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En tidslinje uke for uke gjennom det første året på semaglutid. Hva som er normalt, hva som ikke er det, og når du skal ringe legen. This is patient education, not a substitute for the prescriber who knows your case. Generic names sit next to brand names throughout: semaglutide (Ozempic, Wegovy), tirzepatide (Mounjaro, Zepbound).
Key points
- Week 1, first injection (0.25 mg). The starting dose is 0.25 mg once weekly per the Ozempic prescribing information, sub-therapeutic by design, used for tolerability. Appetite suppression is reported within 48-72 hours by many patients (Blundell et al. 2017 measured energy-intake reduction in the first dosing interval). Mild nausea, mild bloating, and early satiety are the dominant reports. This week is rarely the hardest week.
- Week 2, body adjusting at 0.25 mg. Most week-1 GI symptoms have eased. Energy is often described as flat or slightly low, partly the appetite signal eating less than usual, partly the body's adjustment. The STEP-1 trial reported that nausea typically peaked in the first 8-16 weeks and faded; week 2 of any new dose is usually the back half of the peak.
- Week 3, settling at 0.25 mg. Most patients describe week 3 as the settle-in week. Eating habits have started to adjust to the smaller portions the appetite signal is allowing. Weight change at this point is typically minimal, a few pounds at most, often water rather than fat per Wilding 2021 (STEP-1) early-timepoint data.
- Week 4, last week at 0.25 mg. Most prescribers titrate to 0.5 mg at the end of week 4 per the FDA-approved schedule. The 0.25 mg dose is not therapeutic for glycaemic control or weight management, it is a tolerability dose. If GI symptoms have been rough, this is the conversation point with the prescriber about holding for an extra month.
- Week 5, first 0.5 mg injection. The dose-escalation week tends to mirror week 1 in terms of side-effect profile: nausea, possibly diarrhoea or constipation, possible reflux. The Ozempic prescribing information lists these as the most common adverse reactions and notes they are typically heaviest right after a dose change. Plan a quiet 48 hours after the shot.
Frequently asked questions
When does Ozempic start working?
Appetite suppression usually shows up in the first week. A lot of people notice it within 48-72 hours of the first 0.25mg dose. Measurable weight change is slower. In the STEP-1 trial of semaglutide 2.4mg (the Wegovy dose), the average weight curve separated from placebo around week 4 and kept going for 68 weeks. Blood sugar changes in people with type 2 diabetes often show up faster, sometimes within the first few weeks.
What week is Ozempic the worst?
For most people, the hardest stretch is the first two weeks of any new dose. So weeks 1-2 after starting, and again the week you step up from 0.25mg to 0.5mg (usually week 5), and again from 0.5mg to 1mg. The Ozempic prescribing information lists nausea, diarrhea, and vomiting as the most common adverse reactions, typically heaviest right after a dose change. Things usually settle within 1-2 weeks as the body adjusts.
When do Ozempic side effects go away?
Usually 1-2 weeks after each dose change, sometimes a bit longer. In the STEP trials, GI side effects were described as transient: they came on, peaked, and faded for most participants. A smaller group had persistent issues and either stayed at a lower dose or stopped the drug. If nausea, vomiting, or abdominal pain is getting worse instead of better by week 3 of any dose, that's a reason to call your prescriber.
How much weight loss is typical in the first month?
The STEP-1 trial of semaglutide 2.4mg reported an average of roughly 6% body-weight loss by week 20, which means the first month is usually modest. Often a few pounds, sometimes none. Ozempic (approved for type 2 diabetes, maxing at 2mg) tends to produce slightly less. Very early weight change is mostly water and reduced food intake, not fat. If the scale isn't moving in month 1, that's within the range of normal.
Do I have to increase my dose?
The FDA-approved schedule for Ozempic escalates every 4 weeks: 0.25mg, 0.5mg, 1mg, with 2mg as the maximum. But the prescribing information allows clinicians to slow the titration if side effects are rough. A lot of prescribers will hold you at 0.25mg or 0.5mg for an extra month if week 5 is miserable. Dose escalation is a conversation with your doctor, not a fixed calendar.
Should I take my shot on the same day every week?
The prescribing information says yes, same day of the week, any time of day, with or without food. If you need to move the day, the label allows it as long as the last dose was at least 2 days (48 hours) earlier. Many people pick a day and time that's boring and quiet. Sunday morning is a common choice because nausea in the first 48 hours is easier to ride out at home.
What if I miss a dose?
Per the Ozempic prescribing information: if the missed dose is within 5 days, take it when you remember, then go back to your regular schedule. If it's been more than 5 days, skip the missed dose and resume the next one on your regular day. Don't double up. If you're not sure, call your pharmacist. They deal with this question constantly and can check your specific dose.
Sources
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