GLP-1: Dosing Protocols
Dosing guidelines, reconstitution, and administration information
๐TL;DR
- โข5 dosing protocols documented
- โขReconstitution instructions included
- โขStorage: Pre-filled pens: Store refrigerated at 2-8 degrees C before first use. After first use, may be stored at room temperature (up to 30 degrees C) for the product-specific in-use period (14-56 days depending on product). Do not freeze.
Protocol Quick-Reference
Weight management and type 2 diabetes treatment via GLP-1 receptor agonism
Dosing
Amount
Semaglutide: 0.25 mg escalating to 2.4 mg weekly (obesity); Tirzepatide: 2.5 mg escalating to 15 mg weekly
Frequency
Once weekly (semaglutide, tirzepatide) or once daily (liraglutide)
Duration
Chronic therapy (ongoing); weight regain common upon discontinuation
Step-wise Titration (16 weeks)
Administration
Route
SCSchedule
Once weekly (semaglutide, tirzepatide) or once daily (liraglutide)
Timing
Any time of day, with or without meals; same day each week for weekly agents
โ Rotate injection sites
Cycle
Duration
Chronic therapy (ongoing); weight regain common upon discontinuation
Repeatable
Yes
Preparation & Storage
โ Ready-to-use โ no reconstitution required
Storage: Pre-filled pens: Store refrigerated at 2-8 degrees C before first use. After first use, may be stored at room temperature (up to 30 degrees C) for the product-specific in-use period (14-56 days depending on product). Do not freeze.
โ๏ธ Suggested Bloodwork (6 tests)
HbA1c and fasting glucose
When: Baseline
Why: Baseline glycemic status
Comprehensive metabolic panel (CMP)
When: Baseline
Why: Renal and hepatic function baseline
Lipid panel
When: Baseline
Why: Baseline cardiovascular risk markers
TSH
When: Baseline
Why: Thyroid function baseline (thyroid C-cell concerns in animal studies)
Lipase and amylase
When: Baseline
Why: Baseline pancreatic enzymes
HbA1c
When: 3 months
Why: Assess glycemic improvement
๐ก Key Considerations
- โOral semaglutide (Rybelsus) must be taken on empty stomach with no more than 4 oz plain water, 30 min before food
- โContraindication: Contraindicated in personal or family history of medullary thyroid carcinoma or MEN2 syndrome
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| Purpose | Dose | Frequency | Duration | Notes |
|---|---|---|---|---|
| Type 2 diabetes (semaglutide injectable) | 0.25 mg to 2.0 mg weekly | Once weekly subcutaneous | Chronic therapy | Start 0.25 mg x 4 weeks, then 0.5 mg; may increase to 1.0 mg then 2.0 mg |
| Obesity (semaglutide injectable) | 0.25 mg escalating to 2.4 mg weekly | Once weekly subcutaneous | Chronic therapy (weight regain upon discontinuation) | 16-week titration schedule; target dose 2.4 mg weekly |
| Type 2 diabetes (liraglutide) | 0.6 mg escalating to 1.8 mg daily | Once daily subcutaneous | Chronic therapy | Start 0.6 mg x 1 week, increase to 1.2 mg, then 1.8 mg |
| Obesity (liraglutide) | 0.6 mg escalating to 3.0 mg daily | Once daily subcutaneous | Chronic therapy | Weekly dose escalation from 0.6 mg to target 3.0 mg over 5 weeks |
| Type 2 diabetes and obesity (tirzepatide) | 2.5 mg escalating to 15 mg weekly | Once weekly subcutaneous | Chronic therapy | Start 2.5 mg x 4 weeks; increase by 2.5 mg every 4 weeks to target |
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๐Reconstitution Instructions
GLP-1 receptor agonists are supplied as pre-filled injection pens ready for use. No reconstitution is required. Native GLP-1 for research use is reconstituted in sterile buffer per manufacturer specifications.
Recommended Injection Sites
- โSubcutaneous (abdomen, thigh, upper arm)
๐งStorage Requirements
Pre-filled pens: Store refrigerated at 2-8 degrees C before first use. After first use, may be stored at room temperature (up to 30 degrees C) for the product-specific in-use period (14-56 days depending on product). Do not freeze.
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Before You Begin
Review safety warnings and contraindications before starting any protocol.
Dosing Information#
GLP-1 receptor agonists are approved medications with well-established dosing protocols. Unlike many peptides on this site, several GLP-1 RAs have received full regulatory approval and have standardized prescribing information.
