Semaglutide's most common side effects — nausea, vomiting, and GI discomfort — are almost entirely dose-dependent and occur primarily during the titration phase. The standard titration protocol is designed to allow GLP-1 receptor adaptation before escalating to therapeutic doses.
The Standard Titration Schedule
| Weeks | Weekly Dose | Expected Tolerance |
|---|---|---|
| Weeks 1–4 | 0.25mg | Mild nausea possible |
| Weeks 5–8 | 0.5mg | GI adaptation underway |
| Weeks 9–12 | 1.0mg | Significant appetite suppression |
| Weeks 13–16 | 1.7mg | Near-therapeutic range |
| Week 17+ | 2.4mg | Full therapeutic dose |
Managing GI Side Effects
If GI side effects are intolerable at any dose, hold at the current dose for an additional 4 weeks before escalating. Do not rush the titration — the therapeutic effect at 0.5mg is still clinically meaningful, and forcing escalation increases dropout rates significantly.
Administration Protocol
Administer once weekly, on the same day each week. Subcutaneous injection into the abdomen, thigh, or upper arm. Rotate injection sites. The day of the week does not matter — consistency matters. If a dose is missed by less than 5 days, administer as soon as possible. If more than 5 days have passed, skip and resume on the next scheduled day.