How Ozempic is used

What does this page cover and not cover?

This page summarizes what is written in the SmPC (Turkish KÜB) approved in Türkiye for Ozempic. The SmPC is official information directed at the physician who prescribes the drug; the doses and schedules here describe the framework of the treatment plan between physician and patient and are not instructions to be carried out on one’s own. The choice of dose, the time of escalation and the decision to stop belong to the physician.

How is Ozempic administered?

According to the Turkish SmPC, Ozempic is administered once a week, at any time of day, with or without food. It is injected subcutaneously into the abdomen, thigh or upper arm; the injection site can be changed without a need for dose adjustment. It is not administered intravenously or intramuscularly. ^[1]

The SmPC states that the weekly administration day can be changed when necessary provided there are at least 3 days (more than 72 hours) between two doses, and that once a new day is chosen, once-weekly administration continues. ^[1]

How are the dose steps defined in the SmPC?

The schedule in the SmPC is based on starting with a low dose and escalating gradually to limit digestive side effects. The table below transfers the SmPC text; which step a person stays on is decided by the physician.

Source: Turkish SmPC, section 4.2. ^[1]

In the US label, there is one more step: after at least 4 weeks on 1 mg, the dose can be raised to 2 mg when additional glycemic control is needed. ^[6] This step is not in the Turkish SmPC; this difference is a licensing difference between countries.

Dose together with other diabetes drugs

According to the SmPC, when Ozempic is added to metformin, thiazolidinedione or SGLT2 inhibitor treatment, the dose of these drugs can continue unchanged. When added to sulfonylurea or insulin treatment, a reduction in the dose of these drugs should be considered to reduce the risk of hypoglycemia. Home blood glucose measurement is not needed to adjust the Ozempic dose; however, blood glucose measurement is needed to adjust sulfonylurea and insulin doses, particularly when Ozempic is started and insulin is reduced. The SmPC recommends a stepwise approach to insulin reduction. ^[1]

Wegovy’s schedule is different

In the SmPC of Wegovy, licensed for weight management, the dose is escalated stepwise over 16 weeks: 0.25 mg in weeks 1–4, 0.5 mg in weeks 5–8, 1 mg in weeks 9–12, 1.7 mg in weeks 13–16, maintenance 2.4 mg. Doses above 2.4 mg weekly are not recommended; if marked digestive symptoms occur, delaying escalation or returning to the previous dose is considered. ^[4] Although Ozempic and Wegovy contain the same active ingredient, they are licensed with different indications, different doses and different pens; the Wegovy SmPC states that it should not be used together with other semaglutide products or other GLP-1 receptor agonists. ^[4]

What happens if an Ozempic dose is forgotten?

The rule in the SmPC is as follows: If a dose is missed, it is administered as soon as possible and within 5 days after the missed dose. If more than 5 days have passed, the missed dose is skipped and the next dose is administered on the regularly scheduled day. In either case, the regular once-weekly dose schedule continues. ^[1]

The Wegovy SmPC contains the same 5-day rule and adds that if more than one dose is missed, a reduction of the starting dose should be considered when restarting the schedule. ^[4] Which dose to continue with after a long gap is a physician decision.

How do Ozempic pens differ?

Three separate Ozempic pens are licensed in Türkiye; each pen delivers a single dose level:

• 0.25 mg pen: Contains 2 mg semaglutide in 1.5 mL of solution and provides 4 doses of 0.25 mg. ^[2]
• 0.5 mg pen: Contains 2 mg semaglutide in 1.5 mL of solution and provides 4 doses of 0.5 mg. ^[3]
• 1 mg pen: Contains 4 mg semaglutide in 3 mL of solution and provides 4 doses of 1 mg. ^[1]

According to the SmPC, the pen can be used with disposable 30G, 31G and 32G needles up to 8 mm in length; the needle is discarded after each injection and the pen is stored without the needle attached. The rationale given in the SmPC is prevention of needle blockage, contamination, infection, solution leakage and incorrect dosing. The pen is for use by a single person only; it is not used if the solution does not look clear and colorless (or almost colorless) or if it has frozen. ^[1] The US label also states that the pen is not shared between patients even if the needle is changed. ^[6]

Why does a metered pen matter?

