Week 4 on Semaglutide: Closing Out the Starter Dose
Week 4 is the last week of the 0.25mg introductory phase. Per the standard schedule, the dose increases to 0.5mg at week 5 — this week is about consolidating what you have learned and preparing for that step.
By week 4, most people have a stable read on how semaglutide feels in their body. The early side effect spike has usually faded, portions feel naturally smaller, and the "food noise" — that low background pull toward snacks, cravings, and grazing — has quieted for most users.
The Ozempic and Wegovy schedules both call for a four-week 0.25mg starter phase, after which the dose increases to 0.5mg. Per Ozempic's dosing reference, "after the initial 4-week period, the dose increases to 0.5 mg once weekly at Week 5." That is not a guarantee — some prescribers hold patients longer at 0.25mg if side effects are still significant — but week 4 is the standard pivot point.
This week, then, is for noticing what is working and bringing a clear-eyed account to your check-in. The starter dose was never expected to deliver dramatic weight loss; the next step is where that often picks up.
Appetite Suppression
Often at its plateau for the 0.25mg dose. Steady, but more is typically possible at higher doses.
Typical weekly loss as appetite control becomes consistent. Total month-one loss for many is 4-8 lbs.
The Week 4 Timeline
The Week 4 Timeline
Day 22 (Injection 4)
Final Starter Injection
Your last 0.25mg dose. By now, the rhythm of injection day, the next 48 hours, and the back half of the week should feel familiar.
Days 24-26
Pattern Consolidation
Side effects, if any, are usually mild and predictable. Appetite suppression should feel steady rather than fluctuating.
Days 27-28
Pre-Titration Check
A good moment to reflect honestly: are side effects manageable? Is appetite control still meaningful? Bring this to your provider before stepping up.
Symptoms this week
Navigating Symptoms
Most people report that early GI side effects have mostly resolved by week 4. The bigger watch-outs now are dehydration (because you may not feel thirsty) and constipation (from smaller portions plus slower digestion).
What to focus on
The most useful thing you can do this week is keep a short, honest log of how you have actually felt across the four weeks. Not a perfect record — just notes on energy, side effects, what foods sat well, and where appetite suppression has been most useful. Bring it to your prescriber check-in. The decision to titrate up is supposed to be informed by your real experience, not just the calendar.
If side effects have been minimal and appetite suppression has plateaued, the standard 0.5mg step at week 5 is very likely. If side effects have been heavy, ask about staying at 0.25mg for another four weeks — many prescribers will agree, and it can prevent a difficult week 5 and 6.
Lock in your protein and hydration habits now while the dose is gentle. Once you titrate up, appetite suppression usually deepens, which means smaller meals need to carry more nutrition. The habits you build at the starter dose are the ones that hold when the medication intensifies. The resources hub has more general guidance.
What other users report
What Users Report
“Week 4 felt like the easy week. No nausea, steady portion control, and a few pounds down. I went into my titration appointment feeling confident about moving up.”
— Aisha L.
“I asked my doctor to keep me at 0.25mg for another month. The starter dose was working well and I wanted to be sure before adding more.”
— Tomás G.
Looking ahead
Week 5 is the first dose increase, from 0.25mg to 0.5mg. The intensity of appetite suppression usually steps up, and some of the early side effects can briefly return. Knowing what to expect — and bringing your starter-phase habits with you — makes the step easier.