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

Wegovy Dosing Regimen

Start Wegovy at 0.25 mg subcutaneously once weekly and titrate upward every 4 weeks through a fixed escalation schedule (0.25 mg → 0.5 mg → 1.0 mg → 1.7 mg) until reaching the maintenance dose of 2.4 mg once weekly, which is typically achieved after 16-20 weeks. 1

Standard Titration Schedule

The dose escalation follows this specific timeline to minimize gastrointestinal side effects 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 not optional—it is essential to allow gastrointestinal tolerance to develop and minimize nausea, vomiting, diarrhea, and constipation, which are the most common adverse effects 1. The 2.4 mg maintenance dose has demonstrated mean weight loss of 14.9-17.4% at 68 weeks in clinical trials 2, 3, with real-world data showing sustained weight loss of approximately 20% at 18-24 months 4.

Practical Administration Details

Timing and storage considerations 1:

• Administer on the same day each week, but can be given at any time of day, with or without meals 1
• Store in refrigerator at 36°F to 46°F (2°C to 8°C); may be kept at room temperature for up to 28 days 1
• Inject subcutaneously in the abdomen, thigh, or upper arm 1

Managing Missed Doses

If a dose is missed 1:

• Less than 5 days since missed dose: Administer as soon as possible and continue regular schedule 1
• More than 5 days since missed dose: Skip the missed dose and resume at next scheduled time 1
• 2 consecutive doses missed: Use clinical judgment—resume at same dose if previously well-tolerated, or consider lowering the dose 1
• 3 or more consecutive doses missed: Restart the entire titration schedule from 0.25 mg to prevent severe gastrointestinal symptoms 1

Dose Optimization Considerations

Not all patients require the full 2.4 mg dose. Some patients achieve significant weight loss at submaximal doses (0.5 mg, 1.0 mg, or 1.7 mg) and can continue at that dose long-term rather than escalating further 1. This is a clinically appropriate strategy if the patient is meeting weight loss goals and tolerating the medication well.

Drug Interactions and Safety Monitoring

Critical contraindications and precautions 1, 5:

• Never combine with other GLP-1 receptor agonists or DPP-4 inhibitors 1
• Use caution when combining with insulin or insulin secretagogues (sulfonylureas)—dose reductions of these medications may be needed due to hypoglycemia risk 1
• Contraindicated in patients with personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2 5
• Monitor for cholelithiasis and gallstone-related complications 5

Special Populations

No dose adjustments are required for renal impairment (including end-stage renal disease) or hepatic impairment 1. This makes Wegovy accessible to patients with these comorbidities without complex dosing calculations.

Common Pitfalls to Avoid

• Do not skip the titration schedule—jumping directly to higher doses dramatically increases gastrointestinal adverse events and treatment discontinuation 1
• Do not restart at 2.4 mg after missing 3+ doses—this will likely cause severe nausea and vomiting requiring dose reduction or discontinuation 1
• Consider perioperative management—stop semaglutide before surgery due to delayed gastric emptying and aspiration risk 1
• Counsel patients upfront that gastrointestinal symptoms are common but typically transient and mild-to-moderate, subsiding over time 1, 3