What is the recommended dose escalation regimen for an adult patient with a Body Mass Index (BMI) of 30 or higher, or a BMI of 27 or higher with at least one weight-related condition, who is already taking Wegovy (semaglutide) and needs a dose increase to 2.4mg subcutaneous weekly?

Wegovy 2.4mg Prescription for Dose Escalation

You should prescribe Wegovy 2.4mg subcutaneous weekly for 6 weeks only if the patient has already completed the mandatory dose escalation schedule and is currently stable on the 2.4mg maintenance dose. 1

Critical Prescribing Requirement

Do not prescribe 2.4mg as an initial or escalating dose. The standard titration protocol mandates a fixed 4-week escalation schedule through lower doses before reaching 2.4mg to minimize gastrointestinal adverse events. 1

Mandatory Dose Escalation Schedule

The patient must have already completed this sequence before receiving 2.4mg: 2, 1

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

Prescription Details for Maintenance Therapy

If the patient has completed escalation and is stable on 2.4mg, prescribe: 1

• Medication: Wegovy (semaglutide) 2.4mg subcutaneous injection
• Dose: 2.4mg subcutaneously once weekly
• Duration: 6 weeks supply (6 pre-filled pens)
• Administration: Inject subcutaneously in abdomen, thigh, or upper arm on the same day each week, at any time of day, with or without meals 1
• Storage: Refrigerate at 36-46°F (2-8°C); may store at room temperature up to 28 days if needed 1

Monitoring Requirements During Treatment

Assess the following at each visit: 1

• Gastrointestinal symptoms (nausea, vomiting, diarrhea, constipation occur in majority of patients) 2
• Body weight (expect mean weight loss of 10.3-12.4% at 68 weeks) 2
• Signs of pancreatitis (severe abdominal pain radiating to back) 2, 1
• Acute gallbladder disease (right upper quadrant pain, especially if rapid weight loss) 2, 1
• Hypoglycemia if patient has type 2 diabetes on insulin or sulfonylureas 2

Concomitant Medication Adjustments

If the patient has type 2 diabetes: 3, 1

• Reduce insulin dose by 20% when initiating semaglutide to prevent hypoglycemia 3
• Consider discontinuing or reducing sulfonylurea doses due to hypoglycemia risk 3, 1
• Do not combine with other GLP-1 receptor agonists or DPP-4 inhibitors 3, 1

Absolute Contraindications to Verify

Do not prescribe if patient has: 1

• Personal or family history of medullary thyroid carcinoma
• Multiple endocrine neoplasia syndrome type 2 (MEN2)
• Pregnancy or breastfeeding
• History of severe hypersensitivity reaction to semaglutide

Critical Counseling Points

For women of reproductive age: Use barrier contraception for 4 weeks after each dose increase, as semaglutide decreases oral contraceptive effectiveness. 1

For missed doses: If less than 5 days have passed, administer as soon as possible and resume regular schedule; if more than 5 days have passed, skip the missed dose and give next dose on regularly scheduled day. 1

Treatment duration: This is lifelong therapy to maintain weight loss and cardiometabolic benefits; discontinuation results in significant weight regain. 3, 1

Expected Outcomes

At 2.4mg maintenance dose, patients typically achieve: 2, 4

• Mean weight loss of 17.6% at 12 months 4
• 43.3% of patients achieve ≥20% weight loss at 12 months 4
• Improvements in blood pressure, lipids, and glucose control 2