Wegovy Dosing for Weight Management
The recommended dose of Wegovy (semaglutide) for weight management is 2.4 mg administered subcutaneously once weekly, reached through a gradual titration schedule starting at 0.25 mg weekly and increasing every 4 weeks over 16 weeks. 1, 2
Standard Titration Schedule
The FDA-approved titration protocol requires the following dose escalation to minimize gastrointestinal side effects 1, 2:
- Weeks 1-4: 0.25 mg 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, 2
This gradual escalation is essential—not optional—as it significantly reduces the gastrointestinal adverse effects (nausea, vomiting, diarrhea) that occur in approximately 53% of patients but are typically mild-to-moderate and transient 1, 2.
Administration Details
Injection technique and timing: Wegovy can be administered at any time of day, with or without meals, via subcutaneous injection in the abdomen, thigh, or upper arm—all sites provide similar exposure 1. The once-weekly schedule provides convenience and steady-state concentrations are achieved after 4-5 weeks of administration 3.
Storage requirements: Store in refrigerator at 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
If a dose is missed: 1
- Less than 5 days since missed dose: Administer as soon as possible
- More than 5 days since missed dose: Skip the missed dose and resume at next scheduled dose
- 2 consecutive doses missed: Resume at the same dose if previously well-tolerated, or consider lowering the dose
- 3 or more consecutive doses missed: Consider restarting the entire titration schedule
Expected Weight Loss Outcomes
With the 2.4 mg maintenance dose, patients can expect 2, 4, 5:
- Mean weight loss: 14.9-17.4% from baseline at 68 weeks
- ≥5% weight loss: Achieved by 86% of patients
- ≥10% weight loss: Achieved by 69% of patients
- ≥15% weight loss: Achieved by 51% of patients
Real-world data from the WeGoTogether program shows even greater long-term results, with mean weight loss of 20.4% at 24 months 6.
Dose Adjustments and Special Considerations
No dose adjustment required for: 1, 3
- Renal impairment (including end-stage renal disease)
- Hepatic impairment
- Age, sex, race, or ethnicity
Some patients may respond to submaximal doses: If a patient achieves significant weight loss and tolerates a lower dose well (e.g., 1.0 mg or 1.7 mg weekly), they could continue at that dose long-term rather than escalating to 2.4 mg 1. However, the 2.4 mg dose provides maximum efficacy for both weight loss and cardiovascular risk reduction 2.
Concomitant Medication Adjustments
When initiating Wegovy, reduce or discontinue: 1
- Insulin: Reduce basal insulin by 20% to prevent hypoglycemia
- Sulfonylureas: Reduce dose by 50% or discontinue entirely
- Other GLP-1 receptor agonists or DPP-4 inhibitors: Must be discontinued—do not use simultaneously
Treatment Duration and Discontinuation Criteria
Wegovy must be used indefinitely to maintain weight loss benefits—discontinuation results in regain of one-half to two-thirds of lost weight within 1 year 1, 2.
Discontinue treatment if: 2
- Weight loss is less than 4-5% after 12-16 weeks at therapeutic dose
- Intolerable gastrointestinal symptoms persist despite dose adjustments
- Signs of pancreatitis (persistent severe abdominal pain) or gallbladder disease develop
- Patient becomes pregnant
Critical Safety Monitoring
Absolute contraindications: 1, 2
- Personal or family history of medullary thyroid carcinoma
- Multiple endocrine neoplasia syndrome type 2 (MEN2)
- Pregnancy and breastfeeding
Monitor at each visit: 2
- Weight and BMI
- Gastrointestinal tolerability (nausea, vomiting, diarrhea)
- Signs of pancreatitis or gallbladder disease
- Blood pressure (may decrease with weight loss, requiring antihypertensive adjustment)
- Heart rate (may increase modestly)
Follow-up schedule: Monthly assessment for the first 3 months during titration, then quarterly thereafter 2.
Common Pitfalls to Avoid
Do not rush titration: Advancing doses faster than every 4 weeks dramatically increases gastrointestinal side effects and treatment discontinuation 1, 2.
Do not use with other GLP-1 agonists: Combining Wegovy with medications like Ozempic, Trulicity, or Victoza is contraindicated due to overlapping mechanisms and potential harm 1.
Do not stop abruptly without counseling: Patients must understand that weight regain is nearly inevitable after discontinuation, and lifelong treatment is typically necessary 1, 2.