Highest Approved Dose of Wegovy (Semaglutide)
The highest approved dose of Wegovy (semaglutide) for weight management is 2.4 mg administered once weekly via subcutaneous injection. 1
Dosing Information
Wegovy (semaglutide) is administered according to a specific dose escalation schedule to minimize gastrointestinal side effects:
- Starting dose: 0.25 mg once weekly for 4 weeks
- Dose escalation:
- 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 and onwards: 2.4 mg once weekly (maintenance dose)
This gradual titration schedule is essential to improve gastrointestinal tolerability, as rapid dose escalation can lead to increased adverse effects.
Clinical Evidence Supporting the 2.4 mg Dose
The 2.4 mg weekly dose of semaglutide was established as the optimal dose for weight management based on clinical trials that demonstrated significant efficacy:
- In the STEP 1 trial, semaglutide 2.4 mg weekly resulted in a mean weight reduction of 14.9% from baseline compared to 2.4% with placebo over 68 weeks 2
- At this dose, 86.4% of participants achieved ≥5% weight loss, 69.1% achieved ≥10% weight loss, and 50.5% achieved ≥15% weight loss 2
- The SELECT trial demonstrated that semaglutide 2.4 mg weekly reduced cardiovascular events in patients with obesity without diabetes 3
Pharmacokinetics of Semaglutide
Semaglutide has favorable pharmacokinetic properties that support once-weekly dosing:
- Elimination half-life: Approximately 1 week
- Steady-state exposure: Achieved after 4-5 weeks of once-weekly administration
- Bioavailability: 89% following subcutaneous injection
- Presence in circulation: Approximately 5 weeks after the last dose 4
Important Considerations and Side Effects
When prescribing the highest dose of Wegovy (2.4 mg), clinicians should be aware of:
- Gastrointestinal side effects: Nausea, vomiting, diarrhea, and constipation are common, particularly during dose escalation 1
- Delayed gastric emptying: May affect absorption of concomitant oral medications 1
- Gallbladder disease risk: Increased risk of cholelithiasis and cholecystitis 1, 5
- Pancreatitis risk: Discontinue if pancreatitis is suspected 5
- Black box warning: Risk of thyroid C-cell tumors in rodents (human relevance not determined) 1
Contraindications
Wegovy at any dose is contraindicated in:
- Personal or family history of medullary thyroid carcinoma
- Multiple endocrine neoplasia syndrome type 2
- Pregnancy (women of reproductive potential must use reliable contraception) 1
Monitoring Recommendations
When patients are on the maximum 2.4 mg dose:
- Assess efficacy and safety at least monthly for the first 3 months and quarterly thereafter
- Early responders (>5% weight loss after 3 months) should continue the medication unless clinical circumstances suggest otherwise 1
- Monitor for signs of dehydration in patients with severe gastrointestinal symptoms 5
- Evaluate for gallbladder disease if symptoms develop 5
The 2.4 mg dose represents the current maximum approved dose, though research is exploring extended-release formulations that might allow for less frequent dosing in the future 6.