Semaglutide dose escalation schedule (Ozempic, Wegovy, Rybelsus)

Semaglutide escalation schedule from the AEMPS ficha tecnica: weeks and steps for Ozempic, Wegovy and Rybelsus, minimum intervals, missed dose rules.

Updated 31 Aug 2026 · Methodology

How to read this calendar

Who this is for

Tool for healthcare professionals: endocrinologists, family physicians, community and hospital pharmacists. The calculation is not intended for patients to adjust their own dose.

What it shows

The calendar reproduces the escalation schedule from section 4.2 of the AEMPS ficha tecnica and the EMA SmPC, and adds dates counted from the day of the first dose. The label schedule is fixed and the same for everyone. There is no individual adjustment here: body weight, BMI, glycaemia and laboratory results are not part of the calculation.

What this calendar does not do

It does not prescribe the medicine and does not decide the indication. It does not replace the product information or the decision of the treating physician. It does not account for comorbidities, interactions or laboratory findings. Semaglutide is a prescription-only medicine, and in Spain prescription medicines cannot be sold online.

Regulatory status

Evigrade provides educational reference information, not a medical device: the tool carries no CE marking and is not intended for diagnostic or therapeutic decision-making. Where the calendar and the AEMPS-authorised ficha tecnica disagree, the ficha tecnica prevails.

Safety points to keep in mind

The only contraindication in the European product information is hypersensitivity to the active substance or to any excipient. Medullary thyroid carcinoma and MEN 2 appear as a contraindication in the FDA label, but no such entry exists in the European ficha tecnica; these are two separate regulatory frameworks and must not be mixed. For acute pancreatitis the labelled approach is explicit: on suspicion semaglutide is discontinued, and if the diagnosis is confirmed it is not restarted. Semaglutide should not be used during pregnancy, and because of its long half-life it is stopped at least 2 months before a planned pregnancy. Semaglutide alone rarely causes hypoglycaemia, but with a sulfonylurea or insulin a dose reduction of those medicines should be considered. In people with diabetic retinopathy an increased risk of retinopathy complications has been observed.

EMA signal on NAION

The PRAC completed its review at the meeting of 2-5 June 2025, and the EMA published the conclusion on 6 June 2025. Non-arteritic anterior ischaemic optic neuropathy was added to sections 4.4 and 4.8 of the product information for Ozempic, Rybelsus and Wegovy as a very rare adverse reaction, up to 1 case in 10 000 people. The AEMPS issued Nota Informativa MUH (FV), 03/2025 on 9 June 2025. Labelled approach: sudden vision loss calls for an ophthalmological examination, and if NAION is confirmed treatment is stopped.

Falsified and compounded semaglutide

The EMA and the HMA warned about a sharp rise in illegal medicines sold as GLP-1 analogues through fraudulent websites and social media advertising. Such products are not authorised, may not contain the declared active substance and may contain harmful amounts of other substances. The AEMPS advises against buying them outside a pharmacy or without a prescription.

About this calculator

This tool lays out the escalation schedule written in the ficha tecnica week by week from the start date. The three products differ more than the shared active substance suggests. Ozempic: start at 0.25 mg once weekly, mandatory step to 0.5 mg after 4 weeks, then optional steps to 1 mg and 2 mg for further glycaemic control, each after at least 4 weeks on the current dose; weekly doses above 2 mg are not recommended and 0.25 mg is not a maintenance dose. Wegovy: a fixed 16-week escalation 0.25 / 0.5 / 1 / 1.7 reaching the 2.4 mg maintenance dose at week 17; a 7.2 mg step is allowed in adults with baseline BMI 30 or above after at least 4 weeks at 2.4 mg, it is not marketed in Spain, and the label directs a step back to 2.4 mg when there is no further weight response. Rybelsus in the current Spanish edition follows 1.5 / 4 / 9 / 25 / 50 mg with no more than one step per month; the tablet is taken fasting with up to half a glass of water, waiting 30 minutes before food, drink or other oral medicines. Missed dose rules: Ozempic and Wegovy share the same 5-day window, after which the dose is skipped and the next one falls on the regular day; Wegovy adds one condition of its own – when several doses in a row are missed, going back to the starting dose and re-escalating should be considered; Rybelsus has no window and the missed tablet is simply skipped. The tool shows a calendar and does not pick a dose for a patient: tolerability, concomitant sulfonylurea or insulin and any decision to slow escalation stay with the prescriber, and the ficha tecnica of the AEMPS takes precedence over anything shown here.

Source

Ficha técnica de Ozempic (AEMPS/CIMA 1171251005), Wegovy (1211608010) y Rybelsus (1201430022), sección 4.2; EMA SmPC Ozempic and Wegovy, section 4.2.

Formula version: aemps-ft-ema-smpc-2026-08-v1

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