What is the starting dose of Wegovy (semaglutide)?

Wegovy Starting Dose

The starting dose of Wegovy (semaglutide) is 0.25 mg subcutaneously once weekly for the first 4 weeks. 1

Dose Titration Schedule

After the initial 4-week period at 0.25 mg, Wegovy requires a structured escalation protocol to reach the therapeutic maintenance dose:

• 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 associated with semaglutide therapy. 1

Administration Details

Timing and flexibility:

• Administer once weekly on the same day each week 2
• Can be given at any time of day, with or without meals 1
• Inject subcutaneously in the abdomen, thigh, or upper arm 3

Missed dose management:

• If less than 5 days since the missed dose: administer as soon as possible 1
• If more than 5 days have passed: skip the missed dose and resume the regular schedule 1
• If 2 consecutive doses are missed: consider resuming at the same dose if previously well-tolerated, or lower the dose 1
• If 3 or more consecutive doses are missed: restart the titration schedule from 0.25 mg 1

Clinical Considerations for Dose Adjustments

Individualized dosing:

• Some patients achieve significant weight loss at submaximal doses (0.5 mg, 1.0 mg, or 1.7 mg) and may continue long-term at these lower doses rather than escalating to 2.4 mg 1
• The maintenance dose of 2.4 mg demonstrated mean weight loss of 14.9% at 68 weeks in clinical trials 3

No dose adjustments required for:

• Renal impairment, including end-stage renal disease 1, 2
• Hepatic impairment 1, 2
• Age or gender 4

Key Safety Warnings

Gastrointestinal effects:

• Nausea, vomiting, diarrhea, and constipation are the most common adverse events 1, 3
• These symptoms are typically transient and mild-to-moderate in severity 3
• Gradual dose titration minimizes these effects 1
• In clinical trials, 4.5% of patients discontinued due to gastrointestinal events 3

Drug interactions:

• Do not use with other GLP-1 receptor agonists or DPP-4 inhibitors 1
• Use caution when combining with insulin or insulin secretagogues (sulfonylureas) due to hypoglycemia risk; dose reductions of these medications may be necessary 1
• Semaglutide delays gastric emptying and may impact absorption of oral medications 4

Contraindications:

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

Storage Requirements

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