Home / Compounds / Semaglutide
Weight management

Semaglutide

Semaglutide is a once-a-week injection for weight loss and type 2 diabetes. It is FDA-approved as Ozempic and Wegovy, and as daily tablets. It acts like GLP-1, a natural gut hormone released after meals. In studies, people felt full sooner and food felt less rewarding, so they ate less.

Dose range0.25–2.4 mgHow oftenOnce weeklyDosage ↓

What it’s studied for

  • Weight lossStudied in humans

    In a 68-week trial, people lost about 15% of their body weight, against about 2% on . source

  • Heart eventsStudied in humans

    In people with heart disease and extra weight, heart attacks, strokes and heart deaths were 20% less common over about 3 years. source

  • Kidney outcomesStudied in humans

    In people with diabetes and kidney disease, serious kidney problems were about a quarter less common. source

1 more use studied
  • Blood sugarStudied in humans

    Approved for type 2 diabetes since 2017. In trials, HbA1c, a long-term blood sugar marker, improved. source

Also listed asNN9535OzempicWegovyRybelsus
Educational only, not medical advice. Talk to a doctor before using any compound.Last reviewed October 23, 2026
New here? Three things worth knowing first

What’s a ? A short chain of amino acids, the building blocks of protein. Many act like messengers in the body.

Why the vial has to be mixed. It ships as a dry powder. You add , and the amount you add decides how many on the syringe equal one dose. The calculator does that math.

injection, Once weekly. Subcutaneous means into the fat layer just under the skin. It uses a small insulin syringe. Any word with a dotted underline on this page opens a short definition.

Dosage guidelines

Standard titration (weight management). Starts at 0.25 mg and goes up every 4 weeks: 0.25, 0.5, 1.0, 1.7, then 2.4 mg. Protocols hold a step 4 more weeks when side effects are strong.

StepWeeksWeekly doseDraw to
1Weeks 1–40.25 mg (250 mcg)5 units
2Weeks 5–80.5 mg (500 mcg)10 units
3Weeks 9–121 mg (1,000 mcg)20 units
4Weeks 13–161.75 mg (1,750 mcg)
rounded to the nearest 5-unit mark; the source says 1.7 mg
35 units
5Weeks 17+2.5 mg (2,500 mcg)
rounded to the nearest 5-unit mark; the source says 2.4 mg
50 units

Units are for a 15 mg vial mixed with 3 mL of water. Change the vial in the calculator

Full protocol details

Mixing in the protocols: 5 mg vial + 2 mL bacteriostatic water · 2.5 mg/mL; 0.25 mg = 10 units. Research-grade vials come in 5, 10, 20 and 30 mg; the water volume sets the concentration. Refrigerated after mixing..
Other forms: Oral: the Wegovy pill is 25 mg once daily for weight management. In its main trial, OASIS 4, adults lost 13.6% of body weight over 64 weeks vs 2.2% on placebo (human trial). Rybelsus is the diabetes tablet. Tablets use an absorption helper (SNAC), and only about 0.8% of an oral dose reaches the blood, which is why oral doses are in the tens of milligrams a day against 2.4 mg a week injected.

Standard titration (weight management)

The Wegovy schedule used in the STEP trials

Dose
0.25 → 0.5 → 1.0 → 1.7 → 2.4 mg
How often
Once weekly
Timing
Same day each week; the day can move if the previous dose was at least 2 days earlier. No fasting needed
Route
Subcutaneous
How long
Ongoing; the dose steps up every 4 weeks, with 2.4 mg as maintenance from week 17
Break
No off-period stated

Where side effects are strong, protocols hold the current dose for an extra 4 weeks. Skipping steps or starting high is described as causing severe nausea and vomiting. Many people are described as doing well below 2.4 mg, some at 1.0 mg; higher doses can add side effects without a matching gain.

Type 2 diabetes (Ozempic)

The diabetes dosing

Dose
0.25 mg, then 0.5 mg; up to 1.0 or 2.0 mg
How often
Once weekly
Route
Subcutaneous
How long
Ongoing

From week 5 the dose is 0.5 mg, which can go up to 1.0 or 2.0 mg depending on response.

Peptide calculator

How much is in your vial?

Check the label. The most common strengths:

Not listed above? Type it here.
mg
The amount your protocol lists for each injection.
mg
3 mL of BAC water
3 mL
This vial holds up to 3 mL of water.
Easy math
5units
That’s the 5 mark on a U-100 syringe. That’s 0.05 mL of liquid.
Every 10 units = 0.5 mg.
0102030405060708090100 5 units
Syringe size:
Strength5 mg/mL
Your dose0.25 mg
Doses per vial60

5 units. 3 mL of BAC water

How the vial is mixed

The powder has to be dissolved in bacteriostatic (BAC) water before use. For a 15 mg vial this page uses 3 mL, which puts the usual dose on a round syringe mark: every 10 units is 0.5 mg.

