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

Wegovy Dosing Regimen

Start Wegovy at 0.25 mg subcutaneously once weekly for 4 weeks, then increase the dose every 4 weeks (0.5 mg → 1.0 mg → 1.7 mg) until reaching the maintenance dose of 2.4 mg once weekly. 1

Standard Titration Schedule

The dose escalation follows a fixed 5-step protocol over 20 weeks:

• 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 with semaglutide. 1

Administration Guidelines

Timing and Flexibility:

• Administer once weekly on the same day each week 1
• Can be given at any time of day, with or without meals 1
• Inject subcutaneously in the abdomen, thigh, or upper arm 1

Missed Dose Management:

• If <5 days since missed dose: administer as soon as possible 1
• If ≥5 days since missed dose: skip and resume regular schedule 1
• If 2 consecutive doses missed: resume at same dose if previously well-tolerated, or consider lowering dose 1
• If ≥3 consecutive doses missed: restart the entire titration schedule 1

Clinical Efficacy at Maintenance Dose

The 2.4 mg maintenance dose demonstrated robust weight loss outcomes:

• Mean weight loss of 14.9%-17.4% from baseline at 68 weeks 2, 3
• 86.4% of participants achieved ≥5% weight loss (vs. 31.5% with placebo) 2
• 69.1% achieved ≥10% weight loss (vs. 12.0% with placebo) 2
• 50.5% achieved ≥15% weight loss (vs. 4.9% with placebo) 2

Dose Optimization Considerations

Submaximal Dosing: Some patients achieve significant clinical response at doses below 2.4 mg and may continue long-term at that lower dose. 1 This is particularly relevant for patients experiencing dose-limiting gastrointestinal side effects who have already achieved meaningful weight loss.

Safety Profile and Common Pitfalls

Gastrointestinal Effects:

• Nausea, vomiting, diarrhea, and constipation are most common 1
• Typically transient and mild-to-moderate in severity 1, 2
• Subside with time as patients acclimate to each dose 2
• 4.5% discontinued due to GI events in clinical trials 2

Critical Drug Interactions:

• Do not combine with other GLP-1 receptor agonists or DPP-4 inhibitors 1
• Use caution with insulin or insulin secretagogues; dose reductions of these medications may be needed to prevent hypoglycemia 1
• May delay gastric emptying and impact absorption of oral medications 4

Special Populations

Renal Impairment: No dosage adjustment required for any degree of renal impairment, including end-stage renal disease. 1

Storage Requirements:

• Refrigerate at 36°F to 46°F (2°C to 8°C) 1
• May be kept at room temperature for up to 28 days 1