You’ve finally decided to try semaglutide. Maybe the pharmacy just handed you a vial and a pack of tiny syringes, and now you’re staring at them wondering how "units" on a plastic tube actually turn into milligrams of medicine. It’s confusing. Honestly, it's one of the biggest hurdles people face when they step away from the pre-filled, "clicky" pens of the big-name brands and into the world of compounded options.
The compounded semaglutide dosing chart isn't just a suggestion; it’s your roadmap to avoiding a weekend spent on the bathroom floor.
I’ve seen people get eager. They think more is better, or they want the weight to vanish by Tuesday. But semaglutide is a slow burner. It’s a peptide that mimics your body’s GLP-1 hormone, and your gut needs time to realize that its new roommate is here to stay. If you rush the process, your stomach will let you know. Loudly.
The Standard "Slow and Steady" Ramp-Up
Most doctors follow a titration schedule that lasts about five months before you even hit the "maximum" dose. You start at 0.25 mg. That’s it. It’s a tiny, sub-therapeutic amount meant to introduce the drug to your system without causing a full-scale digestive revolt.
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You stay there for four weeks.
If you feel fine—meaning the nausea is manageable and you aren't living on ginger chews—you move up to 0.5 mg for the next month. This "step-up" continues every four weeks: 1.0 mg, then 1.7 mg, and finally 2.4 mg. But here’s the kicker: not everyone needs to get to 2.4 mg.
Some people find their "sweet spot" at 1.0 mg. They’re losing weight, their cravings are gone, and they feel great. If that’s you, why would you increase it? Pushing the dose higher just because a chart says so is a recipe for unnecessary side effects.
Navigating the Units vs. Milligrams Trap
This is where the real headaches happen. When you use a compounded vial, the concentration matters more than the volume.
Let's say your vial says 5 mg/mL. In that scenario, your 0.25 mg starting dose is usually just 5 units on a standard U-100 insulin syringe. But if your pharmacy sends a vial that is 2.5 mg/mL, that same 0.25 mg dose is now 10 units.
Do you see the danger? If you switch pharmacies and don't check the concentration on the label, you could accidentally double your dose or cut it in half.
A Quick Look at the Math (For a 5mg/mL Concentration)
If your medicine is concentrated at 5 mg per 1 mL, the "units" on your syringe usually look like this:
- Month 1 (0.25 mg): 5 units. It looks like almost nothing in the syringe.
- Month 2 (0.5 mg): 10 units. Still a very small amount.
- Month 3 (1.0 mg): 20 units.
- Month 4 (1.7 mg): 34 units.
- Month 5+ (2.4 mg): 48 units.
Again, these numbers change if your concentration is different. Always, always read the vial. I can’t stress that enough. If the label says 2 mg/mL or some other variation, your "units" will be totally different.
Why the "Microdosing" Trend is Gaining Ground
Lately, some providers—like those mentioned in recent 2025 pilot studies—are experimenting with "flexible titration."
Basically, instead of jumping from 0.25 mg to 0.5 mg (a 100% increase!), they might have you move up by just a few units every week or two. This is one of the massive perks of compounded semaglutide. You aren't locked into the fixed settings of a brand-name pen.
If 0.25 mg feels like it's working but you're starting to feel "food noise" creep back in on day six, your doctor might suggest a slightly faster bump or a "split dose" where you take half on Monday and half on Thursday. It keeps the levels in your blood more stable.
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What Happens if You Skip a Step?
Don't.
I've talked to patients who thought they were "tougher" than the side effects. They jumped from 0.25 mg straight to 1.0 mg because they weren't seeing the scale move fast enough. They ended up in the ER with uncontrollable vomiting and dehydration.
The compounded semaglutide dosing chart exists because of how the drug interacts with your gastric emptying. It slows down your stomach. If you put too much in your system before your body adapts, the food just sits there. That’s what causes the "sulfur burps" and the intense nausea.
Managing the Escalation Side Effects
Expect some weirdness.
Nausea is the big one, affecting about 44% of people when they hit the higher doses. It usually peaks about 24 to 48 hours after your shot. Constipation is another "fun" one because, well, if things move slowly, they stay in there longer.
- Hydrate like it's your job: Water helps the medication process and keeps your bowels moving.
- Protein first: You won't be as hungry, so make sure the food you do eat counts.
- Injection site matters: Some people swear that injecting into the thigh instead of the stomach reduces nausea. There’s no hard clinical proof for everyone, but anecdotally? It's a game-changer for many.
When to Stop Increasing Your Dose
There is no prize for reaching 2.4 mg.
If you are at 1.0 mg and you are losing 1-2 pounds a week, stay there. The goal isn't to hit the "max" dose; it's to find the lowest dose that gives you the results you want. Higher doses mean more money and more side effects.
If you hit a plateau for four weeks or more, then talk to your provider about stepping up.
Actionable Steps for Your Journey
- Check your concentration: Before your first shot, look at the vial. Is it 2.5 mg/mL? 5 mg/mL? Write it down.
- Verify the unit math: Ask your pharmacist exactly how many units on your specific syringe equal 0.25 mg.
- Keep a "Symptom Journal": For the first two days after each injection, jot down how you feel. If you’re miserable, don’t move up next month.
- Stay on the current dose if it's working: If the weight is coming off and you feel good, there is zero medical reason to rush the titration.
- Talk to your doctor about "maintenance": Once you hit your goal weight, you'll likely need a maintenance dose (often lower) to keep the weight off long-term.