Vial with alcohol padSTEP 1Wipe both topsAlcohol pad on the peptide vial and the BAC water vial.
Drawing water into the syringeSTEP 2Draw 3 mL of waterThat’s 3 full 1 mL syringes.
Adding water down the vial wallSTEP 3Add it slowlyAim at the glass wall, not at the powder.
Gently swirling the vialSTEP 4Swirl, don’t shakeRoll gently until clear. Refrigerate after.

Read the full mixing guide →

What to watch for

  • Nausea, diarrhea, vomiting or constipation, mostly while the dose is going upStudied in humans
  • Gallbladder problems, which are more common across this drug classStudied in humans
  • Hair loss, a little more common than on Studied in humans
  • Tiredness, often tied to eating too littleReported by users
  • Anxiety, irritability or feeling emotionally flatReported by users

Not for anyone with a personal or family history of medullary thyroid cancer or MEN 2. Also not for pregnancy, breastfeeding or a past serious allergy to semaglutide. Talk to a doctor first, especially with a history of pancreatitis, diabetic eye disease or depression.

Reasons to get medical help right away: trouble breathing, swelling of the face or throat, chest pain, fainting, or any severe or worrying reaction.

Full side-effect list and who should avoid it

In published research

  • Nausea: 44% vs 17% on placebo
  • Diarrhea: 32% vs 16% on placebo
  • Also vomiting, constipation, stomach pain, headache and tiredness; dose-dependent, usually easing after 4 to 8 weeks
  • About 4.5% stopped for stomach and gut side effects (STEP-1)
  • Less common: reflux, bloating, gas, dizziness, injection-site reactions, hair loss (2.5% vs 1.0%)
  • Gallbladder disease: 37% higher risk across the GLP-1 drug class
  • Slowed stomach emptying (gastroparesis): most cases resolve after stopping; the FDA has unresolved reports
  • Pancreatitis: no increase in meta-analyses (OR 0.7, 95% CI 0.5 to 1.2), but still a listed precaution
  • Unusual skin sensations (dysesthesia), more common at the 7.2 mg dose

What users report

  • Nausea during dose increases
  • Constipation
  • Tiredness, often traced to too few calories or too little protein
  • "Sulfur burps"
  • Anxiety, irritability or emotional flatness

Not for

  • Personal or family history of medullary thyroid cancer, or MEN 2 (a label contraindication)
  • Past serious allergy to semaglutide
  • Pregnancy or breastfeeding

Use caution with

  • History of pancreatitis
  • Diabetic eye disease (retinopathy), which a rapid drop in blood sugar can worsen
  • Kidney disease, because of dehydration-related kidney injury
  • Gallbladder disease
  • Gastroparesis or other gut motility disorders
  • Depression or a history of suicidal thoughts
  • Upcoming surgery or deep sedation
  • Insulin or sulfonylureas, which may need lower doses
  • Prokinetic drugs such as metoclopramide or erythromycin, which may work against the stomach effects
  • Oral contraceptives: absorption timing could in theory shift. No clinically significant interactions were found with metformin, warfarin, atorvastatin or digoxin

How the body handles it

  • 94% structurally identical to natural GLP-1
  • Changes that resist breakdown by the enzyme DPP-4, plus a fatty side chain that binds albumin; over 99% is albumin-bound
  • Half-life about 7 days, so dosed weekly
  • Steady state after 4 to 5 weeks
  • Cleared by protein breakdown and fat oxidation; excreted in urine and feces
  • Oral bioavailability about 0.8%

Supplies

What 12 weeks of the schedule above takes, counted dose by dose.

Plan for
Semaglutide 15 mg
Our trusted peptide supplierSemaglutide 15 mg1 vial7 mg over 12 weeks of the schedule aboveSee the vial on PepSelect
Bacteriostatic water 30 mL
PepSelectBacteriostatic water 30 mL1 vial3 mL in each peptide vial, 3 mL in allSee BAC water on PepSelect
U-100 insulin syringes, 1 mL
AmazonU-100 insulin syringes, 1 mL13 syringes12 injections + 1 to mix the vialSee syringes on Amazon
Alcohol prep pads
AmazonAlcohol prep pads26 padsTwo each time: one for the vial top, one for the skinSee alcohol pads on Amazon

By clicking this link, WikiPep may receive a commission.

