Overview
Ozempic and Wegovy.
Weekly shot that slows your stomach and quiets hunger.
The drug that started the GLP-1 wave.
What It Does
FDA-approved GLP-1 receptor agonist (Ozempic®/Wegovy®), appetite suppression via hypothalamic satiety centres + gastric-emptying delay. 94% amino-acid homology to native GLP-1.
Reconstitution
| Vial Size | BAC Water / Solvent | Concentration |
|---|---|---|
| 10 mg | + 2 mL | 5 mg/mL |
| 15 mg | + 3 mL | 5 mg/mL |
| 20 mg | + 4 mL | 5 mg/mL |
| 50 mg | + 10 mL | 5 mg/mL |
Reconstitution Calculator
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Protocol
| Phase | Frequency | Amount | Notes |
|---|---|---|---|
| Weeks 1–4 | 0.25 mg/wk | 5u | |
| Weeks 5–8 | 0.5 mg/wk | 10u | |
| Weeks 9–12 | 1 mg/wk | 20u | |
| Weeks 13–16 | 1.7 mg/wk | 34u | |
| Weeks 17+ | 2.4 mg/wk | 48u |
Ongoing per FDA Wegovy/Ozempic labels; no scheduled off-cycle. Discontinue ≥2 months before planned pregnancy (long half-life).
Weekly, same day each week. FDA indications (injectable): T2D glycemic control; CV-risk reduction (established CVD); CKD (FLOW, Jan 2025); MASH with F2–F3 fibrosis (Wegovy, Aug 2025). 2026 compounding: FDA proposed removing semaglutide / tirzepatide / liraglutide from the 503B bulks list (public comments to Jun 29, 2026); 503A compounding continues under added scrutiny.
Women lose more than men at the same dose but report more GI (start lower). In PCOS they improve cycles, lower free testosterone and raise ovulation; a real unplanned-pregnancy risk. Stop before conceiving. Men: In men, excess fat lowers testosterone; GLP-1 raises total testosterone, SHBG and gonadotropins as weight drops, and improves sperm and erectile function; and preserves fertility, unlike TRT (which suppresses spe Women lose more than men at the same dose but report more GI (start lower). In PCOS they improve cycles, lower free testosterone and raise ovulation; a real unplanned-pregnancy risk. Stop before conceiving. Men: In men, excess fat lowers testosterone; GLP-1 raises total testosterone, SHBG and gonadotropins as weight drops, and improves sperm and erectile function; and preserves fertility, unlike TRT (which suppresses sperm).
Handling & Stacking
- Freeze-dried: -4°F.
- Reconstituted: 36–46°F.
- Best used within 28 days.
- No clear reconstituted-potency data (the pen label gives an in-use date, not potency), so defer to the 28-day sterility limit; commercial pens follow their own pen date.
- Appetite reduction within week 1.
- Nausea peaks weeks 1–4 then diminishes.
- Weight loss most apparent at 12–16 weeks.
- Titrate slowly to minimise GI side effects.
- Supply math 10mg → 5 vials | 15mg → 3 | 20mg → 3 | 50mg → 1 vial (17-wk @ 2.4 mg × 1/wk)
FDA Label vs Community Dosing
| Approach | Ramp / dose (weekly) | Philosophy |
|---|---|---|
| FDA, Wegovy (weight loss) | 0.25 → 0.5 → 1.0 → 1.7 → 2.4 mg, +4 wks per step | Escalate to the max approved dose (2.4 mg) for maximum weight loss. |
| FDA, Ozempic (type-2 diabetes) | 0.25 → 0.5 → 1.0 → up to 2.0 mg | Glycemic control; lower ceiling than Wegovy. |
| Community | Same ramp, but hold at the lowest effective dose (often | Titrate to effect, not to the max; step up only if progress stalls. 0.5–1.0 mg); microdose 0.25 for tolerance Bottom line: the FDA ramp targets the maximum dose; community practice targets the lowest dose that keeps working, to minimize nausea and cost. Both use the same 4- week step cadence, never escalate faster. Nutrition & timing: protein first (1.2–1.6 g/kg/day), carbs last, to protect the lean mass these drugs burn with fat; lift 2–3×/wk + creatine 5 g/day. Stop eating ~3 h before bed (slowed emptying + lying flat drives reflux). Low intake favors mild ketosis, so a low-carb/keto approach pairs well; push water (2.5–3 L/day) + electrolytes, both dehydrate. |
| Contraindications | Personal or family history of medullary thyroid carcinoma (MTC) or MEN 2; personal/family history of any thyroid cancer Personal history of pancreatitis (any cause) Pre-existing gastroparesis or significant gastric motility disorder; severe GERD, scleroderma, or other delayed-emptying conditions Prior serious hypersensitivity to the compound or excipients Pregnancy and lactation; discontinue 2 months before planned conception. History of cholelithiasis / gallbladder disease. Active or pre-existing diabetic retinopathy; eating-disorder history; CKD stage 4–5 | |
| Warnings | Acute pancreatitis: discontinue if suspected (severe abdominal pain radiating to back) Acute gallbladder disease; diabetic-retinopathy progression; acute kidney injury from GI-related volume depletion (highest during escalation) NAION (non-arteritic anterior ischemic optic neuropathy), rare sudden monocular vision loss; EU label change 2025 Severe GI: ileus, obstruction, severe constipation, impaction. Anaphylaxis/angioedema reported. Tachycardia (1–4 bpm). Aspiration risk under anesthesia. | |
| Drug interactions | Delayed gastric emptying affects oral absorption (levothyroxine, oral contraceptives, warfarin); separate timing. Insulin / secretagogues: reduce at initiation. Do not combine with other GLP-1 agonists. | |
| Labs | Baseline: BMP/CMP, CBC, HbA1c, lipid panel, TSH, pregnancy test. BMP at every dose escalation and any time GI side effects cause >24h reduced intake. HbA1c at 3 + 6 mo; lipids at 6 mo; repeat eGFR if dehydration. Lipase if abdominal pain. Drop hsCRP / routine calcitonin., Out of range? Rising glucose/HbA1c = blood sugar creeping toward diabetes (recheck, tighten diet); a falling eGFR = kidney strain, usually dehydration (hydrate, hold the dose). | |
| Stop criteria | Creatinine rise >0.3 mg/dL or eGFR drop >20%: hold, rehydrate. Severe abdominal pain: evaluate for pancreatitis. Vision changes: ophthalmology. Persistent vomiting >48h: hold. New neck mass / hoarseness / dysphagia: thyroid workup. | |
| Patient education | acute kidney injury on GLP-1s is from dehydration, not the drug. Target 2.5–3 L water/day; hold next dose for any day of vomiting/diarrhea/reduced food; resume same level after 24h recovery. Required during any GLP-1 cycle: protein 1.2 g/kg IBW/day (1.6 if training), resistance training 2–3×/wk, creatine 5 g/day; else 25–40% of weight lost is lean mass with rapid regain. Eat slowly, stop at first fullness. Hold ≥1 week before general anesthesia/deep sedation (check current ASA position). Inform any anesthesiologist. Use contraception; discontinue ≥2 months before planned pregnancy. Pen sharing prohibited even with a new needle. | |
| References | rxlist · researchdosing · peptidedosages · DailyMed · PubMed · ClinicalTrials · GLP-1 sex differences · Jensterle 2020 |
