 13+ | 25 mg | Maintenance dose. 16.6% weight loss at 64 weeks in OASIS 4. |
Oral Tablet Titration
| Phase | Duration | Daily dose | Notes |
|---|---|---|---|
| Phase 1 | Weeks 1–4 | 3 mg | Tolerability dose only. No clinical effect expected. |
| Phase 2 | Weeks 5-8 | 7 mg | First therapeutic dose. May stay here for ongoing T2D control. |
| Phase 3 | Week 9+ | 14 mg | Maximum FDA-approved Rybelsus dose. |
Cycle Guidelines
| Approach | Duration | Maintenance phase | Best for |
|---|---|---|---|
| Standard obesity titration | About 16 weeks to 2.4 mg | Ongoing weekly maintenance | Wegovy-style obesity research |
| Standard T2D titration | About 8-16 weeks to 1.0 or 2.0 mg | Ongoing weekly maintenance | Ozempic-style diabetes research |
| Delayed escalation | Add 4 weeks at any intolerable step | Same target maintenance | When side effects slow the planned ramp |
Semaglutide Reconstitution Guide
| Vial size | BAC water added | 0.25 mg | 0.5 mg | 1.0 mg | 1.7 mg | 2.4 mg |
|---|---|---|---|---|---|---|
| 2 mg | 0.8 mL | 0.10 mL (10 u) | 0.20 mL (20 u) | 0.40 mL (40 u) | 0.68 mL (68 u) | 0.96 mL (96 u) |
| 3 mg | 1.2 mL | 0.10 mL (10 u) | 0.20 mL (20 u) | 0.40 mL (40 u) | 0.68 mL (68 u) | 0.96 mL (96 u) |
| 5 mg | 2.0 mL | 0.10 mL (10 u) | 0.20 mL (20 u) | 0.40 mL (40 u) | 0.68 mL (68 u) | 0.96 mL (96 u) |
Semaglutide Reconstitution Guide
| Vial size | BAC water added | 0.25 mg | 0.5 mg | 1.0 mg | 1.7 mg | 2.4 mg |
|---|---|---|---|---|---|---|
| 10 mg | 3.0 mL | 0.075 mL (7.5 u) | 0.15 mL (15 u) | 0.30 mL (30 u) | 0.51 mL (51 u) | 0.72 mL (72 u) |
Semaglutide Reconstitution Guide
| Vial size | BAC water added | 0.25 mg | 0.5 mg | 1.0 mg | 1.7 mg | 2.4 mg |
|---|---|---|---|---|---|---|
| 5 mg | 1.0 mL | 0.05 mL (5 u) | 0.10 mL (10 u) | 0.20 mL (20 u) | 0.34 mL (34 u) | 0.48 mL (48 u) |
| 10 mg | 2.0 mL | 0.05 mL (5 u) | 0.10 mL (10 u) | 0.20 mL (20 u) | 0.34 mL (34 u) | 0.48 mL (48 u) |
Semaglutide Timeline & What to Monitor
| Checkpoint | What clinical trials show |
|---|---|
| Weeks 1-4 (0.25 mg) | Tolerability phase. No meaningful weight or HbA1c change expected. |
| Weeks 5-8 (0.5 mg) | Early appetite changes possible. Most stomach side effects show up here. |
| Weeks 8–12 | Appetite suppression often clearly noticeable at 1.0 mg in diabetes research. |
| Weeks 16-20 | Stomach side effects usually plateau. Weight loss curve starts to accelerate. |
| Week 28 | STEP 1 interim data: significant weight loss vs placebo. |
| Week 68 | STEP 1 endpoint: 14.9% mean weight loss at 2.4 mg vs 2.4% placebo. |
Semaglutide vs Tirzepatide vs Retatrutide vs Liraglutide
| Factor | Semaglutide | Tirzepatide | Retatrutide | Liraglutide |
|---|---|---|---|---|
| Receptor targets | GLP-1 only | GLP-1 + GIP | GLP-1 + GIP + glucagon | GLP-1 only |
| Half-life | ~7 days | ~5 days | ~6 days | ~13 hours |
| Dosing frequency | 1×/week | 1×/week | 1×/week | 1×/day |
| Max studied dose | 2.4 mg/week (SubQ); 25 mg/day oral | 15 mg/week | 12 mg/week | 3.0 mg/day |
| Peak trial weight loss | -14.9% at 68 wks (STEP 1) | -22.5% at 72 weeks (SURMOUNT-1) | -28.7% at 68 wks (TRIUMPH-4) | -8% at 56 wks (SCALE) |
| FDA status (June 2026) | Approved (T2D, obesity, CVD, MASH, CKD, oral) | Approved (T2D, obesity) | Investigational - Phase 3 | Approved (Saxenda obesity, Victoza T2D) |
| CV outcomes data | Yes - SELECT (20% MACE drop) | SURPASS-CVOT ongoing | TRIUMPH-3 ongoing | Yes - LEADER (13% MACE drop) |
Storage and handling
The rules below apply to practically every lyophilized peptide in this reference. Where a compound has its own requirement, it appears in the table in the previous section.
- Lyophilized powder, sealed: refrigerator, between 2 and 8 °C, protected from light. Many tolerate room temperature for short transport periods, but that is tolerance, not a recommendation.
- After reconstitution: always refrigerated, between 2 and 8 °C. The stability window drops to days or a few weeks, depending on the compound.
- Never freeze after reconstituting. The freeze–thaw cycle degrades the peptide.
- Do not shake. Swirl the vial slowly. Shaking breaks the peptide chain.
- Bacteriostatic water down the wall of the vial, in a slow stream, not squirted directly onto the powder.
- Cloudy solution, with particles or a color change: discard. There is no recovery.
Lab tests and monitoring
This list is the one that appears recurrently in the source, with small variations by compound. It serves as a starting point for a conversation with a professional — not as a substitute for that conversation.
- Before starting: complete blood count, comprehensive metabolic panel, lipid panel, fasting glucose and HbA1c, TSH and free T4, blood pressure and resting heart rate.
- Depending on the compound: IGF-1 (GH axis), lipase and amylase (VIP and the incretin agonists), serum copper and ceruloplasmin (GHK-Cu and blends containing it), CRP.
- Reassessment: most protocols review between week 4 and week 8, and then every 8–12 weeks.
- Do not wait for the routine lab test in the face of abdominal pain, visual changes, a change in a mole, shortness of breath, asymmetric swelling or any new and persistent symptom. That is a reason to seek care, not a spreadsheet item.
Evidence limits
Data source: peptidedosingprotocols.com, accessed on September 3, 2026. Translation and organization in Portuguese are original work. No primary source (PubMed, trial registry, package insert) was checked in building this page — the check was against the secondary source, and that alone.