Is Microdosing Ozempic Safe?

Some people who take Ozempic or Wegovy (semaglutide) are using a method called “counting clicks” or microdosing to get a little more or less medication in each shot than the standard amount measured out by the injection pen.

This technique can stretch out a person’s supply of Ozempic or Wegovy, drugs that can be expensive and hard to get due to ongoing shortages. Users of the blockbuster GLP-1 drugs may also adjust doses up or down in tiny increments in order to manage common side effects, such as nausea, vomiting, and diarrhea.

Though microdosing specifically contradicts drugmaker instructions, some people report that they are doing so with the full approval of their doctor or even that it was their doctor’s idea in the first place.

Beverly Tchang, MD, an endocrinologist and obesity specialist at NewYork-Presbyterian and Weill Cornell Medicine in New York City, instructs some of her patients to microdose to help balance side effects with weight loss goals. The technique, she says, can be both safe and effective when used under medical supervision.

But some experts worry that some patients who microdose may be acting unsafely.

Ozempic and Wegovy come in injection pens, disposable devices with a reservoir for holding the medication and a needle tip. These pens do not deliver the prescribed dose with a single touch of a button. Instead, users have to measure out the dose by rotating a wheel at the base of the pen. As the wheel turns, it clicks. An indicator window displays when the desired dose is ready to inject.

Users and healthcare providers have deduced that if it takes 74 clicks to load a standard 1 milligram (mg) injection, they can use simple arithmetic to dial up any fraction of the amount they wish. Twenty-six clicks of that pen, for example, would result in a dose of 0.35 mg, an amount that is not approved by the U.S. Food and Drug Administration (FDA), but which some users of the drug find effective.

Social media is full of discussions regarding the technique of counting clicks. YouTube and TikTok have videos teaching how and why to count Ozempic clicks, and communities on Facebook and Reddit share “click charts,” handy reference images that show how much medicine each click dials up. Some of the advice comes straight from doctors and pharmacists with social media followings.

Tchang doesn’t recommend trusting a click chart. She teaches her patients the technique herself: “I do the math with them.”

Microdosing isn’t nearly as easy with tirzepatide (Mounjaro and Zepbound), another blockbuster diabetes and obesity drug in the same family as semaglutide, because it comes in a pen that does not allow for click counting. It is possible for users to extract custom doses from the pen with a syringe, although Tchang does not recommend the practice.

Experts say that there are several legitimate reasons why people using semaglutide might want to microdose.

Getting Around Shortages

Microdosing has emerged as a strategy to cope with the ongoing Ozempic and Wegovy shortages.

It takes months to gradually “step up” to the maximum dose of Ozempic or Wegovy. If a patient on a high dose of semaglutide cannot fill their prescription for a large injection pen due to a shortage, they may fear that they will have to go back to square one, the smallest starter dose, and lose months of progress.

Counting clicks to make a pen last longer during a shortage is a viable strategy, says Katherine Saunders, MD, an obesity physician at Weill Cornell Medicine and the cofounder of FlyteHealth. “If patients are unable to obtain their medication for a period of time due to a supply shortage, it’s always better to stay on whatever dose they can, instead of stopping the medication completely,” Dr. Saunders says.

And at times during semaglutide shortages, larger dose injection pens have been easier to find than smaller ones. As a result, doctors have been able to prescribe larger doses than their patients actually need, instructing them to count clicks to administer smaller doses.

Saving Money

There’s very little difference in the sticker price between a pen with 2 mg of Ozempic and one with 8 mg. Who doesn’t want more bang for their buck? Some people who do not require a maximum dose are trying to save money by filling prescriptions for high-capacity pens and counting clicks to administer smaller doses.

Managing Side Effects

Ozempic can result in substantial gastrointestinal side effects, including diarrhea, nausea, and vomiting. Not everyone experiences these uncomfortable symptoms, but those who do tend to feel them most severely when they step up to a higher dose of the medicine.

Microdosing allows users to raise their doses by smaller amounts than the standard increments. “A patient might be cautious of increasing semaglutide from 0.25 to 0.5 mg, so we might discuss microdosing to achieve a dose in between,” says Tchang.

Other patients may be unable to tolerate the side effects on even the standard starter dose, but microdosing allows them to begin at an even lower level. “Some of our patients are on tiny doses if they don’t need or don’t tolerate higher doses,” says Saunders.

Click counting could also help people manage side effects temporarily in situations where gastrointestinal distress might spell disaster. If you are scheduled to take your shot before a wedding, job interview, vacation, or some other important event, microdosing might offer a good alternative to skipping Ozempic doses entirely.

Maintaining Weight Loss

Some GLP-1 users who achieve their weight loss goals gradually dial down their dose by tiny amounts in the hope of saving money, building up a stockpile, or even having a more “normal” appetite without compromising their weight loss success.

Saunders warns against making such adjustments without the help of a doctor: “If someone with obesity has lost a significant amount of weight with a GLP-1 medication and they decide on their own to greatly reduce the dose of the medication, they’ll be at high risk of regaining. Medication dosage should never be adjusted without consulting the prescribing provider.”

Microdosing is essentially an experimental technique, which makes it inherently risky. Obesity experts say no one should count clicks without a doctor’s approval.

“Microdosing is an off-label strategy that requires specific instructions that should be tailored to the individual,” says Tchang. “Errors in microdosing could result in ‘overdosing,’ where you might be exposed to much higher doses than intended.”

For instance, different injection pens load different amounts of medicine with each click. A 1 mg pen and an 8 mg pen require different click charts, and using the incorrect click chart could result in a very wrong and possibly dangerous dose.

These risks are likely more serious when people use their medicine without the close cooperation of a doctor. Saunders worries that too many people are counting clicks “for superficial or very experimental reasons,” she says. “I only really hear about microdosing when it comes to compounding medications, which we never recommend, or off-label use of GLP-1s for longevity, addiction, and other indications.”

Some people may be interested in microdosing in order to lose just a few pounds. Others may be interested in one or more of the dizzying number of secondary benefits associated with GLP-1 medications, including relief from addictive behavior, “food noise,” and sleep apnea.

It is possible that, in the future, the FDA will approve very small GLP-1 doses to treat conditions for which these drugs are not currently approved, such as type 1 diabetes. In the meantime, however, experts warn against using GLP-1 medications this way, even in microdoses.

“These are powerful medications that need to be prescribed and managed by trained clinicians,” says Saunders.

• Some Ozempic and Wegovy users are microdosing to navigate drug shortages, save money, or reduce side effects.
• The technique involves “counting clicks” on the drug injection pen, which allows users to administer precise custom doses.
• Some doctors encourage their patients to microdose, but it has risks and should only be attempted under the direction of a healthcare provider.