Stacking

What the community pairs with semaglutide, and why. Most pairings aim to keep muscle while weight comes off. None has been tested in a trial.

  • Strength training and proteinReported by users

    Described as the most important pairing. Without it, a large share of the weight lost can be muscle, so training and protein are used to hold on to it.

  • Growth-hormone peptidesReported by users

    Paired to help hold on to lean mass. Lower appetite may make their empty-stomach timing easier.

  • Testosterone therapyReported by users

    Paired to help keep lean mass. No interaction is described.

Also used alongside it, with no interactions described: BPC-157 and TB-500.

Not combined with: Other GLP-1 drugs, because they act on the same target.

Talk to a doctor before combining it with: insulin or sulfonylureas, whose doses may need lowering because of the risk of low blood sugar.

Go deeper

Every study, community report and source behind this page.

What the studies show17 findings, each with its evidence label

Status, October 2026. FDA-approved as Ozempic (2017, type 2 diabetes; kidney-disease indication added Jan 2025), Rybelsus tablets (2019), and Wegovy (2021 weight management; 2024 major heart-event risk in adults with heart disease and overweight; 2025 MASH; Dec 2025 tablets; Mar 2026 Wegovy HD 7.2 mg). Source

How it works

In the brain, semaglutide acts on receptors in the hypothalamus and brainstem. In human studies this strengthened fullness signals, quieted hunger signals and lowered how rewarding food feels, which is why users so often describe food simply becoming less interesting.

In the stomach, it slows emptying. In one human study, 37% of a solid meal was still in the stomach after 4 hours, against none on . Meals feel larger and last longer.

In the pancreas, it raises insulin only when blood sugar is high and lowers glucagon after meals. On its label, that glucose-dependent action is why low blood sugar is uncommon when semaglutide is used on its own.

It does not burn fat or raise metabolic rate. The weight loss in trials came from eating less than the body burns, which semaglutide makes easier to sustain.

Benefits

Each one carries an evidence label, so you can see how much is actually known.

Weight loss

In the STEP-1 trial, adults lost 14.9% of body weight over 68 weeks on 2.4 mg a week, against 2.4% on . STEP-3 reached 16.0% with intensive lifestyle support, and STEP-5 held 15.2% at 2 years. source

Studied in humans

Blood sugar and metabolic markers

Approved for type 2 diabetes since 2017. In human trials, fasting glucose, insulin sensitivity and HbA1c improved. source

Studied in humans

Heart events in SELECT

In 17,604 adults with heart disease and overweight but no diabetes, 6.5% on semaglutide vs 8.0% on placebo had a heart attack, stroke or heart-related death over about 3 years, a 20% lower rate. source

Studied in humans

Kidney outcomes in FLOW

In people with type 2 diabetes and chronic kidney disease, the trial's main kidney outcome occurred 24% less often than on placebo over a median 3.4 years. source

Studied in humans

What the science shows

STEP-1 (human, 68 weeks)

Studied in humans

1,961 adults with obesity and no diabetes, 2.4 mg weekly vs . Weight fell 14.9% vs 2.4%. 86% lost at least 5%, 69% at least 10% and 50% at least 15%. About 4.5% stopped because of stomach and gut side effects. source

STEP-3 (human, 68 weeks)

Studied in humans

611 adults given intensive behavioral therapy and an initial low-calorie diet on top of treatment. Weight fell 16.0% vs 5.7% on placebo, and about 40% lost 20% or more. source

STEP-5 (human, 2 years)

Studied in humans

304 adults without diabetes. The 15.2% loss held at 104 weeks on continued treatment. source

STEP-1 extension, after stopping (human)

Studied in humans

327 participants followed for a year off treatment regained about two-thirds of the weight they had lost. source

Body composition in STEP-1 (human, DXA)

Studied in humans

In 140 participants scanned, fat mass fell 19.3% and 27.4%, while lean mass fell 9.7%. The share of the body made up of lean tissue rose 3.0 percentage points. Roughly 60 to 65% of the weight lost was fat and 35 to 40% lean tissue. source

SEMALEAN (human, 12 months)

Studied in humans

106 patients on 2.4 mg. Fat mass fell 18% at 12 months. Lean mass fell 3 kg by month 7 and then held steady, handgrip strength rose 4.5 kg, and the share with sarcopenic obesity fell from 49% to 33%. source

SURMOUNT-5, head to head with tirzepatide (human, 72 weeks)

Studied in humans

751 adults without diabetes. Tirzepatide lost 20.2% and semaglutide 13.7%. Stopping for stomach and gut side effects: 5.6% on semaglutide, 2.7% on tirzepatide. source

