From the Guidelines
Wegovy (semaglutide) therapy for weight loss should be initiated at 0.25 mg once weekly by subcutaneous injection for the first 4 weeks, followed by gradual dose escalation to minimize gastrointestinal side effects, as recommended by the American Gastroenterological Association 1. The dose should be increased to 0.5 mg weekly for 4 weeks, then 1.0 mg weekly for 4 weeks, followed by 1.7 mg weekly for 4 weeks, and finally reaching the maintenance dose of 2.4 mg weekly after 16 weeks.
Key Considerations for Initiation and Management
- Patients should inject Wegovy on the same day each week, and can change the day if needed as long as the last dose was administered at least 2 days prior.
- The medication should be administered in the abdomen, thigh, or upper arm.
- Common side effects include nausea, vomiting, diarrhea, abdominal pain, and constipation, which typically improve over time.
- Patients should be advised to follow a reduced-calorie diet and increased physical activity program alongside medication therapy.
- Regular monitoring for potential adverse effects is important, including pancreatitis, gallbladder problems, hypoglycemia (especially in patients with type 2 diabetes), and increased heart rate, as suggested by the AGA clinical practice guideline 1.
Special Clinical Considerations
- Clinical judgment is recommended for adjusting the titration schedule as needed for an individual patient’s response, tolerance, and adverse effects.
- If more than 2 consecutive doses are missed, clinical judgment is required to decide on subsequent dosing, and resuming at the same dose can be considered if a patient has tolerated the medication well, otherwise, prescribers should consider lowering the next dose.
- Restarting the titration schedule should be considered if 3 or more consecutive doses are missed.
- Some patients may achieve a strong response at a submaximal dose and could continue that given dose long term.
- Treatment should be discontinued if a patient has not lost at least 5% of initial body weight by 12 weeks on the maintenance dose.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Initiating Wegovy Therapy for Weight Loss
To initiate Wegovy (semaglutide) therapy for weight loss, it is essential to understand the recommended dosage and administration. The typical starting dose is 0.25 mg injected subcutaneously once a week, and the dose is gradually increased every 4 weeks to reach the target dose of 2.4 mg 2.
Patient Selection and Education
Patients should be selected based on their body mass index (BMI) and the presence of weight-related comorbidities. Those with a BMI of 30 or greater, or 27 or greater with at least one weight-related condition, may be eligible for treatment 2. It is crucial to educate patients on the proper administration of the medication, potential side effects, and the importance of lifestyle interventions, such as diet and exercise, to support weight loss.
Dose Titration and Management
Dose titration is critical to minimize gastrointestinal side effects, which are common with semaglutide therapy. The dose should be increased gradually, as tolerated by the patient, to reach the maximum dose of 2.4 mg 2. However, real-world studies have shown that few patients follow the recommended dose titration schedule, and many continue with lower doses 3.
Monitoring and Follow-up
Regular monitoring of patients' weight, BMI, and cardiometabolic risk factors is necessary to assess the effectiveness of the treatment. Patients should also be monitored for potential side effects, such as nausea, diarrhea, and vomiting, which are commonly reported with semaglutide therapy 2, 4.
Lifestyle Intervention
Lifestyle intervention, including diet and exercise, is essential to support weight loss and maintain weight reduction after treatment discontinuation. Studies have shown that participants who received semaglutide plus lifestyle intervention had greater improvements in weight loss and cardiometabolic risk factors compared to those who received placebo plus lifestyle intervention 2, 5.
Weight Regain after Treatment Discontinuation
Weight regain is a significant concern after discontinuation of semaglutide therapy. Studies have shown that patients regain a significant portion of their lost weight after treatment discontinuation, highlighting the need for ongoing treatment and lifestyle interventions to maintain weight loss 5.
Key Points for Patient Education
- The importance of proper administration and dose titration
- Potential side effects and their management
- The need for lifestyle interventions, such as diet and exercise, to support weight loss
- Regular monitoring and follow-up to assess treatment effectiveness and potential side effects
- The risk of weight regain after treatment discontinuation and the need for ongoing treatment and lifestyle interventions to maintain weight loss 6, 2, 5