What are the dose instructions for Wegovy (semaglutide) for chronic weight management?

Wegovy Dosing Instructions for Chronic Weight Management

Wegovy (semaglutide 2.4 mg) must be initiated at 0.25 mg subcutaneously once weekly and titrated upward every 4 weeks through a fixed escalation schedule (0.25 mg → 0.5 mg → 1.0 mg → 1.7 mg → 2.4 mg maintenance dose) to minimize gastrointestinal side effects. 1

Standard Titration Schedule

The dose escalation follows this specific timeline 2, 1:

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

This gradual titration is essential—not optional—because gastrointestinal adverse effects (nausea, vomiting, diarrhea, constipation) are the most common side effects and occur in a dose-dependent manner 2, 1, 3.

Administration Practicalities

Timing and storage considerations 1:

• Administer at any time of day, with or without meals
• Store refrigerated at 36°F to 46°F (2°C to 8°C)
• May be kept at room temperature for up to 28 days if needed

Missed Dose Management

If a dose is missed 1:

• Less than 5 days since missed dose: Administer as soon as possible, then resume regular weekly schedule
• More than 5 days since missed dose: Skip the missed dose entirely and give next dose on regularly scheduled day

For multiple consecutive missed doses, clinical judgment is required 1:

• 2 consecutive doses missed: Consider resuming at the same dose if previously well-tolerated, or lower the dose one step
• 3 or more consecutive doses missed: Restart the entire titration schedule from 0.25 mg to avoid severe gastrointestinal reactions

Dose Optimization Considerations

Not all patients require the maximum 2.4 mg dose 1. Some patients achieve significant weight loss at submaximal doses (1.0 mg or 1.7 mg) and can continue long-term at that dose if they are losing ≥1 lb per week and tolerating the medication well. This individualized approach balances efficacy with tolerability.

Special Populations

Renal impairment: No dosage adjustment required, even in end-stage renal disease 1, 4. This is a significant practical advantage over many other medications.

Patients with type 2 diabetes: Wegovy is indicated for weight management in patients with BMI ≥30 kg/m² or BMI ≥27 kg/m² with weight-related comorbidities 4. When combining with insulin or sulfonylureas, dose reductions of these medications may be necessary due to hypoglycemia risk 1.

Critical Drug Interactions and Contraindications

Do not combine with 1:

• Other GLP-1 receptor agonists (including liraglutide, dulaglutide, exenatide)
• DPP-4 inhibitors (sitagliptin, saxagliptin, linagliptin)

Absolute contraindications 2:

• Personal or family history of medullary thyroid carcinoma
• Multiple endocrine neoplasia syndrome type 2 (MEN2)
• Pregnancy and breastfeeding

Use extreme caution or avoid in 2:

• History of pancreatitis (precaution, not absolute contraindication)
• Active gallbladder disease or cholelithiasis
• Severe gastroparesis or gastrointestinal disease

Monitoring Requirements

Monitor for 2:

• Signs/symptoms of pancreatitis (severe abdominal pain radiating to back)
• Acute gallbladder disease (right upper quadrant pain, especially after fatty meals)
• Suicidal ideation and behavior changes
• Hypoglycemia if on concurrent insulin or sulfonylureas

Efficacy Expectations and Discontinuation Criteria

Expected weight loss outcomes 2, 5, 6:

• Mean weight loss of 14.9-17.4% at 68 weeks in patients without diabetes
• 69-79% of patients achieve ≥10% weight loss
• 51-64% achieve ≥15% weight loss

Common pitfall: Unlike some other anti-obesity medications, there is no specific discontinuation threshold based on inadequate weight loss at a defined timepoint for semaglutide in the guidelines reviewed. However, clinical judgment should guide continuation—if patients show no meaningful response after reaching maintenance dose for 12-16 weeks, consider alternative therapies 2.

Oral Contraceptive Interaction

Critical for women of reproductive age 2: GLP-1 receptor agonists delay gastric emptying, which can decrease effectiveness of oral contraceptives. Add a barrier method for 4 weeks after initiation and after each dose increase.