Starting Dose of Wegovy (Semaglutide)
The starting dose of Wegovy (semaglutide) is 0.25 mg once weekly administered subcutaneously for the first 4 weeks. 1
Dose Escalation Schedule
Wegovy follows a specific dose escalation schedule to minimize gastrointestinal side effects:
- 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)
This gradual titration is essential as it helps patients adapt to the medication while minimizing adverse effects, particularly gastrointestinal symptoms which are the most common side effects of semaglutide 2.
Clinical Evidence and Indications
Wegovy (semaglutide 2.4 mg) is FDA-approved for:
- Weight management in adults with BMI ≥30 kg/m² or BMI ≥27 kg/m² with at least one weight-related comorbidity 1
- Weight management in pediatric patients ages 12 and older with obesity 3
Administration Guidelines
- Administer subcutaneously once weekly on the same day each week
- Can be injected at any time of day, with or without meals
- Injection sites include abdomen, thigh, or upper arm
- If a dose is missed and the next scheduled dose is more than 2 days away, take the missed dose as soon as possible
Monitoring Recommendations
- Assess efficacy and safety at least monthly for the first 3 months and quarterly thereafter 2
- Early responders (>5% weight loss after 3 months) should continue the medication unless clinical circumstances suggest otherwise 2
- Monitor for gastrointestinal symptoms, particularly during dose escalation
Important Considerations and Contraindications
- No dosage adjustments required for patients with renal impairment 1
- Contraindicated in patients with:
- Personal or family history of medullary thyroid carcinoma
- Multiple endocrine neoplasia syndrome type 2
- Pregnancy 2
Common Side Effects
The most common adverse effects are gastrointestinal:
- Nausea (44%)
- Diarrhea (32%)
- Constipation (23%)
- Vomiting (25%) 1
These side effects are typically transient and mild-to-moderate in severity, subsiding with time. The gradual dose escalation schedule is specifically designed to minimize these effects.
Real-World Considerations
Recent real-world data shows that many patients do not follow the recommended dose escalation schedule, with only 10% following the recommended dose increases every 4 weeks, and only 25% reaching the maximum 2.4 mg dose 4. This suggests that in clinical practice, dose titration may be slower than in clinical trials.