What is the recommended dosing schedule for Wegovy (semaglutide)?

Wegovy Dosing Schedule

Wegovy (semaglutide 2.4 mg) requires a gradual 5-step dose escalation over 16-20 weeks, starting at 0.25 mg subcutaneously once weekly for 4 weeks, then increasing every 4 weeks through 0.5 mg, 1.0 mg, and 1.7 mg, until reaching the maintenance dose of 2.4 mg once weekly. 1

Standard Titration Protocol

The dose escalation follows this specific schedule:

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

This gradual titration is essential—not optional—to minimize gastrointestinal adverse effects (nausea, vomiting, diarrhea, constipation), which are the most common side effects but typically transient and mild-to-moderate in severity. 1, 2

Managing Missed Doses

If less than 5 days since missed dose: Administer as soon as possible and continue regular weekly schedule. 1

If more than 5 days since missed dose: Skip the missed dose and resume at next scheduled time. 1

If 2 consecutive doses missed: Resume at the same dose if previously well-tolerated; otherwise consider lowering to the previous dose level. 1

If 3 or more consecutive doses missed: Restart the entire titration schedule from 0.25 mg weekly to minimize gastrointestinal side effects. 1, 3

Dose Optimization Considerations

Some patients achieve significant weight loss at submaximal doses (0.5 mg, 1.0 mg, or 1.7 mg weekly) and can continue long-term at these lower doses without progressing to 2.4 mg. 1 In clinical trials, mean weight loss at the 2.4 mg maintenance dose ranged from 14.9% to 17.4% at 68 weeks, with 69-79% of participants achieving ≥10% weight loss. 4

Administration Details

• Timing: Can be administered at any time of day, with or without meals 1
• Route: Subcutaneous injection once weekly 1
• Storage: Refrigerate at 36°F to 46°F (2°C to 8°C); may be kept at room temperature for up to 28 days 1

Critical Safety Considerations

Drug interactions requiring dose adjustments:

• When combining with insulin or insulin secretagogues (sulfonylureas), reduce the dose of these medications to minimize hypoglycemia risk 1
• Do not use with other GLP-1 receptor agonists or DPP-4 inhibitors 1

No dose adjustment required for:

• Renal impairment, including end-stage renal disease 1
• Hepatic impairment 3

Common Pitfall to Avoid

Never advance doses faster than the 4-week intervals. Accelerating the titration significantly increases gastrointestinal side effects and treatment discontinuation rates. 3 In the STEP 1 trial, 4.5% of patients discontinued due to gastrointestinal events with proper titration. 2