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

Recommended Dosing and Treatment Plan for Wegovy (Semaglutide) for Weight Management

The recommended dosing regimen for Wegovy (semaglutide) 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

Dose Titration Schedule

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

Administration Guidelines

• 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
• For patients who miss 2 consecutive doses, clinical judgment is needed - consider resuming at the same dose if well-tolerated previously, or lowering the dose 2
• If 3 or more consecutive doses are missed, restart the titration schedule 2
• Some patients may achieve significant response at submaximal doses and could continue at that dose long-term 2

Expected Outcomes

• Clinical trials demonstrated mean weight loss of 14.9% from baseline at 68 weeks with semaglutide 2.4 mg compared to 2.4% with placebo 3
• In real-world settings, patients using Wegovy with the WeGoTogether support program achieved:
  • 13.4% weight loss at 6 months
  • 17.6% weight loss at 12 months
  • 20.3% weight loss at 18 months
  • 20.4% weight loss at 24 months 4
• More than 50% of patients achieved ≥20% weight loss at 18 and 24 months in real-world settings 4

Treatment Continuation Assessment

• If a patient has not lost at least 5% of baseline body weight after 12 weeks on the maintenance dose (2.4 mg), consider discontinuing treatment 2
• Patients who respond well should continue treatment as Wegovy is indicated for chronic weight management 1

Common Side Effects and Management

• Gastrointestinal adverse effects are most common and typically transient 3:
  • Nausea (most common)
  • Vomiting
  • Diarrhea
  • Constipation
  • Abdominal pain
  • Dyspepsia
• The gradual dose titration schedule is specifically designed to minimize these GI adverse effects 2
• Most side effects are mild to moderate in severity and subside with time 3

Important Precautions

• Do not use with other GLP-1 receptor agonists or dipeptidyl peptidase-4 inhibitors 2
• Use caution when combining with insulin or insulin secretagogues due to potential hypoglycemia risk; dose adjustments of these medications may be needed 2
• Monitor for potential adverse effects including:
  • Pancreatitis (rare, <0.1% in post-marketing data) 2
  • Gallbladder disease (rare, <0.05% in post-marketing data) 2
  • Hypoglycemia (particularly in patients on antidiabetic medications) 2

Storage Requirements

• 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

Wegovy has demonstrated superior efficacy compared to other weight management medications, with semaglutide 2.4 mg showing greater weight loss than liraglutide 3.0 mg in comparative studies (13.8% vs 7.8% weight reduction) 5. The SELECT trial also showed significant cardiovascular benefits in patients with pre-existing cardiovascular disease who were overweight or obese but without diabetes 2.