How to Write a Prescription for Wegovy Initial Dose
The initial dose of Wegovy (semaglutide) is 0.25 mg subcutaneously once weekly for the first 4 weeks, dispensed as a box of 4 single-dose prefilled pens. 1
Prescription Details
Write the prescription exactly as follows:
Wegovy (semaglutide) 0.25 mg subcutaneous injection
- Dispense: 4 single-dose prefilled pens (NDC 0169-4525-14)
- Sig: Inject 0.25 mg subcutaneously once weekly
- Duration: 4 weeks (one pen per week)
- Refills: 0 (requires new prescription for dose escalation)
Dosing Algorithm and Titration Schedule
After the initial 4-week period at 0.25 mg, you must write a new prescription for each dose escalation, increasing monthly as tolerated 2:
- Weeks 1-4: 0.25 mg once weekly
- Weeks 5-8: 0.5 mg once weekly
- Weeks 9-12: 1.0 mg once weekly
- Weeks 13-16: 1.7 mg once weekly
- Week 17 onward: 2.4 mg once weekly (maintenance dose)
Each dose level requires 4 pens (one month supply). The target maintenance dose is 2.4 mg weekly, which achieves mean weight loss of 14.9% versus 2.4% with placebo 3.
Critical Prescribing Considerations
Route and frequency: Subcutaneous injection once weekly only. Each pen is single-dose and must be discarded after use 1.
Injection sites: Abdomen (preferred), thigh, or upper arm. Rotate sites weekly 1.
Contraindications to screen before prescribing:
- Personal or family history of medullary thyroid carcinoma
- Multiple endocrine neoplasia syndrome type 2 (MEN 2)
- History of serious hypersensitivity to semaglutide 3, 2
Precautions requiring monitoring:
- History of pancreatitis (not an absolute contraindication but requires caution)
- Concurrent use of insulin or sulfonylureas (increased hypoglycemia risk—dose adjustment needed)
- Renal impairment (monitor hydration due to GI side effects) 3, 2
Common Pitfalls to Avoid
Do not skip the titration schedule. The 0.25 mg starting dose is essential for tolerability—jumping to higher doses dramatically increases gastrointestinal side effects (nausea 44%, diarrhea 32%, vomiting 25% at therapeutic doses) 3. Real-world data shows only 13% of patients reach maximum dose by their fifth prescription when titration is rushed 4.
Do not allow dose modifications during the initial titration. Each dose level must be maintained for the full 4 weeks before escalation 5. Patients who cannot tolerate a dose increase should remain at their current tolerated dose rather than discontinue entirely.
Ensure proper disposal counseling. Each pen is single-use only and requires FDA-cleared sharps container disposal 1. Patients cannot reuse pens or remove/replace caps once opened.
Patient Selection and Monitoring
Approved indications for Wegovy:
- Adults with BMI ≥30 kg/m² (obesity), OR
- Adults with BMI ≥27 kg/m² (overweight) plus at least one weight-related comorbidity (hypertension, dyslipidemia, obstructive sleep apnea, cardiovascular disease)
- Adolescents ≥12 years with obesity 2
Baseline assessments before first prescription:
- Weight and BMI documentation
- Thyroid examination (palpate for nodules given MTC risk)
- Lipase if history suggests pancreatic disease
- Pregnancy test in women of childbearing potential (discontinue if pregnant) 2
Follow-up schedule:
- Week 4: Assess tolerability before escalating to 0.5 mg
- Week 16: Evaluate early response (≥4% weight loss predicts long-term success)
- Ongoing: Monitor for gallbladder disease symptoms, pancreatitis signs, suicidal ideation 2
Real-World Effectiveness Context
In real-world settings with the WeGoTogether support program, patients achieved mean weight loss of 13.4% at 6 months, 17.6% at 12 months, and 20.4% at 24 months 6. However, 5.7% of patients discontinue after the first prescription, primarily due to gastrointestinal side effects 4. Setting realistic expectations about GI symptoms during the initial titration phase improves persistence.
The 2.4 mg maintenance dose demonstrates superior efficacy compared to liraglutide 3.0 mg (14.9% vs 8.0% weight loss) and provides cardiovascular risk reduction in patients with established CVD 2.