Recommended Dosing Regimen for Wegovy (Semaglutide)
The recommended dosing regimen for Wegovy (semaglutide) for weight management requires a gradual dose titration starting at 0.25 mg subcutaneously once weekly for 4 weeks, followed by incremental increases every 4 weeks (0.5 mg, 1.0 mg, 1.7 mg) until reaching the maintenance dose of 2.4 mg once weekly. 1, 2, 3
Dose Titration Schedule
- Initial dose: 0.25 mg subcutaneously once weekly for 4 weeks 1, 3
- Week 5-8: 0.5 mg once weekly 1, 3
- Week 9-12: 1.0 mg once weekly 1, 3
- Week 13-16: 1.7 mg once weekly 1, 3
- Week 17 and beyond: 2.4 mg once weekly (maintenance dose) 1, 3
Clinical Considerations
- Gradual dose titration is essential to minimize gastrointestinal adverse effects, which are the most common side effects 4, 3
- If a patient misses 2 consecutive doses, clinical judgment is needed for subsequent dosing - consider resuming at the same dose if well-tolerated previously, or lowering the dose 4
- If 3 or more consecutive doses are missed, consider restarting the titration schedule 4
- Some patients may achieve significant response at submaximal doses and could continue at that dose long-term 4
Efficacy and Outcomes
- At the 2.4 mg maintenance dose, Wegovy produces mean weight loss of approximately 15% of body weight after 68 weeks compared to 2.4% with placebo 3
- Long-term data shows sustained weight loss of 15.2% at 104 weeks (2 years) compared to 2.6% with placebo 5
- Real-world data shows mean weight loss of 20.4% at 24 months in patients using Wegovy with the WeGoTogether support program 6
- Wegovy (semaglutide 2.4 mg) demonstrates superior weight loss compared to liraglutide 3.0 mg (15.8% vs 6.4% at 68 weeks) 7
Safety Considerations
- Gastrointestinal adverse effects are common (nausea, vomiting, diarrhea, constipation) but typically transient and mild-to-moderate in severity 4, 3
- Approximately 4.5% of patients discontinue treatment due to gastrointestinal events 3
- Wegovy should not be used with other GLP-1 receptor agonists or dipeptidyl peptidase-4 inhibitors 4
- Use caution when combining with insulin or insulin secretagogues due to potential hypoglycemia risk; dose adjustments of these medications may be needed 4
- No dosage adjustment is required for patients with renal impairment, including those with end-stage renal disease 1, 4
Practical Administration Tips
- Administer subcutaneously in the abdomen, thigh, or upper arm 8
- Wegovy can be administered at any time of day, with or without meals 1
- If a dose is missed and it has been less than 5 days since the missed dose, administer as soon as possible; if more than 5 days have passed, skip the missed dose 1
- Store in refrigerator (36°F to 46°F/2°C to 8°C); may be kept at room temperature for up to 28 days 1
Wegovy's dosing regimen requires careful titration to maximize efficacy while minimizing adverse effects. The substantial and sustained weight loss demonstrated in clinical trials and real-world settings supports its use as an effective weight management option when combined with lifestyle interventions.