What is the recommended dose of Wegovy (semaglutide) for weight management in adults with obesity?

Wegovy (Semaglutide) Dosing for Weight Management

Wegovy should be initiated at 0.25 mg subcutaneously once weekly and titrated gradually over 16-20 weeks to the maintenance dose of 2.4 mg weekly, with each dose level maintained for 4 weeks before escalation. 1, 2

Standard Titration Schedule

The FDA-approved dosing protocol follows this specific escalation pattern 1:

• Weeks 1-4: 0.25 mg once weekly
• 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 (maintenance dose) once weekly

This gradual titration is critical—it minimizes gastrointestinal adverse effects, which are the most common reason for treatment discontinuation. 1, 2

Administration Details

• Administer subcutaneously at any time of day, with or without meals 1
• Injection sites include abdomen, thigh, or upper arm 1
• Must be combined with lifestyle interventions: 500-calorie daily deficit diet and 150 minutes of physical activity per week 1

Patient Eligibility Criteria

Wegovy is indicated for 1:

• BMI ≥30 kg/m², OR
• BMI ≥27 kg/m² with at least one weight-related comorbidity (hypertension, type 2 diabetes, dyslipidemia, obstructive sleep apnea, cardiovascular disease)

Expected Outcomes

At the 2.4 mg maintenance dose, patients achieve 1, 3, 4:

• Mean weight loss: 14.9-17.4% of total body weight at 68 weeks
• ≥5% weight loss: 86% of patients (vs. 32% placebo)
• ≥10% weight loss: 69% of patients (vs. 12% placebo)
• ≥15% weight loss: 51% of patients (vs. 5% placebo)

Clinically meaningful weight loss (≥5%) should be evident by 16 weeks on the maintenance dose—if not achieved, reassess treatment strategy. 2

Absolute Contraindications

Do not prescribe Wegovy in patients with 1, 2:

• Personal or family history of medullary thyroid carcinoma
• Multiple endocrine neoplasia syndrome type 2 (MEN2)
• Pregnancy or breastfeeding
• Previous serious hypersensitivity to semaglutide

Critical Safety Considerations

Gastrointestinal effects are the primary concern 1, 4:

• Nausea (44% vs. 17% placebo), diarrhea (32% vs. 16%), vomiting (25% vs. 7%), constipation (23% vs. 10%)
• Typically transient, mild-to-moderate, and subside with continued treatment
• 4.5% discontinue due to GI events (vs. 0.8% placebo)

Pancreatitis and gallbladder disease require monitoring 1, 2:

• Use with caution in patients with history of pancreatitis or cholelithiasis
• Monitor for severe abdominal pain, nausea, vomiting
• May cause cholelithiasis and gallstone-related complications

Delayed gastric emptying has perioperative implications 2:

• Discontinue 10-14 days before elective surgery
• Inform anesthesia team—increased aspiration risk requires modified intubation protocols

Renal Dosing

No dose adjustment required for any level of renal function, including end-stage kidney disease. 1 This distinguishes semaglutide from some other GLP-1 receptor agonists that require dose modification or are contraindicated in advanced chronic kidney disease.

Oral Contraceptive Interaction

Semaglutide delays gastric emptying and may reduce oral contraceptive effectiveness 1:

• Add barrier contraception method for 4 weeks after initiation
• Continue barrier method for 4 weeks after each dose escalation
• Consider switching to non-oral contraceptive methods

Cost Considerations

The average wholesale price is approximately $1,619 per month (National Average Drug Acquisition Cost: $1,296) 1. Insurance coverage varies significantly and represents a major barrier to access, particularly for vulnerable populations 1.

Monitoring Parameters

Assess at each visit 1, 2:

• Body weight and BMI
• Waist circumference
• Blood pressure and heart rate
• Gastrointestinal symptoms
• Signs/symptoms of pancreatitis (severe abdominal pain)
• Gallbladder symptoms (right upper quadrant pain, jaundice)
• If taking insulin or sulfonylureas: monitor for hypoglycemia and adjust doses accordingly

Common Pitfall to Avoid

Do not advance the dose too rapidly—the 4-week intervals at each dose level are evidence-based and critical for tolerability 1, 2. Patients who experience persistent nausea may benefit from remaining at the current dose for an additional 4 weeks before escalating, though this delays reaching the therapeutic 2.4 mg dose.