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 following a structured 5-step protocol to reach the maintenance dose of 2.4 mg weekly. 1

Standard Titration Protocol

The dose escalation follows this specific schedule over 16 weeks: 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 once weekly (maintenance dose)

This gradual titration is critical to minimize gastrointestinal side effects, which are the most common adverse events with semaglutide. 1, 2

Administration Guidelines

Injection technique and timing: 1

• Administer via subcutaneous injection once weekly
• Can be given at any time of day, with or without meals
• Must be taken on the same day each week for optimal adherence
• Injection sites include abdomen, thigh, or upper arm

Missed Dose Management

If one dose is missed: Resume at the next scheduled dose without adjustment. 1

If two consecutive doses are missed: Use clinical judgment based on the patient's prior tolerance to the medication—resuming at the same dose is reasonable if previously well-tolerated. 1

If three or more consecutive doses are missed: Consider restarting the entire titration schedule from 0.25 mg to minimize gastrointestinal adverse effects. 1

Critical Safety Contraindications

Absolute contraindications: 1, 2

• Personal or family history of medullary thyroid cancer
• Multiple endocrine neoplasia syndrome type 2 (MEN2)

Monitor closely for: 1, 2

• Signs of pancreatitis (persistent severe abdominal pain)
• Gallbladder disease symptoms (right upper quadrant pain, jaundice)
• Blood pressure changes (may require antihypertensive adjustment as weight decreases)

Important Drug Interactions

Do not combine with: 1

• Other GLP-1 receptor agonists
• Dipeptidyl peptidase-4 (DPP-4) inhibitors

Use caution when combining with: 1

• Insulin or insulin secretagogues (increased hypoglycemia risk—dose adjustment may be needed)

Clinical Context

Wegovy is indicated for chronic weight management in adults with BMI ≥30 kg/m² or BMI ≥27 kg/m² with at least one weight-related comorbidity (hypertension, dyslipidemia, type 2 diabetes, cardiovascular disease). 2 The medication must be used as an adjunct to reduced-calorie diet and increased physical activity, not as monotherapy. 2

Expected outcomes: Mean weight loss of 14.9% at 68 weeks in clinical trials, with 86.4% of patients achieving ≥5% weight loss and 50.5% achieving ≥15% weight loss. 3 Real-world data shows mean weight loss of 17.6% at 12 months and 20.4% at 24 months when combined with patient support programs. 4

Common pitfall: Patients often experience weight regain after discontinuation (11.6% of lost weight regained after 52 weeks), emphasizing the need for long-term or lifelong use. 2 Counsel patients upfront that this is a chronic medication, not a short-term intervention.