What is the recommended dosing and treatment plan for Wegovy (semaglutide) for weight management?

Wegovy (Semaglutide) Dosing and Treatment Plan for Weight Management

The recommended dosing for Wegovy (semaglutide) for weight management is a once-weekly subcutaneous injection starting at 0.25 mg and gradually titrating up to a maintenance dose of 2.4 mg over 16-20 weeks. 1, 2, 3

Dosing Schedule and Administration

• Initial dose: 0.25 mg once weekly subcutaneously for 4 weeks 1, 2
• Week 5-8: Increase to 0.5 mg once weekly 1, 2
• Week 9-12: Increase to 1.0 mg once weekly 1, 2
• Week 13-16: Increase to 1.7 mg once weekly 2, 3
• Week 17 onwards: Maintenance dose of 2.4 mg once weekly 1, 2

Administration Guidelines

• Administer as a subcutaneous injection in the abdomen, thigh, or upper arm 2, 3
• Injection can be given at any time of day, with or without meals 2
• If a dose is missed, administer as soon as possible within 5 days after the missed dose; if more than 5 days have elapsed, skip the missed dose and administer the next dose on the regularly scheduled day 4
• If 3 or more consecutive doses are missed, consider restarting the titration schedule 4

Treatment Evaluation and Continuation

• Evaluate weight loss progress after 16 weeks at the 2.4 mg dose 1, 4
• If a patient has not lost at least 4% of baseline body weight after 16 weeks on the maintenance dose, consider discontinuing treatment as further weight loss is unlikely 4, 3
• For patients achieving adequate weight loss, continue treatment indefinitely as obesity is a chronic condition requiring ongoing management 1, 2

Expected Outcomes

• Mean weight loss of 14.9% from baseline after 68 weeks of treatment (compared to 2.4% with placebo) 3
• Approximately 86% of patients achieve ≥5% weight loss, 69% achieve ≥10% weight loss, and 50% achieve ≥15% weight loss after 68 weeks 3
• Real-world data shows mean weight loss of 17.6% at 12 months and 20.4% at 24 months with continued treatment 5
• Additional benefits include improvements in waist circumference, blood pressure, lipid profile, and glycemic control 1, 3

Side Effects Management

• Gastrointestinal effects are most common (nausea, vomiting, diarrhea, constipation, abdominal pain) 4, 2, 3
• Most GI side effects are mild to moderate and transient, typically resolving with continued treatment 4, 3
• Slow dose titration helps minimize GI side effects 2, 3
• Advise patients to stay well-hydrated and eat smaller, more frequent meals to help manage GI symptoms 4

Special Populations and Considerations

• No dose adjustment required for patients with renal impairment, including severe renal impairment 1, 4
• Contraindicated in patients with personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 (MEN2) 1, 4
• Use caution in patients with history of pancreatitis 4
• Do not use concurrently with other GLP-1 receptor agonists 1, 4
• Monitor for hypoglycemia when used with insulin or insulin secretagogues (sulfonylureas) 1, 4

Higher Dose Considerations

• For patients with obesity and type 2 diabetes who do not reach weight reduction goals with the 2.4 mg dose, a higher dose of 7.2 mg once weekly has shown greater efficacy (13.2% weight loss vs. 3.9% with placebo) 6
• The higher dose has similar side effect profile as 2.4 mg, except for increased incidence of dysesthesia (18.9% vs. 4.9%) 6

Cost Considerations

• The median monthly cost for Wegovy (semaglutide) 2.4 mg is approximately $1,619 (AWP) or $1,296 (NADAC) for a 30-day supply 1
• Insurance coverage may be limited, which could affect accessibility for some patients 2