Wegovy (Semaglutide 2.4 mg) for Weight Management
Wegovy should be initiated at 0.25 mg subcutaneously once weekly and titrated every 4 weeks through doses of 0.5 mg, 1.0 mg, and 1.7 mg until reaching the maintenance dose of 2.4 mg once weekly after 16 weeks. 1, 2
Dose Titration Schedule
The standard escalation protocol is critical to minimize gastrointestinal adverse effects:
- Week 1-4: 0.25 mg once weekly 1, 2
- Week 5-8: 0.5 mg once weekly 1, 2
- Week 9-12: 1.0 mg once weekly 1, 2
- Week 13-16: 1.7 mg once weekly 1, 2
- Week 17 onward: 2.4 mg once weekly (maintenance dose) 1, 2
Some patients achieve significant weight loss at submaximal doses (e.g., 1.7 mg) and may continue long-term at that dose rather than escalating further. 1, 2 This is an important clinical consideration when patients experience adequate response with better tolerability at lower doses.
Expected Weight Loss Outcomes
Wegovy demonstrates superior efficacy compared to other weight management medications:
- At 68 weeks: Mean weight loss of 14.9-16.0% versus 2.4-5.7% with placebo 1, 3
- 86.4% of patients achieve ≥5% weight loss 3
- 69.1% achieve ≥10% weight loss 3
- 50.5% achieve ≥15% weight loss 3
- Real-world data shows 20.4% mean weight loss at 24 months 4
Semaglutide 2.4 mg produces significantly greater weight loss than liraglutide 3.0 mg (15.8% vs 6.4% at 68 weeks, difference of 9.4 percentage points). 5
Administration and Practical Considerations
Wegovy can be administered at any time of day, with or without meals. 2 This flexibility improves adherence compared to daily medications.
Missed Dose Management
- If <5 days since missed dose: Administer as soon as possible 2
- If >5 days since missed dose: Skip and resume with next scheduled dose 2
- If 2 consecutive doses missed: Resume at same dose if previously well-tolerated, or consider lowering dose 1, 2
- If ≥3 consecutive doses missed: Restart the full titration schedule 1, 2
Storage
Safety Profile and Adverse Effects
Gastrointestinal adverse effects are the most common side effects but are typically transient and mild-to-moderate in severity. 1, 3
- Nausea: 40% of patients (vs 14.8% placebo) 1
- Vomiting: 16% of patients (vs 4.3% placebo) 1
- Diarrhea and constipation are also common 1, 3
- 4.5% discontinue due to GI events (vs 0.8% placebo) 3
The gradual dose titration is specifically designed to minimize these effects. 1, 2
Critical Drug Interactions and Contraindications
Do not combine Wegovy with other GLP-1 receptor agonists or DPP-4 inhibitors. 1, 2
Absolute contraindications: 1
- Personal or family history of medullary thyroid cancer or MEN2 syndrome 1
- Pregnancy and breastfeeding 1
Use with caution when combining with insulin or sulfonylureas - dose adjustments of these medications are required to prevent hypoglycemia. 1, 2 Monitor patients closely for hypoglycemic episodes.
Exercise caution in patients with: 1
Renal Considerations
No dosage adjustment is required for patients with renal impairment, including end-stage renal disease. 2 However, severe renal impairment can result from dehydration secondary to vomiting, so monitor fluid status carefully. 1
Cardiovascular Benefits
Beyond weight loss, semaglutide 2.4 mg reduces cardiovascular events in patients with pre-existing CVD who are overweight or obese without diabetes (HR 0.80,95% CI 0.72-0.90 for cardiovascular death, MI, or stroke). 1 This represents a significant mortality benefit that extends beyond weight management alone.
Long-Term Use Considerations
Long-term continuous use is necessary to maintain weight loss. 1 After discontinuation:
- Mean weight regain of 11.6% of lost weight at 52 weeks post-cessation 1
- Mean weight regain of 6.9% when transitioned to placebo after 20 weeks of treatment 1
This underscores that Wegovy is a chronic disease medication requiring ongoing treatment, not a short-term intervention.