What is the starting dose for Wegovy (semaglutide)?

Starting Dose for Wegovy (Semaglutide)

The recommended starting dose for Wegovy (semaglutide) is 0.25 mg subcutaneously once weekly for the first 4 weeks, followed by a gradual dose escalation schedule. 1

Dose Titration Schedule

• Begin with 0.25 mg subcutaneously once weekly for 4 weeks 1
• Increase to 0.5 mg once weekly for 4 weeks 1
• Increase to 1.0 mg once weekly for 4 weeks 1
• Increase to 1.7 mg once weekly for 4 weeks 1
• Reach maintenance dose of 2.4 mg once weekly 1, 2

Rationale for Gradual Titration

• Gradual dose escalation is essential to minimize gastrointestinal adverse effects, which are the most common side effects 1
• Studies show that gastrointestinal side effects (nausea, vomiting, diarrhea) are typically transient and mild-to-moderate in severity 2
• Without proper titration, discontinuation rates due to gastrointestinal events increase significantly (4.5% of patients discontinued due to GI events even with proper titration) 2

Missed Dose Management

• If a patient misses a dose and it has been less than 5 days since the missed dose, administer as soon as possible 1
• If more than 5 days have passed, skip the missed dose and resume the regular schedule 1
• For 2 consecutive missed doses: consider resuming at the same dose if previously well-tolerated, or lower the dose 1
• For 3 or more consecutive missed doses: restart the titration schedule from the beginning 1

Clinical Considerations

• Wegovy can be administered at any time of day, with or without meals 1
• No dosage adjustment is required for patients with renal impairment, including those with end-stage renal disease 1
• Use caution when combining with insulin or insulin secretagogues due to potential hypoglycemia risk; dose adjustments of these medications may be needed 1
• Do not use concurrently with other GLP-1 receptor agonists or dipeptidyl peptidase-4 inhibitors 1

Storage Information

• Store in refrigerator (36°F to 46°F/2°C to 8°C) 1
• May be kept at room temperature for up to 28 days 1

Efficacy Expectations

• In clinical trials, semaglutide 2.4 mg once weekly resulted in average weight reduction of 14.9% from baseline after 68 weeks compared to 2.4% with placebo 2
• Approximately 86.4% of participants achieved ≥5% weight reduction, 69.1% achieved ≥10% weight reduction, and 50.5% achieved ≥15% weight reduction 2
• Some patients may achieve significant response at submaximal doses and could continue at that dose long-term 1