SELECT, heart events (human, about 40 months)

Studied in humans

17,604 adults aged 45 or older with heart disease, a BMI of 27 or more and no diabetes, followed for a mean 39.8 months. Major heart events: 6.5% vs 8.0% on placebo (hazard ratio 0.80, 95% CI 0.72 to 0.90, P < 0.001). source

FLOW, kidney outcomes (human, 3.4 years)

Studied in humans

People with type 2 diabetes and chronic kidney disease. Over a median 3.4 years, the combined kidney outcome occurred 24% less often than on placebo. source

Gallbladder risk across the drug class (human, meta-analysis)

Studied in humans

76 randomized trials of drugs. Gallbladder and bile-duct disease was 37% more common (RR 1.37, 95% CI 1.23 to 1.52), gallstones 27% and gallbladder inflammation 36%. Risk was higher at higher doses and in weight-loss trials. source

Thyroid question (human review)

Studied in humans

Across 10 randomized trials with 14,550 participants, thyroid cancer cases were isolated, under 1% within study groups. source

Thyroid C-cell tumors (animal studies)

Studied in animals or lab

Thyroid C-cell tumors, including medullary thyroid cancer, were seen in animal studies. Whether that applies to people is not established, and the label carries a boxed warning. source

Suicidal thoughts (FDA review, human)

Studied in humans

An FDA review of post-marketing reports and placebo-controlled trials found no increased risk. People with active major depression or past suicide attempts were not well represented in the trials. source

What the community reports7 user reports, a timeline and 6 pairings

What to expect

Weeks 1–2

Appetite usually drops within the first one to two weeks, even at the 0.25 mg starting dose.

Reported by users
Month 2

Weight loss usually becomes visible in the second month.

Reported by users
Weeks 16–17

The standard schedule reaches the full 2.4 mg dose, about 16 to 17 weeks after the first injection.

Studied in humans
Months 3–9

The period with the largest losses.

Reported by users
Months 12–15

In STEP-5, most of the loss came in the first year and plateaued around 15%, which held through 2 years on continued treatment. For someone starting at 240 lb, 15% is about 36 lb.

Studied in humans
After stopping

In the STEP-1 extension, people who had lost 17.3% regained about two-thirds within a year, ending 5.6% below their starting weight.

Studied in humans

The protocols are described for adults with obesity, or overweight with weight-related health problems. Protein, resistance training and sleep are framed as the foundation that decides how much of the loss is fat and how much of it lasts.

What people report

Gathered from user communities. Anecdotal: useful for what to expect, not proof.

Weight lost

Users commonly describe losing 8 to 18% of body weight over 6 to 12 months.

Reported by users

Food becomes less interesting

The effect is described less as willpower and more as food simply mattering less.

Reported by users

Nausea at each dose step

Worst for one to two weeks after each increase. Smaller meals, less fatty food, plenty of fluids and staying upright after eating are the strategies users describe.

Reported by users

Constipation

Nearly as common as nausea. Fiber, magnesium and water are described as helping partly.

Reported by users

Face and hair

Facial fat loss with rapid weight loss ("Ozempic face") and hair shedding, reported more often by women.

Reported by users

Muscle and strength

Users with low protein intake describe feeling weaker and losing definition. The best results are reported with high protein, at least 1 g per pound of goal body weight, and resistance training.

Reported by users

Switching

Some move on to tirzepatide or retatrutide for more weight loss or better muscle retention, and describe appetite control as weaker on retatrutide.

Reported by users

Stacking

How it is described alongside other compounds.

Resistance training and protein

Described as the most important pairing. Without it, 35 to 40% of the weight lost can be lean tissue. The targets described are training 2 to 3 days a week and at least 1 g of protein per pound of goal body weight a day.

BPC-157 and TB-500

No interaction concerns described. Some users say BPC-157 eases stomach discomfort; no published data backs this.

Growth-hormone peptides (CJC-1295, ipamorelin, sermorelin)

No interaction described. Those peptides need a fasted window, which reduced appetite may make easier. Paired to help hold on to lean mass.

Testosterone therapy

No interaction described; it is paired to help keep lean mass.

Other GLP-1 drugs

Not combined. They act on the same receptor.

Insulin or sulfonylureas

Those doses may need lowering because of the risk of low blood sugar, which calls for medical supervision.

Common questions11 questions

Common questions

Does semaglutide burn fat directly?

No. It lowers appetite so that eating less than the body burns is easier to sustain. The fat loss comes from that deficit.

Does the weight come back after stopping?

In the STEP-1 extension, most people regained about two-thirds of their loss within a year. The habits built while on it are described as what decides how much returns.

