What are the prescribing details for Wegovy (semaglutide), including dosing schedule, administration sites, storage, contraindications, precautions, and monitoring recommendations?

Wegovy (Semaglutide) Prescribing Information

Wegovy is initiated at 0.25 mg subcutaneously once weekly and titrated every 4 weeks through 0.5 mg, 1 mg, and 1.7 mg to reach the maintenance dose of 2.4 mg (or 1.7 mg if not tolerated) by week 17. 1

Dosing Schedule

The dose escalation follows a structured 16-week titration protocol 2, 1:

• Weeks 1-4: 0.25 mg once weekly
• Weeks 5-8: 0.5 mg once weekly
• Weeks 9-12: 1 mg once weekly
• Weeks 13-16: 1.7 mg once weekly
• Week 17 onward: 2.4 mg once weekly (recommended maintenance) or 1.7 mg once weekly

If patients do not tolerate a dose during escalation, delay the next increase by 4 weeks rather than abandoning therapy. 1 This gradual titration is critical to minimize gastrointestinal adverse effects (nausea occurs in 44% vs 17% placebo; vomiting in 25% vs 7% placebo) 3, 2.

Administration Details

Inject subcutaneously in the abdomen, thigh, or upper arm once weekly on the same day each week, at any time of day, with or without meals. 1 The injection site and time of day can be changed without dose adjustment 1.

Missed Dose Protocol

• If >48 hours until next scheduled dose: Administer immediately
• If <48 hours until next scheduled dose: Skip and resume regular schedule
• If ≥2 consecutive doses missed: Either resume at scheduled dose OR restart the full titration schedule to reduce GI symptoms 1

Storage and Handling

• Store unused pens refrigerated until first use
• Protect from light and do not freeze
• Each pen is single-dose only; dispose in FDA-cleared sharps container immediately after use 1
• Do not reuse or recycle pens 1

Absolute Contraindications

Wegovy is contraindicated in: 1

1. Personal or family history of medullary thyroid carcinoma (MTC)
2. Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
3. Prior serious hypersensitivity reaction to semaglutide (including anaphylaxis/angioedema)

The thyroid C-cell tumor risk is based on dose-dependent rodent data at clinically relevant exposures, though human relevance remains uncertain 2, 1.

Critical Precautions

High-Risk Populations Requiring Caution

• Pancreatitis history: GLP-1 RAs are associated with increased pancreatitis risk; monitor for persistent severe abdominal pain 2
• Gallbladder disease: Risk of cholelithiasis and cholecystitis; <0.05% required hospitalization in post-marketing data 2
• Diabetic retinopathy: Monitor patients with diabetes for retinopathy progression 1
• Renal impairment: Risk of acute kidney injury from dehydration due to GI adverse effects 4

Drug Interactions

Do not combine with: 2

• Other GLP-1 receptor agonists
• DPP-4 inhibitors

Use caution with: 2

• Insulin or sulfonylureas: Adjust doses and monitor for hypoglycemia (though GLP-1 RAs have glucose-dependent insulin secretion with inherently low hypoglycemia risk)
• Oral medications requiring rapid absorption: Delayed gastric emptying may affect absorption

Monitoring Recommendations

Before Initiation

• In patients with type 2 diabetes: Check baseline blood glucose 1
• Screen for contraindications (MTC/MEN 2 history, prior hypersensitivity)

During Treatment

Essential monitoring: 3, 1, 4

• Blood glucose if diabetic (especially if on insulin/sulfonylureas)
• Hydration status (to prevent acute kidney injury)
• Signs/symptoms of pancreatitis (persistent severe abdominal pain)
• Gallbladder symptoms (right upper quadrant pain, jaundice)
• Thyroid symptoms (neck mass, dysphagia, dyspnea, persistent hoarseness)

Routine serum calcitonin or thyroid ultrasound monitoring is of uncertain value and not recommended. 1

Treatment Response Assessment

Expected weight loss by duration: 5

• 1-3 months: 6% median weight loss
• 3-6 months: 12%
• 6-12 months: 17%

• 1 year: 20%

Clinical trials demonstrated mean 14.9% total body weight loss vs 2.4% with placebo over 52-72 weeks 3, 2. Some patients achieve adequate response at submaximal doses (particularly 1 mg or 1.7 mg) and can continue long-term at that dose 2, 5.

Common Pitfalls to Avoid

1. Rushing titration: The 4-week intervals between dose increases are essential—faster escalation dramatically increases nausea/vomiting rates
2. Abandoning therapy for transient GI symptoms: These typically resolve; consider delaying dose escalation rather than discontinuing
3. Improper dosing technique: 10% of real-world users dose by "counting clicks" rather than following prescribed doses 5
4. Inadequate patient education on missed doses: Clear protocols prevent treatment interruption
5. Combining with other GLP-1 RAs: This provides no additional benefit and increases adverse effects

Special Populations

Adolescents ≥12 years: Same titration schedule; 1.7 mg maintenance dose is FDA-approved and provides comparable efficacy to 2.4 mg with similar tolerability 6

Cardiovascular disease: Wegovy reduces major adverse cardiovascular events (cardiovascular death, non-fatal MI, non-fatal stroke) in adults with established CVD and obesity/overweight 1, 7

MASH with F2-F3 fibrosis: FDA-approved based on ESSENCE trial showing 62.9% MASH resolution vs 34.3% placebo 4