The Semaglutide Dosing Schedule in Canada: 0.25 mg to 2.4 mg

One molecule, one ladder

Semaglutide is not prescribed at its target dose. It starts at 0.25 mg once weekly and climbs in steps, typically about four weeks apart, until you reach a maintenance dose. The ladder is the same molecule throughout — what changes is how much of it, and how much your gut has had time to adapt.

Where the ladder ends depends on the product

This is where Ozempic and Wegovy separate, and it is the single most common point of confusion:

• Ozempic is authorised in Canada for type 2 diabetes, with doses up to 2.0 mg weekly
• Wegovy is authorised for weight management and titrates to 2.4 mg weekly
• Generic semaglutide contains the same active ingredient at the same strengths, authorised by Health Canada on demonstrated bioequivalence to the reference product

Same drug, different authorised indication, different maximum dose, different injection device. Prescribing Ozempic for weight management alone is off-label — permitted, but a clinical judgement your prescriber makes and documents rather than a technicality.

Why four weeks between steps

Because the gastrointestinal effects are dose-related and the adaptation is real. Nausea, reflux and constipation cluster in the days after an increase and generally settle within the step. A prescriber who holds you at a dose rather than climbing on schedule is managing that adaptation, not falling behind.

Injection practicalities

Semaglutide is injected subcutaneously once a week — abdomen, thigh or upper arm — on the same day each week, rotating the site. It is temperature-sensitive, which is why Canadian programs ship it cold-chain and why a delayed refill is more than an inconvenience. If a dose is missed, the guidance depends on how long ago it was due; ask your prescriber rather than doubling up.

What the ladder does to your bill

Brand-name semaglutide pricing in Canada generally scales with dose, so the quote you get at 0.25 mg is not the quote you will be paying at 1.7 mg or 2.4 mg. Generic programs hold much closer to a flat monthly figure across the same climb. Two programs that look close at the starting dose can be hundreds of dollars apart by maintenance — price the rung you expect to hold at.

What no Canadian prescriber can offer

Compounded semaglutide. Health Canada does not permit it, at any dose or price. In the United States compounding pharmacies were permitted to supply the molecule during shortages, and much of the dosing content Canadians find online assumes that. Any Canadian-facing seller offering a compounded version, or vials to draw your own doses from, is operating outside Canadian regulation.