What is the recommended maintenance dose of Wegovy (semaglutide) for weight loss?

Recommended Maintenance Dose of Wegovy (Semaglutide) for Weight Loss

The recommended maintenance dose of Wegovy (semaglutide) for weight loss is 2.4 mg administered subcutaneously once weekly. 1, 2

Dosing Titration Schedule

The full dosing schedule follows a gradual titration to minimize gastrointestinal side effects:

• Week 1-4: 0.25 mg subcutaneously once weekly 2
• Week 5-8: 0.5 mg subcutaneously once weekly 2
• Week 9-12: 1.0 mg subcutaneously once weekly 2
• Week 13-16: 1.7 mg subcutaneously once weekly 2
• Week 17 onwards: 2.4 mg subcutaneously once weekly (maintenance dose) 2, 1

Efficacy of Maintenance Dose

• At the 2.4 mg maintenance dose, semaglutide has demonstrated significant weight loss in clinical trials:
  • 14.9% mean weight loss from baseline at 68 weeks (compared to 2.4% with placebo) 3
  • 12.6% total body weight loss at 104 weeks 1
  • In real-world settings, patients achieved 17.6% weight loss at 12 months and 20.4% weight loss at 24 months 4

Clinical Considerations for Maintenance Dosing

• Gradual dose titration is essential to minimize gastrointestinal adverse effects, which are the most common side effects 2
• Some patients may achieve significant response at submaximal doses and could continue at that dose long-term 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 2
• Semaglutide should be discontinued if the patient has not lost at least 5% of baseline body weight after 12 weeks on the maintenance dose 1

Administration of Maintenance Dose

• Semaglutide can be administered at any time of day, with or without meals 2
• 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 2

Safety Considerations

• The most common adverse effects at the maintenance dose include:
  • Gastrointestinal symptoms: nausea, vomiting, diarrhea, constipation, abdominal pain 1
  • Other effects: headache, fatigue, dizziness 1
• Contraindications include:
  • Pregnancy and breastfeeding 1
  • Personal or family history of medullary thyroid cancer or Multiple Endocrine Neoplasia type 2 (MEN2) 1
  • History of pancreatitis 1

Long-term Maintenance Considerations

• Weight regain is common after discontinuation of semaglutide, with studies showing regain of 11.6% of lost weight after stopping the medication 1
• This suggests that long-term maintenance therapy at the 2.4 mg weekly dose is necessary for sustained weight loss 1
• Continued lifestyle modifications remain essential during maintenance therapy 1, 3

Comparative Efficacy

• Semaglutide 2.4 mg has demonstrated greater weight loss efficacy compared to other GLP-1 receptor agonists:
  • Superior to liraglutide 3.0 mg (8.0% weight loss for liraglutide vs. 14.9% for semaglutide) 1, 2
  • Oral semaglutide at 14 mg (the highest dose approved for diabetes) produces less weight loss (5.7%) than the 2.4 mg injectable maintenance dose 5

Pitfalls and Caveats

• Patients must be counseled that the maintenance dose needs to be continued long-term to maintain weight loss 1
• Insurance coverage may limit access to the maintenance dose for some patients 6
• Semaglutide should not be used with other GLP-1 receptor agonists or DPP-4 inhibitors 2
• Use caution when combining with insulin or insulin secretagogues due to potential hypoglycemia risk 2