From the Guidelines
The recommended titration schedule for Wegovy (semaglutide) starts with 0.25 mg injected subcutaneously once weekly for the first 4 weeks, then increases to 0.5 mg once weekly for weeks 5-8, followed by 1 mg once weekly for weeks 9-12,1.7 mg once weekly for weeks 13-16, and finally 2.4 mg once weekly at week 17 and continued thereafter. This gradual titration schedule is designed to minimize gastrointestinal side effects such as nausea, vomiting, and diarrhea, which are common with semaglutide 1. The dose escalation should only occur if the current dose is tolerated; if not, consider delaying the dose escalation. Patients should administer Wegovy on the same day each week, but the day can be changed if needed as long as the last dose was administered at least 2 days prior. If a dose is missed and the next scheduled dose is more than 2 days away, the patient should take the missed dose as soon as possible; if less than 2 days away, they should skip the missed dose and resume at the next scheduled time. This gradual approach allows the body to adjust to the medication's effects on the GLP-1 receptors, which slow gastric emptying and regulate appetite and food intake.
Key considerations for the titration schedule include:
- Starting with a low dose of 0.25 mg to minimize side effects
- Gradually increasing the dose over 16 weeks to reach the maintenance dose of 2.4 mg
- Monitoring for gastrointestinal side effects and adjusting the dose escalation as needed
- Administering the medication on the same day each week, with flexibility to change the day if needed
- Handling missed doses by taking the missed dose as soon as possible or skipping it if the next scheduled dose is less than 2 days away. The American Gastroenterological Association recommends using semaglutide 2.4 mg with lifestyle modifications for the long-term treatment of obesity, considering its glucoregulatory benefits and approval for the treatment of type 2 diabetes mellitus 1.
From the Research
Wegovy Titration Schedule
The recommended titration schedule for Wegovy (semaglutide) is as follows:
- The dose of semaglutide should be escalated to 2.4 mg once weekly, as tolerated, to achieve optimal weight loss results 2, 3
- The titration schedule typically involves starting with a lower dose and gradually increasing it over a period of weeks or months
- However, the exact titration schedule may vary depending on the individual patient's response to the medication and their tolerance to its side effects
Key Considerations
- The efficacy and safety of semaglutide for weight loss have been demonstrated in several clinical trials, including the STEP and SUSTAIN trials 4, 2, 3
- Semaglutide has been shown to be effective in achieving significant weight loss, with a mean change in body weight from baseline to week 68 of -14.9% in the semaglutide group compared to -2.4% in the placebo group 2
- The most common adverse events associated with semaglutide are gastrointestinal, including nausea and diarrhea, which are typically mild to moderate in severity and may subside over time 2, 3, 5
Comparison with Other Medications
- Semaglutide has been compared to other medications for obesity management, including tirzepatide, and has been shown to be effective in achieving significant weight loss 5
- However, the choice of medication and titration schedule should be individualized based on the patient's specific needs and medical history 6, 3