Wegovy Starting Dose
Start Wegovy at 0.25 mg subcutaneously once weekly for the first 4 weeks, then escalate 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
Dose Titration Schedule
The FDA-approved dosing regimen follows a structured 16-week titration:
- 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 maintenance dose once weekly 1
This gradual escalation is essential to minimize gastrointestinal adverse effects (nausea, vomiting, diarrhea, constipation), which are the most common side effects but typically transient and mild-to-moderate in severity. 1
Administration Details
- Timing: Administer at any time of day, with or without meals 1
- Route: Subcutaneous injection 2, 1
- Frequency: Once weekly 1
Missed Dose Management
- Less than 5 days since missed dose: Administer as soon as possible 1
- More than 5 days since missed dose: Skip the missed dose and resume at next scheduled time 1
- 2 consecutive doses missed: Resume at the same dose if previously well-tolerated, or consider lowering the dose 1
- 3 or more consecutive doses missed: Consider restarting the entire titration schedule 1
Special Populations
No dosage adjustment required for renal impairment, including patients with end-stage renal disease. 2, 1 This is a significant advantage over some other weight management medications.
Clinical Pearls
Some patients achieve significant weight loss at submaximal doses (e.g., 1.0 mg or 1.7 mg) and may continue at that dose long-term rather than escalating to 2.4 mg. 1 The STEP trials demonstrated mean weight losses of 14.9%-17.4% at the 2.4 mg maintenance dose, with 69%-79% of participants achieving ≥10% weight loss. 3