What is the typical starting dose and titration schedule for Wegovy (semaglutide) for weight management?

Wegovy (Semaglutide) Dosing Regimen for Weight Management

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

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 and beyond: 2.4 mg subcutaneously once weekly (maintenance dose) 1

Clinical Considerations

• Gradual dose titration is essential to minimize gastrointestinal adverse effects, which are the most common side effects (nausea, vomiting, diarrhea, constipation) 1, 2
• If a patient misses 2 consecutive doses, clinical judgment is needed - consider resuming at the same dose if well-tolerated previously, or lowering the dose 1
• If 3 or more consecutive doses are missed, restart the titration schedule from the beginning 1
• Some patients may achieve significant response at submaximal doses (e.g., 1.0 mg or 1.7 mg) and could continue at that dose long-term if they are experiencing good weight loss results 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

Efficacy

• In clinical trials, patients on the 2.4 mg maintenance dose achieved mean weight loss of 14.9% from baseline at 68 weeks compared to 2.4% with placebo 2
• Real-world data shows mean weight loss of 17.6% at 12 months and 20.4% at 24 months with semaglutide 2.4 mg 3
• Significantly more patients achieve clinically meaningful weight loss with semaglutide compared to other GLP-1 receptor agonists:
  • 86.4% of patients achieve ≥5% weight loss 2
  • 69.1% achieve ≥10% weight loss 2
  • 50.5% achieve ≥15% weight loss 2
• Semaglutide 2.4 mg demonstrates superior efficacy compared to liraglutide 3.0 mg, with 15.8% vs 6.4% mean weight loss at 68 weeks 4

Safety Considerations

• Gastrointestinal adverse effects are common but typically transient and mild-to-moderate in severity 1, 2
• Wegovy should not be used concurrently with other GLP-1 receptor agonists or dipeptidyl peptidase-4 inhibitors 1
• Use caution when combining with insulin or insulin secretagogues due to potential hypoglycemia risk; dose adjustments of these medications may be needed 1
• No dosage adjustment is required for patients with renal impairment, including those with end-stage renal disease 1, 5
• Contraindicated in patients with personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 5
• Not recommended during pregnancy or breastfeeding 5

Practical Administration Tips

• Wegovy can be administered at any time of day, with or without meals 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
• Assess efficacy and safety at least monthly for the first 3 months and then at least every 3 months 5
• If there is less than 5% weight loss at 16 weeks after initiation, consider discontinuing the medication 5