Approved Dosing Protocols#
Semaglutide Injectable (Ozempic / Wegovy)#
For Type 2 Diabetes (Ozempic):
| Week | Dose | Notes |
|---|---|---|
| 1-4 | 0.25 mg weekly | Initiation dose |
| 5-8 | 0.5 mg weekly | First therapeutic dose |
| 9+ | 1.0 mg weekly | If additional glycemic control needed |
| 9+ | 2.0 mg weekly | Maximum dose (if available) |
For Obesity (Wegovy):
| Week | Dose | Notes |
|---|---|---|
| 1-4 | 0.25 mg weekly | Titration |
| 5-8 | 0.5 mg weekly | Titration |
| 9-12 | 1.0 mg weekly | Titration |
| 13-16 | 1.7 mg weekly | Titration |
| 17+ | 2.4 mg weekly | Maintenance dose |
The extended 16-week titration for obesity dosing is designed to minimize gastrointestinal side effects by allowing gradual adaptation. Patients who cannot tolerate a dose increase may remain at the lower dose for an additional 4 weeks before attempting escalation.
Oral Semaglutide (Rybelsus)#
| Month | Dose | Notes |
|---|---|---|
| 1 | 3 mg daily | Initiation (not a therapeutic dose) |
| 2 | 7 mg daily | First therapeutic dose |
| 3+ | 14 mg daily | Maximum dose if additional control needed |
Critical administration instructions: Oral semaglutide must be taken on an empty stomach with no more than 4 oz (120 mL) of plain water at least 30 minutes before the first food, beverage, or other oral medication of the day. These requirements ensure adequate absorption of the SNAC permeation enhancer co-formulated in the tablet.
Liraglutide (Victoza / Saxenda)#
For Type 2 Diabetes (Victoza):
- Start: 0.6 mg daily for at least 1 week
- Increase to: 1.2 mg daily
- Maximum: 1.8 mg daily
For Obesity (Saxenda):
| Week | Dose |
|---|---|
| 1 | 0.6 mg daily |
| 2 | 1.2 mg daily |
| 3 | 1.8 mg daily |
| 4 | 2.4 mg daily |
| 5+ | 3.0 mg daily |
If the 3.0 mg dose is not tolerated, discontinuation should be considered. If a patient has not lost at least 4% of body weight after 16 weeks on the 3.0 mg dose, the medication should be discontinued as a meaningful response is unlikely.
Tirzepatide (Mounjaro / Zepbound)#
| Period | Dose | Notes |
|---|---|---|
| Weeks 1-4 | 2.5 mg weekly | Initiation |
| Weeks 5-8 | 5 mg weekly | First therapeutic dose |
| Weeks 9-12 | 7.5 mg weekly | Dose escalation |
| Weeks 13-16 | 10 mg weekly | Dose escalation |
| Weeks 17-20 | 12.5 mg weekly | Dose escalation |
| Weeks 21+ | 15 mg weekly | Maximum dose |
Not all patients require the maximum 15 mg dose. The prescriber should evaluate glycemic control and weight loss response at each titration step and may maintain patients at lower doses if adequate response is achieved.
Administration Guidelines#
Injection Technique#
All injectable GLP-1 RAs are administered subcutaneously using pre-filled pen devices:
- Sites: Abdomen (preferred), thigh, or upper arm
- Rotation: Rotate injection sites within the same body region
- Timing: Can be administered at any time of day, with or without meals (for weekly agents, on the same day each week)
- Needle: Pen needles are typically 30-32 gauge, 4-8 mm length
Dose Titration Rationale#
The gradual dose escalation protocol serves several purposes:
- Allows gastrointestinal adaptation, reducing nausea and vomiting
- Provides time to assess tolerability before reaching full dose
- Permits dose adjustment based on individual response and side effects
- Reduces the rate of treatment discontinuation
Patients who skip doses during titration should not "double up" but should resume at the prescribed dose.
Special Populations#
Renal Impairment#
Most GLP-1 RAs do not require dose adjustment for renal impairment, as they are not primarily renally cleared. However, caution is warranted in severe renal impairment due to the risk of dehydration from GI side effects, which can precipitate acute kidney injury.
Hepatic Impairment#
No dose adjustments are typically required for mild to moderate hepatic impairment. Limited data exist for severe hepatic impairment.
Elderly#
No dose adjustment is required based on age alone, but slower dose titration may be advisable to minimize GI side effects.
Storage#
| Product | Before first use | After first use |
|---|---|---|
| Ozempic/Wegovy | 2-8 degrees C | Room temperature up to 30 degrees C, 56 days |
| Victoza/Saxenda | 2-8 degrees C | Room temperature up to 30 degrees C, 30 days |
| Mounjaro/Zepbound | 2-8 degrees C | Room temperature up to 30 degrees C, 21 days |
| Rybelsus | Room temperature | Protect from moisture, use within 30 days of opening |
Related Reading#
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Medical Disclaimer
This website is for educational and informational purposes only. The information provided is not intended to diagnose, treat, cure, or prevent any disease. Always consult with a qualified healthcare professional before using any peptide or supplement.