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

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

Wegovy (semaglutide 2.4 mg) should be administered as a once-weekly subcutaneous injection with a gradual dose escalation schedule to minimize gastrointestinal side effects and achieve optimal weight loss outcomes. 1, 2

Dosing Schedule and Administration

• Wegovy requires a specific dose escalation schedule to minimize side effects and optimize treatment outcomes 1:

  • Week 1-4: Start with 0.25 mg once weekly
  • Week 5-8: Increase to 0.5 mg once weekly
  • Week 9-12: Increase to 1.0 mg once weekly
  • Week 13-16: Increase to 1.7 mg once weekly
  • Week 17 and beyond: Maintenance dose of 2.4 mg once weekly

• Administer as a subcutaneous injection in the abdomen, thigh, or upper arm 2

• Wegovy is indicated 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

Efficacy and Expected Outcomes

• Wegovy produces significant weight loss compared to placebo:

  • 14.9% mean weight reduction from baseline at 68 weeks (vs. 2.4% with placebo) 3
  • Real-world data shows mean weight loss of 17.6% at 12 months and 20.4% at 24 months 4

• Clinical trials demonstrated that Wegovy helps patients achieve:

  • 86.4% of patients achieve ≥5% weight loss
  • 69.1% achieve ≥10% weight loss
  • 50.5% achieve ≥15% weight loss 3

• Beyond weight loss, Wegovy provides additional cardiometabolic benefits:

  • Improved glycemic control
  • Reduced blood pressure
  • Improved lipid profiles 1, 5

Monitoring and Continuation of Therapy

• Assess efficacy and safety at least monthly for the first 3 months and at least quarterly thereafter 1

• Consider discontinuation if:

  • Patient has not lost at least 5% of baseline body weight after 16 weeks on the maintenance dose 1
  • Intolerable side effects occur 1

• Weight management pharmacotherapy should be continued beyond reaching weight loss goals to maintain health benefits, as sudden discontinuation results in significant weight regain 1, 4

Safety Considerations and Side Effects

• Most common side effects are gastrointestinal:

  • Nausea (44%)
  • Diarrhea (32%)
  • Vomiting (25%)
  • Constipation (23%) 1

• Gastrointestinal side effects are typically:

  • Transient and mild-to-moderate in severity
  • Most common during dose escalation
  • Can be minimized with slow titration 3, 6

• Important safety considerations:

  • Use caution in patients with history of pancreatitis 1
  • May cause cholelithiasis and gallstone-related complications 1
  • Contraindicated in pregnancy and breastfeeding 1
  • Contraindicated in patients with personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 1

Perioperative Considerations

• Due to delayed gastric emptying effects, consider timing of Wegovy administration before elective procedures:
  • For weekly injections like Wegovy, consider stopping one week before elective procedures 1
  • Delayed gastric emptying may increase risk of pulmonary aspiration during anesthesia induction 1

Special Populations and Considerations

• No dose adjustment needed for patients with mild to moderate renal impairment 2

• Use caution in patients with severe renal impairment due to potential risk of acute kidney injury from dehydration 1

• Monitor for potential drug interactions:

  • Wegovy may delay absorption of oral medications due to slowed gastric emptying
  • Monitor patients on medications with narrow therapeutic index (e.g., warfarin) 1, 2

• Screen patients who have lost significant weight for malnutrition, especially those on long-term therapy 1

By following this dosing schedule and monitoring protocol, patients can maximize the benefits of Wegovy while minimizing potential side effects for effective long-term weight management.