Wegovy (Semaglutide) Titration Schedule
The standard titration protocol for Wegovy (semaglutide) requires starting at 0.25 mg once weekly for 4 weeks, then increasing the dose every 4 weeks (0.5 mg, 1.0 mg, 1.7 mg) until reaching the maintenance dose of 2.4 mg weekly. 1
Detailed Titration Schedule
| Weeks | Semaglutide Dose |
|---|---|
| 1-4 | 0.25 mg weekly |
| 5-8 | 0.5 mg weekly |
| 9-12 | 1.0 mg weekly |
| 13-16 | 1.7 mg weekly |
| 17+ | 2.4 mg weekly (maintenance) |
This gradual titration approach is specifically designed to:
- Minimize gastrointestinal side effects (nausea, vomiting, diarrhea)
- Optimize medication tolerability
- Improve patient adherence to therapy
Rationale for Slow Titration
The American Diabetes Association recommends this gradual titration schedule because:
- Gastrointestinal adverse effects are dose-dependent and occur in up to 40% of patients 1, 2
- Starting at low doses and titrating slowly significantly reduces the severity of these side effects
- Each 4-week interval allows the body to adjust to the medication before increasing to the next dose level
Managing Side Effects During Titration
If a patient experiences significant gastrointestinal side effects during titration:
- Consider maintaining the current dose for longer than 4 weeks until side effects subside
- Do not skip doses or titration steps
- Advise patients that side effects are typically transient and mild-to-moderate in severity 2
- Ensure patients understand that gastrointestinal effects typically diminish with continued treatment
Special Considerations
- No dose adjustment is required for patients with renal impairment, including those with advanced renal insufficiency 1
- The titration schedule should be followed even in patients with type 2 diabetes who may already be using other GLP-1 receptor agonists
- For maximum efficacy, patients should continue the medication long-term at the maintenance dose, as discontinuation results in significant weight regain (50-67% within one year) 1
Monitoring During Titration
- Monitor for gastrointestinal symptoms at each dose increase
- Assess weight loss response throughout the titration period
- For patients with diabetes, monitor blood glucose levels regularly
- Consider temporary withholding of the medication during times of prolonged fasting, surgery, or critical medical illness when patients may be at greater risk for ketosis 3
Following this established titration schedule will maximize the chances of treatment success while minimizing adverse effects, leading to better long-term outcomes in terms of weight management and metabolic health.