Wegovy (Semaglutide 2.4 mg) Dosing and Administration
Wegovy is initiated at 0.25 mg subcutaneously once weekly and titrated upward every 4 weeks following a mandatory 5-step escalation schedule, reaching the maintenance dose of 2.4 mg weekly after 16-20 weeks. 1
Standard Titration Schedule
The FDA-approved dosing escalation must be followed to minimize gastrointestinal adverse effects 1:
- Weeks 1-4: 0.25 mg once weekly 2
- Weeks 5-8: 0.5 mg once weekly 2
- Weeks 9-12: 1.0 mg once weekly 2
- Weeks 13-16: 1.7 mg once weekly 2
- Week 17 onward: 2.4 mg once weekly (maintenance dose) 2
This gradual titration is not optional—it significantly reduces the incidence and severity of nausea, vomiting, and diarrhea that occur in 17-44% of patients. 2
Administration Instructions
Injection Technique
- Administer as a subcutaneous injection once weekly on the same day each week 1
- Injection sites include abdomen, thigh, or upper arm—all provide similar drug exposure 1
- Rotate injection sites with each dose to reduce injection site reactions 1
- Can be given at any time of day, with or without meals 1
Missed Dose Protocol
If a single dose is missed: Take the missed dose as soon as possible within 5 days of the scheduled dose, then resume the regular weekly schedule 1
If 2 consecutive doses are missed: Clinical judgment is required—if the patient tolerated the medication well, resuming at the same dose can be considered 2
If 3 or more consecutive doses are missed: Restart the entire titration schedule from 0.25 mg weekly to prevent severe gastrointestinal adverse effects 2
Patient Eligibility Criteria
Wegovy is FDA-approved for adults meeting these criteria 3, 4:
- BMI ≥30 kg/m² (obesity), OR
- BMI ≥27 kg/m² with at least one weight-related comorbidity including:
- Type 2 diabetes
- Hypertension
- Dyslipidemia
- Obstructive sleep apnea
- Cardiovascular disease
Mandatory Lifestyle Interventions
Wegovy must be prescribed as an adjunct to—not a replacement for—lifestyle modifications 3, 4:
- Caloric deficit: 500 kcal reduction below daily requirements 3
- Physical activity: Minimum 150 minutes per week 3
- Resistance training: To preserve lean body mass during weight loss 3
- Behavioral counseling: For sustainable lifestyle changes 3
Absolute Contraindications
Do not prescribe Wegovy in patients with 3, 2:
- Personal or family history of medullary thyroid cancer
- Multiple endocrine neoplasia syndrome type 2 (MEN2)
- Previous serious hypersensitivity reaction to semaglutide
Critical Drug Interactions
Do not combine with 2:
- Other GLP-1 receptor agonists (including Ozempic, Rybelsus, Victoza, Trulicity)
- DPP-4 inhibitors (sitagliptin, linagliptin, saxagliptin)
Use caution with 2:
- Insulin or insulin secretagogues (sulfonylureas)—reduce doses by 20% when initiating Wegovy to prevent hypoglycemia 2
Expected Weight Loss Outcomes
At 68 weeks, patients achieve mean weight loss of 14.9% (vs. 2.4% with placebo) 5:
- 86.4% of patients lose ≥5% body weight 5
- 69.1% of patients lose ≥10% body weight 5
- 50.5% of patients lose ≥15% body weight 5
Real-world data from 8,177 patients shows sustained weight loss extending to 24 months, with mean weight loss of 20.4% at 24 months 6.
Monitoring Schedule
During titration (first 16-20 weeks): Assess every 4 weeks for gastrointestinal tolerance, weight loss progress, and blood pressure 2
After reaching maintenance dose: Monitor at least every 3 months for 2:
- Weight and BMI
- Blood pressure (may require antihypertensive adjustment)
- Cardiovascular risk factors
- Signs of pancreatitis or gallbladder disease
- Medication adherence
Treatment Response Assessment
Evaluate efficacy at 12-16 weeks on the maximum tolerated dose 2:
- If weight loss <5% after 3 months: Discontinue Wegovy and consider alternative approaches 2
- If weight loss ≥5% after 3 months: Continue long-term therapy, as these patients typically achieve further weight loss 2
Common Adverse Effects and Management
Gastrointestinal effects occur in 82.2% of patients but are typically mild-to-moderate and transient 7:
- Nausea (most common): Peaks during dose escalation, subsides over time 5
- Diarrhea and vomiting: Usually resolve within weeks 5
- Constipation: May persist longer 5
Mitigation strategies 2:
- Follow the mandatory slow titration schedule
- Reduce meal size and eat slowly
- Limit alcohol and carbonated beverages
- Stay well-hydrated
Serious Adverse Events Requiring Monitoring
Pancreatitis: Monitor for persistent severe abdominal pain radiating to the back 3
Gallbladder disease: Watch for right upper quadrant pain, especially after fatty meals 3
Acute kidney injury: Can occur secondary to severe dehydration from gastrointestinal effects 2
Perioperative Management
For elective surgery requiring anesthesia, discontinue Wegovy at least 3 weeks (three half-lives) before the procedure 2. Semaglutide causes delayed gastric emptying that persists even after extended fasting, creating aspiration risk—24.2% of semaglutide users show retained gastric contents versus 5.1% of controls despite 10-14 day discontinuation and 12-hour fasting 2.
Long-Term Treatment Considerations
Wegovy requires lifelong use to maintain weight loss—discontinuation results in regain of 50-67% of lost weight within 1 year 2. After 52 weeks off medication, patients regain an average of 11.6% of their lost weight 2.
Cost: Average wholesale price is approximately $1,557-$1,600 per 30-day supply 2. Insurance authorization can be challenging, particularly for obesity management without diabetes 2.