From the Guidelines
Wegovy (semaglutide) should be escalated gradually over 16 weeks to reach the therapeutic dose of 2.4 mg once weekly, with a recommended schedule starting at 0.25 mg once weekly for the first 4 weeks, then increasing to 0.5 mg, 1.0 mg, and 1.7 mg once weekly every 4 weeks, to minimize gastrointestinal side effects. This approach is supported by the most recent and highest quality study, which emphasizes the importance of gradual dose titration to reduce the risk of adverse effects 1. The recommended dose escalation schedule is as follows:
- 0.25 mg once weekly for the first 4 weeks
- 0.5 mg once weekly for weeks 5-8
- 1.0 mg once weekly for weeks 9-12
- 1.7 mg once weekly for weeks 13-16
- 2.4 mg once weekly from week 17 onward It is essential to administer all injections subcutaneously in the abdomen, thigh, or upper arm, on the same day each week, and to consider maintaining a dose for longer if patients experience significant side effects before attempting the next increase 1. If a dose is missed, it should be taken as soon as possible if it's more than 3 days until the next scheduled dose, or skipped if it's less than 3 days, and the regular schedule resumed.
From the Research
Dose Escalation for Wegovy (Semaglutide)
The recommended rate of dose escalation for Wegovy (semaglutide) is not explicitly stated in the provided studies. However, the studies do provide information on the dosing and titration of semaglutide in clinical trials.
- The STEP program, which consisted of four Phase 3 trials, used a dose of 2.4 mg once weekly for subcutaneous semaglutide 2.
- The SUSTAIN and PIONEER clinical trials studied the use of 1.0 mg, once-weekly, subcutaneous and oral semaglutide, respectively, on participants with type 2 diabetes 3.
- The dosing and titration of semaglutide in clinical practice may vary depending on the patient's response to treatment and tolerability of the medication.
Factors to Consider for Dose Escalation
When considering dose escalation for Wegovy (semaglutide), the following factors should be taken into account:
- Efficacy: The patient's response to the current dose, including weight loss and improvement in glycemic control.
- Tolerability: The patient's ability to tolerate the current dose, including the presence of adverse events such as gastrointestinal symptoms.
- Comorbidities: The presence of comorbidities, such as hypertension, hyperlipidemia, and diabetes mellitus, which may affect the patient's response to treatment.
Real-World Utilization of Semaglutide
Real-world studies have evaluated the utilization of semaglutide in clinical practice, including its use in combination with other weight management medications 4, 5.
- A study of 59,160 adults with prior bariatric surgery found that semaglutide was used in 0.52% of patients, with the highest utilization among those aged 45-49 years 4.
- A medication use evaluation of 1959 Veterans newly initiated on weight management medications found that semaglutide was one of the most frequently prescribed medications, with a clinical response rate of 5% and 10% or greater weight loss at the final weight 5.