Wegovy Starting Dose
Start Wegovy at 0.25 mg subcutaneously once weekly for the first 4 weeks. This initial dose is not therapeutic but serves to minimize gastrointestinal adverse effects during the titration phase 1, 2.
Dose Escalation Schedule
After the initial 4-week period at 0.25 mg, follow this structured titration:
- 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)
The maintenance dose of 2.4 mg is reached after 16 weeks of gradual titration 1.
Rationale for Gradual Titration
The slow dose escalation is critical to reduce gastrointestinal adverse events, which are the most common side effects with GLP-1 receptor agonists. In clinical trials, nausea occurred in approximately 40% of patients, making tolerability a key concern 1. The 4-week intervals at each dose level allow the body to adapt to semaglutide's effects on gastric emptying and appetite regulation.
Important Clinical Considerations
Missed Doses
- If 2 or fewer consecutive doses are missed: Resume at the same dose if the patient previously tolerated it well; otherwise consider lowering the dose 1
- If 3 or more consecutive doses are missed: Restart the entire titration schedule from 0.25 mg 1
Submaximal Dosing
Some patients achieve adequate weight loss at doses below 2.4 mg and may continue long-term at that lower dose 1. Real-world data from Denmark shows 45% of users remained on 1 mg with meaningful weight loss (median 12% at 3-6 months) 3. However, the FDA-approved maintenance dose remains 2.4 mg weekly, and this should be the target unless tolerability issues arise.
Administration Details
- Inject subcutaneously in the abdomen, thigh, or upper arm 2
- Injection site does not affect drug exposure 2
- Administer on the same day each week; day of week can be changed if needed with at least 2 days between doses
Common Pitfalls to Avoid
Do not skip the titration schedule. Starting at higher doses or escalating too rapidly significantly increases the risk of severe nausea and vomiting, leading to treatment discontinuation. The gradual 4-week intervals are evidence-based and should be followed unless individual patient circumstances require adjustment 1.
Do not use "click counting" on the injection pen as a dosing method—10% of users in one survey reported this practice, which contradicts prescribing guidelines and may lead to incorrect dosing 3.
Counsel patients that this medication requires long-term use. Weight regain occurs after discontinuation, with studies showing 6.9-11.6% weight regain when semaglutide is stopped 4.