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

Wegovy Dosing Schedule

Wegovy (semaglutide 2.4 mg) should be initiated at 0.25 mg once weekly subcutaneously and titrated monthly over 16 weeks to reach the maintenance dose of 2.4 mg weekly. 1

Standard Titration Schedule

The recommended dose escalation follows a structured 5-step protocol over 16 weeks 1:

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

This gradual titration is essential to minimize gastrointestinal adverse effects, which are the most common side effects (nausea, vomiting, diarrhea) and typically mild-to-moderate in severity 2, 3.

Administration Details

• Route: Subcutaneous injection once weekly 4
• Timing: Can be administered at any time of day, with or without meals 4
• Consistency: The same day each week should be maintained for optimal adherence 1

Missed Dose Management

If doses are missed, specific protocols apply 1:

• 1 missed dose: Resume at the next scheduled dose
• 2 consecutive missed doses: Use clinical judgment; if the patient tolerated the medication well, resume at the same dose 1
• 3 or more consecutive missed doses: Consider restarting the entire titration schedule from 0.25 mg 1

Expected Weight Loss Outcomes

The 2.4 mg maintenance dose produces substantial weight reduction 2, 5:

• At 6 months: Mean weight loss of 13.4% 5
• At 12 months: Mean weight loss of 17.6% 5
• At 24 months: Mean weight loss of 20.4% 5
• 68 weeks (STEP 1 trial): Mean weight loss of 14.9% versus 2.4% with placebo 2

Approximately 86.4% of patients achieve ≥5% weight loss, 69.1% achieve ≥10% weight loss, and 50.5% achieve ≥15% weight loss at 68 weeks 2.

Critical Safety Considerations

Contraindications 1, 2:

• Personal or family history of medullary thyroid cancer
• Multiple endocrine neoplasia syndrome type 2

Monitoring requirements 1:

• Signs of pancreatitis (persistent severe abdominal pain)
• Gallbladder disease symptoms (cholelithiasis, cholecystitis)
• Blood pressure (may require antihypertensive adjustment as weight decreases)

Common adverse effects 2, 3:

• Gastrointestinal symptoms occur in the majority of patients but are typically transient and decrease over time
• Treatment discontinuation due to GI events occurs in approximately 4.5% of patients 2

Combination with Lifestyle Intervention

Wegovy must be used as an adjunct to 2, 6:

• Reduced-calorie diet
• Increased physical activity
• Behavioral intervention

The medication is not effective as monotherapy without lifestyle modifications and may require lifelong use, as significant weight regain (11.6% of lost weight) occurs after cessation 1.

Drug Interactions

Avoid concurrent use with 1:

• Other GLP-1 receptor agonists
• Dipeptidyl peptidase-4 inhibitors

Use caution with 1:

• Insulin or insulin secretagogues (increased hypoglycemia risk, though minimal when used alone)

Renal Dosing

No dosage adjustments are required for renal impairment 4, making Wegovy suitable for patients across the spectrum of kidney function.