How does it compare with tirzepatide?

In SURMOUNT-5, tirzepatide lost 20.2% and semaglutide 13.7% at 72 weeks, about 47% more. Fewer people stopped tirzepatide for stomach and gut side effects (2.7% vs 5.6%). Tirzepatide's added GIP action may also help with muscle retention.

How does it compare with retatrutide?

Retatrutide acts on three receptors (GLP-1, GIP and glucagon). In the phase 3 TRIUMPH-1 trial, 12 mg weekly gave a 25.0% average loss at 80 weeks vs 3.9% on placebo. It is investigational, and Lilly plans to file with the FDA in early 2027.

How much muscle is lost?

In the STEP-1 scans, lean mass fell 9.7%, or about 35 to 40% of the weight lost. High protein and resistance training are described as improving that ratio.

What about the kidneys?

In FLOW, kidney outcomes occurred 24% less often than on placebo in people with diabetes and kidney disease. Case reports of acute kidney injury are tied to dehydration from vomiting or diarrhea, which is why existing kidney disease calls for supervision.

Can it cause hair loss?

In trials, 2.5% reported hair loss vs 1.0% on placebo. It appears tied to how much weight is lost, and may be more common in women.

Does a surgeon need to know?

Yes. Slower stomach emptying raises the risk of stomach contents being inhaled during anesthesia, and anesthesia guidance has advised holding weekly GLP-1 drugs for at least a week before elective surgery. The surgical team sets the plan.

What happens when switching to another compound?

Protocols describe taking the last semaglutide dose and starting the new compound the following week, with no washout.

What does “minimum effective dose” mean?

It is the lowest dose that still produces the effect someone is after. User reports describe starting there and staying there for as long as it keeps working, rather than climbing toward the top of the range. Side effects tend to rise with dose, and the top of each range on this page is a ceiling people report, not a target.

When does the dose go up?

In the trials, the dose went up on a fixed schedule, because a trial has to treat everyone the same way. User reports describe a different pattern outside trials: staying on a dose while it is still working, and moving up only after progress has stalled for two weeks or more and side effects have settled. There is no prize for getting to the top dose fast. These are not quick fixes: most of what people report builds over weeks, not days.

Source material15 studies and documents

References

  1. Wilding JPH, et al. N Engl J Med. 2021;384(11):989-1002. pubmed.ncbi.nlm.nih.gov/33567185/…
  2. Wadden TA, et al. JAMA. 2021;325(14):1403-1413. pubmed.ncbi.nlm.nih.gov/33625476/…
  3. Garvey WT, et al. Nat Med. 2022;28(10):2083-2091. pubmed.ncbi.nlm.nih.gov/36216945/…
  4. Wilding JPH, et al. Diabetes Obes Metab. 2022;24(8):1553-1564. pubmed.ncbi.nlm.nih.gov/35441470/…
  5. Wilding JPH, et al. J Endocr Soc. 2021;5(Suppl 1):A16-A17. pmc.ncbi.nlm.nih.gov/articles/PMC8089287/…
  6. Alissou M, et al. Diabetes Obes Metab. 2026;28(1):112-121. pubmed.ncbi.nlm.nih.gov/41068996/…
  7. Aronne LJ, et al. N Engl J Med. 2025;393(1):26-36. pubmed.ncbi.nlm.nih.gov/40353578/…
  8. Lincoff AM, et al. N Engl J Med. 2023;389(24):2221-2232. pubmed.ncbi.nlm.nih.gov/37952131/…
  9. Perkovic V, et al. N Engl J Med. 2024;391(2):109-121. pubmed.ncbi.nlm.nih.gov/38785209/…
  10. He L, et al. JAMA Intern Med. 2022;182(5):513-519. pubmed.ncbi.nlm.nih.gov/35344001/…
  11. Feier CVI, et al. Int J Mol Sci. 2024;25(8):4346. pmc.ncbi.nlm.nih.gov/articles/PMC11050669/…
  12. Yang XD, Yang YY. Drug Des Devel Ther. 2024;18:2555-2570. pmc.ncbi.nlm.nih.gov/articles/PMC11215664/…
  13. Jastreboff AM, et al. N Engl J Med. 2026. www.nejm.org/doi/full/10.1056/NEJMoa2604169…
  14. Wharton S, et al. N Engl J Med. 2025;393(11):1077-1087. doi.org/10.1056/NEJMoa2500969…
  15. US Food and Drug Administration. Update on ongoing evaluation of reports of suicidal thoughts or actions. January 2024. www.fda.gov/drugs/drug-safety-and-availability/u…