What is the recommended dose of semaglutide (Wegovy) for weight loss?

Recommended Dose for Wegovy (Semaglutide) for Weight Loss

Wegovy (semaglutide) for weight loss requires a gradual dose escalation over 16 weeks, starting at 0.25 mg weekly and reaching the maintenance dose of 2.4 mg weekly, administered as a once-weekly subcutaneous injection. 1, 2, 3

Standard Titration Schedule

The FDA-approved dosing regimen follows a specific escalation protocol to minimize gastrointestinal side effects 1, 2:

• Weeks 1-4: 0.25 mg subcutaneously once weekly 1, 2
• Weeks 5-8: 0.5 mg subcutaneously once weekly 1, 2
• Weeks 9-12: 1.0 mg subcutaneously once weekly 1, 2
• Weeks 13-16: 1.7 mg subcutaneously once weekly 1, 2
• Week 17 onward: 2.4 mg subcutaneously once weekly (maintenance dose) 1, 2

The maintenance dose of 2.4 mg once weekly should be continued indefinitely to maintain weight loss, as discontinuation results in significant weight regain (one-half to two-thirds of lost weight within 1 year). 1

Administration Details

• Inject subcutaneously in the abdomen, thigh, or upper arm—all sites provide similar drug exposure 3
• Administer at any time of day, without regard to meals 2
• If a dose is missed for 2 consecutive weeks, use clinical judgment; if 3 or more consecutive doses are missed, consider restarting the titration schedule 1

Dose Adjustments for Tolerability

If gastrointestinal side effects are severe at any dose level, maintain the current dose for an additional 4 weeks before attempting further escalation. 2 This slow titration is the most effective strategy to mitigate nausea (44% incidence), diarrhea (32%), vomiting (25%), and constipation (23%). 2

Patients unable to tolerate the 2.4 mg maintenance dose may remain on 1.7 mg weekly, though weight loss efficacy will be reduced. 1

Expected Weight Loss Outcomes

With the 2.4 mg maintenance dose 1, 4, 5, 6:

• Mean weight loss: 14.9-17.6% at 68 weeks
• ≥10% weight loss: Achieved by 64.9-70.9% of patients
• ≥15% weight loss: Achieved by 55.6% of patients
• ≥20% weight loss: Achieved by 38.5-50.5% of patients

Real-world data from 8,177 patients showed mean weight loss of 13.4% at 6 months, 17.6% at 12 months, and 20.4% at 24 months. 7

Mandatory Concomitant Interventions

Semaglutide must be combined with lifestyle modifications for FDA-approved use 1, 2:

• Caloric deficit: Minimum 500 kcal/day reduction below daily requirements 1, 2
• Physical activity: Minimum 150 minutes weekly of structured exercise 1, 2
• Resistance training: To preserve lean body mass during weight loss 1
• Behavioral counseling: Ongoing support for dietary and lifestyle changes 1

Monitoring Requirements

During dose escalation (weeks 1-16): 1, 2

• Assess weight and gastrointestinal symptoms every 4 weeks
• Monitor blood pressure (may decrease with weight loss, requiring antihypertensive adjustment)

After reaching maintenance dose: 1

• Evaluate weight, cardiovascular risk factors, and medication tolerance every 3 months minimum
• Assess treatment efficacy at 12-16 weeks on maximum tolerated dose
• Discontinue if weight loss is <5% after 12 weeks at therapeutic dose 2

Critical Safety Considerations

Absolute contraindications 1, 2:

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

Monitor for serious adverse events 1:

• Pancreatitis (persistent severe abdominal pain)
• Gallbladder disease (cholelithiasis, cholecystitis)
• Acute kidney injury from dehydration due to gastrointestinal effects

Common Pitfall to Avoid

Do not use lower-dose semaglutide formulations (Ozempic 0.5-1.0 mg) for weight management. Only Wegovy 2.4 mg is FDA-approved for obesity treatment and provides superior weight loss compared to lower doses. 1 Injectable semaglutide 1.0 mg achieves only 7.0% weight loss compared to 14.9-17.6% with the 2.4 mg dose. 1