Semaglutide

The label starts at 0.25 mg injected under the skin once weekly for 4 weeks, then raises the dose to 0.5 mg once weekly. If more glucose control is needed, the dose may go to 1 mg after at least 4 weeks at 0.5 mg, and then to 2 mg after at least 4 weeks at 1 mg; 2 mg once weekly is the stated maximum. For the chronic kidney disease indication, the label sets maintenance at 1 mg once weekly after at least 4 weeks at 0.5 mg. It is given on the same day each week, at any time of day with or without food, into the abdomen, thigh or upper arm, and a missed dose may be taken within 5 days.

Both tablets are taken by mouth once daily in the morning on an empty stomach with up to 4 ounces of plain water, swallowed whole, followed by a wait of at least 30 minutes before food, drinks or other oral medicines; the label says the two products are not interchangeable milligram for milligram. Rybelsus starts at 3 mg daily for days 1 to 30 (a starter dose the label says does not control glucose), goes to 7 mg daily for days 31 to 60, and from day 61 either stays at 7 mg or goes to 14 mg daily if more glucose control is needed. Ozempic tablets follow the same pattern at 1.5 mg daily for days 1 to 30, 4 mg daily for days 31 to 60, then either 4 mg or 9 mg daily. A missed tablet is skipped.

The injection is given under the skin of the abdomen, thigh or upper arm once weekly, starting at 0.25 mg for weeks 1 to 4 and stepping up every 4 weeks to 0.5 mg, 1 mg and 1.7 mg (weeks 13 to 16) before a maintenance dose from week 17. Maintenance per the label is 2.4 mg (recommended) or 1.7 mg weekly for cardiovascular risk reduction, for weight reduction in adults, and for weight reduction in children 12 and older; for adults who have tolerated 2.4 mg for at least 4 weeks and need more weight reduction, it may be raised to a maximum of 7.2 mg weekly. For MASH the label's maintenance dose is 2.4 mg weekly, reduced to 1.7 mg if not tolerated. If a step is not tolerated, the label suggests delaying escalation by 4 weeks.

The tablet is taken by mouth once daily in the morning on an empty stomach with up to 4 ounces of plain water, swallowed whole, followed by a wait of at least 30 minutes before eating, drinking or taking other oral medicines. The label's schedule is 1.5 mg daily for days 1 to 30, 4 mg for days 31 to 60, 9 mg for days 61 to 90, and 25 mg daily from day 91 as maintenance for cardiovascular risk reduction and weight reduction in adults. If 25 mg is not tolerated, the label suggests considering a switch to the 1.7 mg weekly injection.