What are the dosing guidelines for Wegovy (semaglutide)?

Wegovy Dosing Guidelines

Wegovy (semaglutide) should be initiated at 0.25 mg subcutaneously once weekly for 4 weeks, then escalated every 4 weeks through 0.5 mg, 1.0 mg, and 1.7 mg doses until reaching the maintenance dose of 2.4 mg once weekly at week 16. 1, 2

Standard Titration Schedule

The dose escalation follows this specific timeline to minimize gastrointestinal side effects 1, 2:

• Weeks 1-4: 0.25 mg once weekly 1, 2
• Weeks 5-8: 0.5 mg once weekly 1, 2
• Weeks 9-12: 1.0 mg once weekly 1, 2
• Weeks 13-16: 1.7 mg once weekly 1, 2
• Week 17 onward: 2.4 mg once weekly (maintenance dose) 1, 2

Administration Details

• Timing: Administer on the same day each week at any time of day, with or without meals 2
• Route: Subcutaneous injection 1, 2
• Storage: Refrigerate at 36°F to 46°F (2°C to 8°C); may be kept at room temperature for up to 28 days 2

Managing Missed Doses

If less than 5 days since missed dose: Administer as soon as possible 2

If more than 5 days since missed dose: Skip the missed dose and resume with next scheduled dose 2

If 2 consecutive doses missed: Resume at the same dose if previously well-tolerated, or consider lowering the dose based on clinical judgment 1, 2

If 3 or more consecutive doses missed: Restart the entire titration schedule from 0.25 mg 1, 2

Dose Optimization Considerations

Some patients achieve significant weight loss at submaximal doses (below 2.4 mg) and may continue long-term at that lower dose rather than escalating further 1, 2. This is particularly relevant if patients experience dose-limiting gastrointestinal side effects but are responding well to treatment.

Critical Safety Precautions

Contraindications and warnings:

• Do not use with other GLP-1 receptor agonists or DPP-4 inhibitors 1, 2
• Contraindicated in patients with personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2 1

Drug interactions requiring dose adjustment:

• When used with insulin or insulin secretagogues (sulfonylureas), reduce doses of these medications and monitor for hypoglycemia 1, 2
• May delay gastric emptying and affect absorption of oral medications requiring rapid onset 1

Common adverse effects:

• Gastrointestinal symptoms (nausea, vomiting, diarrhea, constipation) are most common but typically transient and mild-to-moderate 1, 3
• These effects are minimized by the gradual titration schedule 1, 2

Special Populations

No dose adjustment required for:

• Renal impairment, including end-stage renal disease 2
• Hepatic impairment 2

Clinical Efficacy Context

The 2.4 mg maintenance dose achieved mean weight loss of 14.9-17.4% at 68 weeks in clinical trials, with 69-79% of patients achieving ≥10% weight loss 3, 4. Real-world data shows sustained weight loss of approximately 20% at 18-24 months 5.