What is the recommended dosage and usage of Wegovy (semaglutide) for weight management?

Recommended Dosage and Usage of Wegovy (Semaglutide) for Weight Management

For optimal weight management outcomes, Wegovy (semaglutide) should be administered as a once-weekly subcutaneous injection with a gradual dose escalation protocol, starting at 0.25 mg and increasing to the maintenance dose of 2.4 mg over 16-20 weeks. 1, 2

Dosing Schedule and Administration

• Wegovy should be administered once weekly by subcutaneous injection in the abdomen, thigh, or upper arm 2

• The recommended dose escalation schedule is as follows:

  • Weeks 1-4: 0.25 mg once weekly
  • Weeks 5-8: 0.5 mg once weekly
  • Weeks 9-12: 1.0 mg once weekly
  • Weeks 13-16: 1.7 mg once weekly
  • Week 17 and onward: 2.4 mg once weekly (maintenance dose) 1

• Slow titration is essential to minimize gastrointestinal side effects, which are the most common adverse events 1

• Injections should be administered on the same day each week, but the time of day and injection site can be changed without dose adjustment 2

Patient Selection Criteria

• Wegovy is FDA-approved for chronic weight management in adults with:

  • BMI ≥30 kg/m² (obesity) OR
  • BMI ≥27 kg/m² (overweight) with at least one weight-related comorbid condition (e.g., hypertension, type 2 diabetes, dyslipidemia) 1

• Particularly beneficial for patients with type 2 diabetes and obesity, as it provides both weight management and glycemic control benefits 1

Expected Outcomes and Efficacy

• Clinical trials demonstrate significant weight reduction with Wegovy:

  • Average weight loss of 14.9% from baseline at 68 weeks (compared to 2.4% with placebo) 1
  • Approximately 70-73% of patients achieve ≥5% weight loss 2
  • About 50-55% of patients achieve ≥15% weight loss 1, 3

• Real-world data shows sustained weight loss:

  • 13.4% at 6 months
  • 17.6% at 12 months
  • 20.3-20.4% at 18-24 months 3

Monitoring and Continuation of Therapy

• Assess efficacy and safety at least monthly for the first 3 months and quarterly thereafter 1
• If a patient has not lost at least 5% of baseline body weight after 16 weeks on the maintenance dose (2.4 mg), discontinue Wegovy as it is unlikely to achieve clinically meaningful weight loss 1
• For patients achieving and maintaining weight loss, therapy should be continued long-term to maintain benefits 1
• Sudden discontinuation typically results in regain of 50-67% of lost weight within one year 1

Important Safety Considerations

• Most common adverse effects are gastrointestinal (nausea, vomiting, diarrhea, constipation) 1

• Contraindications include:

  • Pregnancy and breastfeeding
  • Personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 (MEN2)
  • Prior serious hypersensitivity reaction to semaglutide 1

• Special perioperative considerations:

  • May delay gastric emptying, potentially increasing risk of pulmonary aspiration during anesthesia
  • Consider timing of surgery in relation to weekly dosing schedule 1

• Monitor for potential complications:

  • Pancreatitis
  • Gallbladder disease
  • Hypoglycemia (especially if used with insulin or sulfonylureas)
  • Acute kidney injury
  • Diabetic retinopathy complications (particularly with rapid glycemic improvement) 1, 4

Practical Implementation Tips

• Administer with or without food 2
• Store in refrigerator before first use; after first use, can be stored at room temperature for up to 28 days 2
• Consider potential drug interactions due to delayed gastric emptying, which may affect absorption of concomitantly administered oral medications 2
• Combine with intensive behavioral therapy including diet and physical activity for optimal results 5
• For patients with type 2 diabetes, monitor blood glucose closely and adjust diabetes medications as needed to prevent hypoglycemia 1

By following this structured dosing approach and monitoring protocol, Wegovy can be effectively used for chronic weight management in appropriate patients, leading to clinically significant weight loss and improvement in weight-related comorbidities.