A semaglutide prescription is really five prescriptions in sequence. The weight-management label moves in four-week steps from 0.25 mg to 2.4 mg once weekly, and each rung is doing a different job. Which job belongs to which milligram is what turns a figure on the semaglutide board into a comparable number, because a monthly price means very little until you know which rung it buys.
0.25 mg is a starting dose and nothing else
The Wegovy label opens at 0.25 mg subcutaneously once weekly for weeks 1 through 4. No approved indication lists that figure as a maintenance dosage. Ozempic opens at the same amount for the same four weeks before moving to 0.5 mg, and its own maintenance options begin a rung higher.
So 0.25 mg is a tolerance test rather than a treatment. Its purpose is to let the gut meet the drug at an amount unlikely to produce the gastrointestinal reactions that cluster early. A plan priced around that figure is priced around the four weeks when the least drug is being dispensed, which is a different proposition from the one a deliberately reduced dose describes.
0.5 mg and 1 mg: waypoints here, destinations in diabetes
On the weight-management schedule, weeks 5 through 8 sit at 0.5 mg and weeks 9 through 12 at 1 mg. Both are transitional. On the diabetes label they are not transitional at all: Ozempic names 0.5 mg, 1 mg and 2 mg as maintenance dosages, selected on glycemic control, with at least four weeks at the current amount before any increase.
STEP 2 puts that split on the record. It randomized 1,210 adults with overweight or obesity and type 2 diabetes to semaglutide 2.4 mg, semaglutide 1.0 mg or placebo once weekly for 68 weeks. Its own report describes the middle arm as the dose approved for diabetes treatment.[1] One milligram is a finish line in one indication and a fourth-month waypoint in the other.
The diabetes ladder then goes one rung further. SUSTAIN FORTE assigned 961 adults with inadequately controlled type 2 diabetes to 2.0 mg or 1.0 mg weekly for 40 weeks. Glycated hemoglobin fell 2.2 percentage points against 1.9, and body weight fell 6.9 kg against 6.0 kg.[2] The higher amount did more, and the margin was narrow enough that tolerability decides it for many people.
1.7 mg is a maintenance dose, not only a step
Weeks 13 through 16 sit at 1.7 mg, which reads like one more waypoint on the way up. The label treats it as more than that. For weight reduction in adults, the maintenance dosage is either 1.7 mg or 2.4 mg once weekly, with 2.4 mg recommended and the choice made on treatment response and tolerability.
That matters to anyone whose climb stalls. Settling at 1.7 mg is a labeled maintenance option rather than an incomplete course, and the same label says that a dose not tolerated during escalation is a reason to consider delaying the next step by four weeks. Neither of those is a failure state, and how long the rough stretch lasts is usually the deciding input.
2.4 mg, and the rung the label added above it
From week 17 onward, 2.4 mg is the recommended maintenance dosage for weight reduction, and it is the amount STEP 1 tested for 68 weeks in 1,961 adults with overweight or obesity and no diabetes.[3] How much that produced is a separate question, answered in the weight-result article.
The ladder is no longer capped there. The current label permits an increase to a maximum of 7.2 mg once weekly for adults who have tolerated 2.4 mg for at least four weeks and need further weight reduction. Ozempic’s maximum remains 2 mg once weekly. The top of the ladder therefore depends on which product is being prescribed, and a plan that says only “the full dose” has not told you which ceiling it means.
A milligram is not a volume
The approved presentations hide the arithmetic on purpose. Wegovy single-dose pens carry one strength each, so a 1.7 mg pen delivers 1.7 mg and there is nothing to calculate. Ozempic pens hold several weekly doses at a fixed concentration, and the label lists them as 0.68 mg/mL, 1.34 mg/mL and 2.68 mg/mL, one concentration per dose size.
A compounded vial usually inverts that. It arrives as a single multiple-dose container at a concentration, and the weekly dose is a volume drawn out of it, which is why the concentration is the number to ask for. What that changes about the contents themselves is set out in what a compounded vial holds.
A compounded ladder may not have every rung
Nothing obliges a seller to stock all five strengths. Some supply the lower three and stop. Some skip 1.7 mg entirely and jump from 1 mg to 2.4 mg. Some hold everyone at one concentration and change the volume instead, which works arithmetically and still leaves the buyer converting milligrams into units at the kitchen table.
Three questions settle it before the first charge. Which strengths does the plan actually dispense? Does the price move when the dose does, a point that sellers holding one price answer in advance? And what is the concentration of the vial being shipped? The individual seller write-ups record what each company publishes on those points, and the gap between a labeled schedule and a prepared one is the subject of the compounding article.
The ladder itself is not controversial. It is published, it is specific, and it has been the same shape for years apart from the new rung at the top. What varies is whether the product in front of you can follow it, and that is a question for the seller rather than the label.