Wegovy Dosing for Chronic Weight Management
Wegovy (semaglutide) is administered as a subcutaneous injection starting at 0.25 mg once weekly, with dose escalation every 4 weeks through 0.5 mg, 1.0 mg, and 1.7 mg, to reach the maintenance dose of 2.4 mg once weekly. 1
Dose Titration Schedule
The American College of Cardiology recommends the following escalation protocol 1:
- Week 1-4: 0.25 mg subcutaneously once weekly
- Week 5-8: 0.5 mg once weekly
- Week 9-12: 1.0 mg once weekly
- Week 13-16: 1.7 mg once weekly
- Week 17 onward: 2.4 mg once weekly (maintenance dose)
This gradual titration is essential to minimize gastrointestinal side effects, which occur in the majority of patients but are typically transient and dose-dependent. 2, 1
Administration Instructions
- Administer subcutaneously in the abdomen, thigh, or upper arm at any time of day, without regard to meals 1, 3
- Injection site rotation achieves similar drug exposure across all three sites 3
- Steady-state concentrations are reached after 4-5 weeks of once-weekly administration 3
Mandatory Concomitant Interventions
Wegovy must be combined with lifestyle modifications—this is not optional. The American Gastroenterological Association requires 1:
- Minimum caloric deficit of 500 kcal/day below total energy requirements
- Minimum 150 minutes weekly of structured physical activity
- Ongoing behavioral counseling for dietary changes
Monitoring Schedule
During dose titration 1:
- Body weight: Every 4 weeks
- Gastrointestinal symptoms: At each visit; if severe, maintain current dose longer before escalating
- Renal function: Especially with severe GI symptoms that could cause dehydration 2
- Signs of gallbladder disease: Periodic assessment 2
After reaching maintenance dose 2:
- Assess efficacy and safety at least monthly for first 3 months
- Then at least quarterly thereafter
Treatment Response Evaluation
After 12 weeks at the 2.4 mg maintenance dose, evaluate weight loss. 1 Consider stopping therapy if weight loss is less than 5% of initial body weight, though the American Diabetes Association recommends intensifying treatment rather than discontinuing if adequate weight loss is not achieved. 1
Common Pitfalls and Management
Gastrointestinal side effects are the primary reason for treatment discontinuation. 2 To mitigate these 2:
- Reduce meal size to manage nausea and vomiting
- Limit alcohol and carbonated drinks to reduce reflux symptoms
- Avoid high-fat diets to help with constipation
- If GI symptoms are severe, maintain the current dose for additional weeks before escalating
If 2 or more consecutive doses are missed: Resume at the same dose if previously well-tolerated. 2
If 3 or more consecutive doses are missed: Restart the entire titration schedule from 0.25 mg. 2
Special Considerations for Your Patient
Given no history of pancreatitis, thyroid cancer, or kidney disease, this patient has no absolute contraindications to Wegovy. 2 However, monitor closely for:
- Acute kidney injury risk: Particularly if severe GI side effects cause dehydration 2
- Gallbladder disease: Increased risk of cholelithiasis and cholecystitis with rapid weight loss 2
- Hypoglycemia: Only if patient is on insulin or sulfonylureas (requires dose reduction of these agents) 2
Duration of Therapy
Wegovy should be considered lifelong therapy to maintain weight loss. 1 Discontinuation results in significant weight regain and worsening of cardiometabolic risk factors. 1 The medication remains in circulation for approximately 5 weeks after the last dose due to its one-week elimination half-life. 3
Additional Benefits Beyond Weight Loss
Wegovy provides weight-independent cardiovascular benefits, including improvements in blood pressure, atherogenic lipids, inflammation, and obstructive sleep apnea. 1 In patients with obesity and established cardiovascular disease, it reduces major adverse cardiovascular events. 1