What is the recommended dosing schedule for Wegovy (semaglutide)?

Wegovy Dosing Schedule

Wegovy (semaglutide 2.4 mg) requires a gradual dose escalation starting at 0.25 mg subcutaneously once weekly for 4 weeks, then increasing every 4 weeks through 0.5 mg, 1.0 mg, and 1.7 mg, until reaching the maintenance dose of 2.4 mg once weekly at week 17. 1

Standard Titration Protocol

The dose escalation follows this specific schedule 1:

• 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)

This 16-week titration period allows gastrointestinal tolerance to develop and minimizes adverse effects, which are the most common side effects of treatment. 1

Administration Guidelines

• Administer once weekly on the same day each week, at any time of day, with or without meals 1, 2
• If a dose is missed and less than 5 days have passed, administer as soon as possible; if more than 5 days have passed, skip the missed dose and resume the regular schedule 1
• Store in refrigerator (36°F to 46°F/2°C to 8°C); may be kept at room temperature for up to 28 days 1

Managing Missed Doses

Critical pitfall: The approach differs based on how many consecutive doses are missed 1:

• 2 consecutive doses missed: Use clinical judgment—if the patient tolerated the medication well previously, consider resuming at the same dose rather than lowering it 1
• 3 or more consecutive doses missed: Restart the titration schedule from the beginning to minimize gastrointestinal adverse effects 1

Dose Flexibility Considerations

Some patients achieve significant weight loss at submaximal doses (less than 2.4 mg) and can continue at that lower dose long-term rather than escalating to the full maintenance dose. 1 This is particularly relevant for patients experiencing adequate response with better tolerability at intermediate doses.

Special Population Considerations

• Renal impairment: No dosage adjustment required, including patients with end-stage renal disease 1, 2
• Hepatic impairment: Use with caution in severe hepatic impairment due to limited experience, though no specific dose adjustment is recommended 3
• Elderly patients: No specific dose adjustment based on age 3

Safety Monitoring and Drug Interactions

Do not combine Wegovy with: 1

• Other GLP-1 receptor agonists
• DPP-4 inhibitors

Use caution when combining with: 1

• Insulin or insulin secretagogues (sulfonylureas)—monitor closely for hypoglycemia and adjust doses of these medications as needed
• Oral medications requiring rapid onset—Wegovy delays gastric emptying and may impact absorption

Common Adverse Effects

Gastrointestinal symptoms (nausea, vomiting, diarrhea, constipation) are the most common adverse effects but are typically transient and mild-to-moderate in severity. 1, 4 These effects subside with time and are minimized by the gradual dose titration schedule.

Contraindications

Wegovy is contraindicated in patients with 2, 5:

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

Expected Outcomes

In clinical trials, patients achieved mean weight loss of 14.9-17.4% at 68 weeks with the 2.4 mg maintenance dose, with 69-79% of participants achieving ≥10% weight loss and 51-64% achieving ≥15% weight loss. 6 Real-world data shows sustained weight loss of approximately 20% at 18-24 months. 7