Wegovy Dosing for Weight Loss
Standard Titration Schedule
Wegovy (semaglutide 2.4 mg) requires a gradual 16-week titration schedule to minimize gastrointestinal side effects, starting at 0.25 mg weekly and increasing every 4 weeks until reaching the maintenance dose of 2.4 mg weekly. 1
The specific dosing progression is:
- Weeks 1-4: 0.25 mg subcutaneously once weekly 1
- Weeks 5-8: 0.5 mg once weekly 1
- Weeks 9-12: 1.0 mg once weekly 1
- Weeks 13-16: 1.7 mg once weekly 1
- Week 17 onward: 2.4 mg once weekly (maintenance dose) 1
Patient Eligibility Criteria
You can prescribe Wegovy for adults meeting these BMI thresholds:
- BMI ≥30 kg/m² (obesity) without additional requirements 1, 2
- BMI ≥27 kg/m² with at least one weight-related comorbidity such as hypertension, dyslipidemia, type 2 diabetes, or cardiovascular disease 1, 2
Administration Details
Administer as a subcutaneous injection once weekly in the abdomen, thigh, or upper arm, with similar exposure achieved regardless of injection site 3. The injection can be given on any day of the week, with or without meals 3.
Expected Weight Loss Outcomes
Patients achieve substantial weight loss with the full 2.4 mg dose:
- Mean weight loss of 14.9% at 68 weeks 4, 5
- 86.4% of patients achieve ≥5% weight loss (versus 31.5% with placebo) 5
- 69.1% achieve ≥10% weight loss (versus 12.0% with placebo) 5
- 50.5% achieve ≥15% weight loss (versus 4.9% with placebo) 5
Real-world data shows mean weight loss of -14.6 kg (-14.1%) after 1 year in patients without diabetes 6.
Mandatory Lifestyle Interventions
Wegovy must be combined with lifestyle modifications—this is not optional. 1 Specifically require:
- 500-kcal reduction below daily caloric requirements 1
- Minimum 150 minutes per week of physical activity 1
- Resistance training to preserve lean body mass during weight loss 1
Absolute Contraindications
Never prescribe Wegovy if the patient has:
- Personal or family history of medullary thyroid cancer 1, 3
- Multiple endocrine neoplasia syndrome type 2 (MEN2) 1, 3
- History of severe hypersensitivity reaction to semaglutide 3
Monitoring Schedule
During titration (first 16 weeks): Assess every 4 weeks for gastrointestinal tolerance, weight loss progress, and blood pressure 1
After reaching maintenance dose: Monitor at least every 3 months for weight stability, cardiovascular risk factors, medication adherence, and adverse effects 1
Critical decision point at 12-16 weeks: Evaluate treatment response on maximum tolerated dose. Discontinue if weight loss is <5% after 3 months, as continued use is unlikely to provide meaningful benefit 1
Managing Missed Doses
If a patient misses 1 dose: Take as soon as remembered if within 5 days; if more than 5 days have passed, skip the missed dose and resume the regular schedule 1
If 2 consecutive doses are missed: Use clinical judgment—resuming at the same dose can be considered if the patient tolerated it well 7
If 3 or more consecutive doses are missed: Consider restarting the titration schedule from 0.25 mg to minimize gastrointestinal side effects 7
Common Adverse Effects and Management
Gastrointestinal effects occur in the majority of patients but are typically mild-to-moderate and transient 4, 5:
Mitigation strategies:
- The gradual 4-week titration schedule minimizes these effects 1
- Advise patients to reduce meal size, limit alcohol and carbonated beverages 7
- Reassure patients these symptoms typically decrease over time 7
Serious adverse events requiring monitoring:
- Pancreatitis: Monitor for persistent severe abdominal pain; discontinue if suspected 1
- Gallbladder disease: Watch for symptoms of cholelithiasis or cholecystitis 1
- Acute kidney injury: Monitor renal function, especially in patients with dehydration from gastrointestinal effects 1
Perioperative Management
Discontinue Wegovy at least 3 weeks (three half-lives) before elective surgery requiring anesthesia due to delayed gastric emptying and aspiration risk 1. This applies even with extended fasting periods, as retained gastric contents are documented in 24.2% of semaglutide users despite 10-14 day discontinuation and 12-hour fasting 7.
Drug Interactions
Do not combine with:
Use caution with:
- Insulin or insulin secretagogues (sulfonylureas): Reduce doses by approximately 20% to prevent hypoglycemia 7
No dose adjustment needed for:
- Metformin, oral contraceptives, warfarin, digoxin, or atorvastatin—semaglutide does not significantly affect their absorption 3
Renal and Hepatic Considerations
No dose adjustment required for any degree of renal impairment, including end-stage renal disease, or hepatic impairment 3. This makes Wegovy particularly valuable for patients with chronic kidney disease 3.
Long-Term Treatment Expectations
Wegovy requires lifelong use to maintain weight loss. 1 Discontinuation results in regain of 50-67% of lost weight within 1 year 1. Counsel patients upfront that this is a chronic disease requiring ongoing treatment, not a short-term intervention 7.
Cost Considerations
The average wholesale price is approximately $1,557-$1,619 per 30-day supply 7. Insurance authorization may be challenging, particularly for obesity management without diabetes 7. Document failed lifestyle modifications and weight-related comorbidities to support prior authorization requests 7.
Critical Pitfalls to Avoid
Do not:
- Advance doses faster than the 4-week schedule—this dramatically increases gastrointestinal side effects 1
- Continue treatment beyond 3-4 months if weight loss is <5%—early non-responders are unlikely to benefit 1
- Prescribe for patients under BMI thresholds or without documented lifestyle intervention attempts 1
- Ignore perioperative aspiration risk—always discontinue 3 weeks before elective surgery 1
- Fail to counsel about lifelong treatment necessity and weight regain upon discontinuation 1