Recommended Dosage of Wegovy (Semaglutide) for Chronic Weight Management
For adults with obesity, Wegovy (semaglutide) should be initiated at 0.25 mg once weekly for 4 weeks, then increased gradually every 4 weeks (0.5 mg, 1.0 mg, 1.7 mg) until reaching the maximum maintenance dose of 2.4 mg once weekly. 1, 2
Dosing Schedule and Administration
- Initial dose: 0.25 mg subcutaneously once weekly for 4 weeks 2, 3
- Week 5-8: Increase to 0.5 mg once weekly 1, 4
- Week 9-12: Increase to 1.0 mg once weekly 1, 4
- Week 13-16: Increase to 1.7 mg once weekly 1, 4
- Week 17 onward: Maintenance dose of 2.4 mg once weekly 1, 3
Efficacy and Clinical Outcomes
- At the 2.4 mg maintenance dose, patients achieve approximately 15% total body weight loss after 68 weeks compared to 2.4% with placebo 1, 3
- In clinical trials, 86.4% of patients achieved ≥5% weight loss, 69.1% achieved ≥10% weight loss, and 50.5% achieved ≥15% weight loss at the 2.4 mg dose 3, 5
- The weight loss effect is dose-dependent, with higher doses producing greater weight reduction 6, 5
- Weight regain occurs after discontinuation, suggesting the need for long-term treatment 1, 5
Monitoring and Evaluation
- Evaluate weight loss response after 16 weeks at the 2.4 mg maintenance dose 1, 2
- If a patient has not lost at least 5% of baseline body weight, consider discontinuing treatment as further therapy is unlikely to be effective 1, 2
- Monitor for gastrointestinal adverse effects, which are typically transient and mild-to-moderate in severity 1, 3
- No dosage adjustments are required for patients with renal impairment 2, 1
Safety Considerations
- The most common adverse effects are gastrointestinal, including nausea (44%), diarrhea (32%), constipation (23%), and vomiting (25%) 1, 3
- Gastrointestinal side effects typically subside with time and are minimized by the gradual dose escalation schedule 3, 5
- Contraindicated in patients with personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 2, 4
- Use caution in patients taking insulin or sulfonylureas due to increased risk of hypoglycemia 1, 2
Special Populations
- For patients with type 2 diabetes, semaglutide provides additional benefits of improved glycemic control 1, 5
- Weight loss may be less pronounced in patients with diabetes (approximately 9.6% vs 15% in non-diabetic patients) 1, 5
- Not recommended for use in pregnancy or pediatric patients 2, 4
Clinical Pearls
- The gradual dose escalation is crucial for minimizing gastrointestinal side effects 1, 3
- Semaglutide should be used in conjunction with lifestyle modifications including reduced-calorie diet and increased physical activity 1
- If a dose is missed, administer as soon as possible within 5 days after the missed dose; if more than 5 days have elapsed, skip the missed dose and administer the next dose on the regularly scheduled day 4
- Oral semaglutide (14 mg) produces less weight loss (approximately 5.7%) compared to the injectable 2.4 mg formulation and is not FDA-approved for obesity management 7