The glucagon-like peptide-1 receptor agonist semaglutide has significantly revolutionized the landscape of management of obesity and related comorbidities including type 2 diabetes. One of the key features of semaglutide is the need for a gradual dose escalation to mitigate gastrointestinal adverse events and the highly evident dose-dependent therapeutic effect¹.

Subcutaneous semaglutide is administered via a prefilled pen. Before administration, the intended dosage of the medication is selected from the device, which holds a particular amount of the drug that delivers the designated dose for the given pen. In recent years, physicians and patients around the world have begun adjusting the dosage of semaglutide, to deliver less than the full intended dose.

Tailored dose adjustments can be rationalized based on four main reasons: To tailor the efficacy of weight loss and/or glycemia to individual goals, to mitigate gastrointestinal adverse events in those who are prone, to deal with the high cost of the medication, and to ensure continued usage in situations where supply may be disrupted due to access issues. This adjustment is usually done by what is now called ‘microdosing’, and a pragmatic guidance is required to assist both physicians and patients and to avoid misdosing^2,3.