Wegovy Maintenance Dosage
The maintenance dose of Wegovy (semaglutide) is 2.4 mg administered subcutaneously once weekly, reached after a 16-week dose escalation protocol. 1, 2, 3
Standard Dose Escalation to Maintenance
The FDA-approved titration schedule follows this specific pathway to minimize gastrointestinal side effects 3:
- Weeks 1-4: 0.25 mg once weekly
- Weeks 5-8: 0.5 mg once weekly
- Weeks 9-12: 1.0 mg once weekly
- Weeks 13-16: 1.7 mg once weekly
- Week 17 onward: 2.4 mg once weekly (maintenance dose) 1, 2, 3
Each dose level must be maintained for at least 4 weeks before advancing to allow gastrointestinal tolerance to develop. 1, 3
Alternative Maintenance Dosing Strategy
Some patients achieve adequate weight loss at submaximal doses (0.5 mg, 1.0 mg, or 1.7 mg) and can remain at that lower dose long-term rather than escalating to 2.4 mg. 1, 2, 3 This decision depends on the patient's therapeutic response and tolerability—if significant weight loss is occurring and side effects are minimal at a lower dose, continuing that dose is acceptable. 1, 3
Managing Missed Doses at Maintenance
The approach differs based on how many consecutive doses are missed 1, 2, 3:
- Less than 5 days since missed dose: Administer as soon as possible and continue regular schedule 2
- More than 5 days since missed dose: Skip the missed dose and resume at next scheduled time 2
- 2 or fewer consecutive doses missed: Resume at the same maintenance dose if previously well-tolerated, or consider lowering one dose level if tolerance was marginal 1, 2, 3
- 3 or more consecutive doses missed: Restart the entire titration schedule from 0.25 mg to minimize gastrointestinal adverse effects 1, 2, 3
Critical Safety Considerations at Maintenance Dose
Do not combine Wegovy with other GLP-1 receptor agonists or DPP-4 inhibitors. 1, 2 This combination provides no additional benefit and increases adverse effect risk. 1
When using Wegovy with insulin or sulfonylureas, monitor closely for hypoglycemia and reduce doses of these medications as clinically indicated, as GLP-1 receptor agonists enhance glucose-dependent insulin secretion. 1, 4
Wegovy delays gastric emptying, which may impact absorption of oral medications requiring rapid onset of action—counsel patients accordingly and consider timing adjustments for critical medications. 1, 4
Renal and Hepatic Dosing
No dosage adjustment is required for renal impairment, including end-stage renal disease. 2 Similarly, no adjustment is needed for hepatic impairment, though limited data exists for severe hepatic dysfunction. 2
Long-Term Treatment Expectations
Semaglutide should be considered lifelong therapy to maintain weight loss. 3 Discontinuation results in significant weight regain, with clinical trial participants regaining most of their lost weight after stopping the medication. 3 The maintenance dose of 2.4 mg weekly must be combined with lifestyle modifications including a caloric deficit of at least 500 kcal/day and minimum 150 minutes weekly of structured exercise. 3
Administration Practicalities
Wegovy can be administered at any time of day, with or without meals, providing flexibility for patient adherence. 2 Store in refrigerator (36°F to 46°F), though it may be kept at room temperature for up to 28 days. 2