From the Guidelines
Wegovy (semaglutide) should be titrated every 4 weeks as tolerated by the patient, with a gradual dose escalation to minimize gastrointestinal side effects. According to the most recent evidence from 2023, the dose titration schedule for Wegovy is not explicitly outlined in the provided study 1, but based on general clinical guidelines and the example provided, the normal stepping of doses begins with 0.25 mg injected subcutaneously once weekly for the first 4 weeks, then increases to 0.5 mg once weekly for weeks 5-8. The dose then escalates to 1 mg once weekly for weeks 9-12, followed by 1.7 mg once weekly for weeks 13-16. Finally, the maintenance dose of 2.4 mg once weekly is reached at week 17 and continued thereafter.
Key Considerations
- The dose escalation schedule is designed to allow the body to gradually adapt to the medication, reducing the likelihood and severity of side effects like nausea, vomiting, and diarrhea 1.
- If a patient experiences significant side effects at any dose level, their healthcare provider may recommend remaining at that dose for longer before attempting to increase further.
- The gradual titration is essential for treatment adherence and success, as abrupt dose increases can lead to intolerable side effects and potential discontinuation of therapy.
Monitoring and Contraindications
- Patients should be monitored for common side effects such as nausea, vomiting, diarrhea, and constipation, as well as more serious concerns like pancreatitis, acute gallbladder disease, and suicidal ideation and behavior 1.
- Contraindications for Wegovy include pregnancy, breastfeeding, personal or family history of medullary thyroid cancer or MEN2, and a history of pancreatitis 1.
From the Research
Normal Titration of Doses with Wegovy (Semaglutide)
- The normal titration of doses with Wegovy (semaglutide) is not explicitly stated in the provided studies, but the dosage of semaglutide used in the studies is 2.4 mg once weekly, with a 16-week escalation period 2, 3, 4.
- In the STEP 6 trial, participants were randomized to receive once-weekly subcutaneous semaglutide 2.4 mg or 1.7 mg, with a 16-week escalation period for the 2.4 mg dose 5.
- The pharmacokinetics of semaglutide indicate that it has a half-life of 7 days, and it would reach steady state in 4-5 weeks, with few drug interactions and no necessary dose adjustments 6.
Dose Escalation
- The dose escalation period for semaglutide is 16 weeks for the 2.4 mg dose, with participants starting at a lower dose and increasing to the target dose over the escalation period 2, 3, 4.
- In the STEP 6 trial, participants who were unable to tolerate the 2.4 mg dose could receive 1.7 mg, and participants who were unable to tolerate the 1.7 mg dose could discontinue treatment and restart the 16-week titration 5.
Clinical Implications
- Semaglutide has been shown to be effective in reducing body weight and improving cardiometabolic risk factors in adults with overweight or obesity, with or without type 2 diabetes 2, 3, 4, 5.
- The most common adverse events associated with semaglutide are gastrointestinal disorders, which are mostly mild to moderate 2, 3, 4, 5.