Maximum Dose of Wegovy (Semaglutide)
The maximum approved dose of Wegovy (semaglutide) for weight management is 2.4 mg administered once weekly via subcutaneous injection. 1
Dosing Information and Titration Schedule
Wegovy (semaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist specifically approved for chronic weight management. The dosing follows a gradual titration schedule to minimize gastrointestinal side effects:
- Starting dose: 0.25 mg once weekly subcutaneously
- Titration schedule:
- Week 1-4: 0.25 mg once weekly
- Week 5-8: 0.5 mg once weekly
- Week 9-12: 1.0 mg once weekly
- Week 13-16: 1.7 mg once weekly
- Week 17 onward: 2.4 mg once weekly (maintenance dose)
Efficacy at Maximum Dose
At the maximum dose of 2.4 mg weekly, semaglutide demonstrates significant weight loss benefits:
- Average weight loss of 9.6% from baseline (compared to 3.4% with placebo) 1
- Up to 14.9% weight loss from baseline in clinical trials 2
- Superior weight loss compared to liraglutide 3.0 mg (15.8% vs 6.4%) 3
Clinical Considerations
Dose Optimization
- The full 2.4 mg dose provides the maximum weight loss benefit, but lower doses may be used if patients cannot tolerate the maximum dose
- Real-world data shows only 13% of patients reach the maximum 2.4 mg dose by their fifth prescription, with 33-48% remaining on the 1.0 mg dose 4
- If a patient cannot tolerate the 2.4 mg dose, 1.7 mg may be used as an alternative 3
Side Effect Management
The most common adverse effects at the maximum dose include:
- Gastrointestinal effects: nausea (44%), diarrhea (32%), constipation (23%), vomiting (25%) 1
- Other effects: injection site reactions, elevated heart rate, potential hypoglycemia (especially if used with insulin or sulfonylureas) 1
Important Precautions
- Black box warning: Risk of thyroid C-cell tumors in rodents (human relevance not determined) 1
- Contraindicated in patients with personal or family history of medullary thyroid cancer or Multiple Endocrine Neoplasia syndrome type 2 1
- May cause cholelithiasis and gallstone-related complications 1
- May cause gastrointestinal disorders including severe constipation and small bowel obstruction/ileus progression 1
- Monitor for potential consequences of delayed absorption of oral medications 1
Comparison to Other GLP-1 RAs
- Semaglutide 2.4 mg weekly provides greater weight loss than liraglutide 3.0 mg daily (15.8% vs 6.4%) 3
- Tirzepatide (a dual GIP/GLP-1 receptor agonist) at 15 mg weekly shows greater weight loss (14.7%) than semaglutide 2.4 mg (9.6%) 1
In conclusion, while the maximum approved dose of Wegovy is 2.4 mg weekly, careful dose titration and monitoring for side effects are essential to optimize outcomes and treatment adherence.