In the US, compounded semaglutide products can be supplied in multi-dose vials. The FDA has stated that it has received reports of side effects with these products, some requiring hospitalization, associated with patients measuring the dose incorrectly and, in some cases, health care workers calculating the dose incorrectly. These products are not FDA-approved. ^[7] Ozempic licensed in Türkiye is in the form of a ready-to-use pen with doses set stepwise. ^[1]

How is Ozempic stored?

Source: Turkish SmPC, section 6.3–6.4. ^[1] In the US label, the storage period after first use is 56 days (15–30°C or refrigerator); this difference between countries arises from the product information being different. ^[6]

How is Rybelsus (tablet) used differently?

Rybelsus is the tablet form of the same active ingredient taken orally once daily, and the rules in its SmPC differ from the injection. According to the SmPC, the start is 3 mg daily for one month, after one month the dose goes up to the 7 mg maintenance dose, after at least one month on 7 mg it can be increased to 14 mg; the recommended highest daily dose is 14 mg. The tablet is swallowed whole on an empty stomach with half a glass (about 120 mL) of water; it is not split, crushed or chewed. After it is taken, a wait of at least 30 minutes is observed before eating, drinking or taking other oral medicines; a shorter wait reduces semaglutide absorption. A missed dose is skipped and the next dose is taken the following day. ^[5]

Which drugs does it interact with?

According to the SmPC, semaglutide delays gastric emptying and may affect the rate of absorption of other drugs taken orally; caution is needed in those using oral drugs requiring rapid absorption. The main interactions examined in the SmPC are as follows: ^[1]

• Warfarin and coumarin derivatives: No clinically significant effect on warfarin has been seen; however, cases of decreased INR have been reported with concomitant use of acenocoumarol. The SmPC recommends frequent INR monitoring when starting treatment.
• Birth control pills: Semaglutide is not expected to reduce the effect of combined oral contraceptives; a 20% increase in levonorgestrel exposure was seen.
• Paracetamol, atorvastatin, digoksin, metformin: No clinically significant change was observed and no dose adjustment was needed.
• Sulfonylurea and insulin: The risk of hypoglycemia increases with concomitant use.

Side effects and serious warnings are covered on a separate page.

Detailed guideOzempic side effects: frequencies, serious warnings and unknowns→ Detailed guideSemaglutide (Ozempic, Wegovy, Rybelsus): evidence and safety→ Detailed guideWhat happens when Ozempic is stopped? Weight regain and evidence→ Detailed guideGLP-1 agonists: the class, its members and licensing status in Türkiye→

Contraindications and warnings in the SmPC before use

• Thyroid: The Turkish SmPC lists a personal or family history of medullary thyroid cancer and MEN 2 syndrome as contraindications. ^[1] The US label gives this contraindication together with a boxed warning on thyroid C-cell tumors seen in rodents; the relevance in humans is unknown. ^[6]
• Pregnancy and breastfeeding: According to the SmPC, semaglutide is not used in pregnancy and during breastfeeding; when pregnancy is desired, the drug is stopped and, because of its long half-life, it is stopped at least two months before a planned pregnancy. ^[1]
• Reliability of the product: In Türkiye, a letter from the Erzurum Provincial Health Directorate to the pharmacists’ chamber (chamber registration date May 20, 2026), referring to the TİTCK (Turkish Medicines and Medical Devices Agency) letter dated May 14, 2026, relays that reports of suspected counterfeiting of medicines containing GLP-1 receptor agonists have increased markedly; in pharmacy and pharmaceutical warehouse inspections, Ozempic, Saxenda and Wegovy pens and Mounjaro solution for injection are stated to carry a high counterfeit risk. The letter emphasizes that medicines should not be bought over the internet and that medicines that cannot be registered in the Medicine Track and Trace System (İTS) should not be kept or used. ^[8]

Limits of this page

This page only transfers what is written in the Turkish SmPC (and, for comparison, in the US label). Injection technique, pen use and personalized dose decisions are provided through the physician, the pharmacist and the product’s patient information leaflet. This page does not address how to obtain any product.