What are the considerations and potential side effects for a patient with a history of weight loss issues, currently on a reduced-calorie diet and increased physical activity, when increasing their dose of Wegovy (semaglutide) from 1.7 mg weekly to 2.4 mg weekly?

Increasing Wegovy from 1.7 mg to 2.4 mg Weekly: Patient Information

You should continue your dose escalation to the full 2.4 mg weekly dose to maximize your weight loss results and cardiovascular benefits. 1, 2

What to Expect When Increasing Your Dose

Timing and Administration

• Take your next injection exactly one week after your last 1.7 mg dose, using the 2.4 mg pen 1
• Inject at any time of day, with or without meals, in your abdomen, thigh, or upper arm 1
• Store your pen in the refrigerator at 36°F to 46°F (2°C to 8°C), or at room temperature for up to 28 days if needed 1

Expected Weight Loss Results

• At the 2.4 mg maintenance dose, you can expect approximately 14.9-17.4% total body weight loss over 68 weeks of treatment 2, 3
• Real-world data shows patients achieve mean weight loss of 17.6% at 12 months and 20.4% at 24 months when staying on treatment 3
• About 51-65% of patients achieve at least 15% weight loss, and 33-50% achieve at least 20% weight loss at this dose 2, 3, 4

Side Effects to Watch For

Common Gastrointestinal Effects (Usually Temporary)

The most common side effects when increasing to 2.4 mg are digestive symptoms that typically improve over time 5, 2:

• Nausea (occurs in 18-44% of patients) 5, 6
• Diarrhea (occurs in 12-32% of patients) 5, 6
• Vomiting (occurs in 8-25% of patients) 5, 6
• Constipation (occurs in 10-23% of patients) 5, 6
• Abdominal discomfort, bloating, or feeling full quickly 5

These symptoms are usually mild-to-moderate and decrease significantly after the first few weeks at the new dose 5, 2

Tips to Minimize Side Effects

• Eat smaller, more frequent meals rather than large portions 1
• Increase fiber intake gradually 5
• Avoid alcohol, carbonated beverages, and high-fat foods 1
• Stay well-hydrated throughout the day 5

Serious Side Effects Requiring Immediate Medical Attention

Call your doctor immediately if you experience: 5, 2

• Persistent severe abdominal pain that may radiate to your back (possible pancreatitis) 5, 2
• Severe nausea and vomiting that prevents you from keeping down fluids (risk of dehydration and kidney problems) 5
• Upper right abdominal pain, especially with fever, yellowing of skin/eyes, or clay-colored stools (possible gallbladder disease) 5, 2
• Rapid heartbeat or palpitations 5
• Changes in vision or eye pain 5
• Signs of allergic reaction including severe rash, itching, difficulty breathing, or swelling of face/throat 2
• Thoughts of self-harm or suicide, or worsening depression 5, 2

Important Safety Information

Who Should NOT Take Wegovy

Do not take Wegovy if you have: 5, 2

• Personal or family history of medullary thyroid cancer 5, 2
• Multiple Endocrine Neoplasia syndrome type 2 (MEN2) 5, 2
• Are pregnant or breastfeeding 5, 2
• Have had a severe allergic reaction to semaglutide 2

Medication Interactions and Adjustments

If you take insulin or diabetes medications (sulfonylureas like glimepiride, glyburide): 5, 1

• Your doctor may need to reduce these doses by 20-50% to prevent low blood sugar 1, 7
• Monitor for symptoms of low blood sugar: shakiness, sweating, confusion, rapid heartbeat 7
• Always carry glucose tablets or a quick sugar source 7

If you take oral birth control pills: 5, 1

• Wegovy can reduce their effectiveness due to delayed stomach emptying 5, 1
• Use a backup barrier method (condoms) for 4 weeks after this dose increase 1
• Consider switching to a non-oral contraceptive method 1

If you take medications with narrow therapeutic windows (like digoxin, warfarin, levothyroxine): 7

• These may be absorbed differently due to delayed stomach emptying 7
• Your doctor may need to monitor blood levels more closely 7

What If You Miss a Dose?

• If less than 5 days have passed: Take the missed dose as soon as you remember, then resume your regular weekly schedule 1
• If more than 5 days have passed: Skip the missed dose and take your next dose on the regularly scheduled day 1
• If you miss 2 consecutive doses: Contact your doctor for guidance on whether to continue at 2.4 mg or restart at a lower dose 7
• If you miss 3 or more doses: You may need to restart the titration schedule from a lower dose to avoid severe side effects 7

Monitoring and Follow-Up

What Your Doctor Will Monitor

• Weight and BMI at every visit 2
• Blood pressure (may decrease as you lose weight, requiring adjustment of blood pressure medications) 5, 2
• Heart rate (Wegovy may cause modest increases) 2
• Signs of gallbladder disease or pancreatitis 5, 2
• Nutritional status after significant weight loss 2

When to See Your Doctor

• Monthly for the first 3 months at the 2.4 mg dose 2
• Every 3 months thereafter once stable 2
• Sooner if you experience severe side effects, inadequate weight loss, or concerning symptoms 2

Lifestyle Requirements for Success

Wegovy must be combined with lifestyle changes to work effectively: 5, 2

• Reduce daily calories by 500 below your maintenance needs 5
• Exercise at least 150 minutes per week (30 minutes, 5 days per week) 5, 2
• Include resistance training 2-3 times per week to preserve muscle mass during weight loss 5
• Attend behavioral counseling or support groups if available 5

Long-Term Expectations

Duration of Treatment

• Wegovy is intended for long-term, potentially lifelong use 7, 2
• Stopping the medication typically results in regaining 50-67% of lost weight within one year 7
• Continue treatment indefinitely as long as you're tolerating it well and maintaining weight loss 7, 2

Additional Health Benefits Beyond Weight Loss

At the 2.4 mg dose, Wegovy provides: 2

• 20% reduction in risk of heart attack, stroke, or cardiovascular death if you have existing heart disease 2
• Improved blood pressure and cholesterol levels 5, 2
• Reduced inflammation markers 2
• Potential improvement in fatty liver disease 7

Surgery or Procedures

If you need surgery or a procedure requiring anesthesia: 7

• Stop Wegovy at least 3 weeks (21 days) before the procedure 7
• Wegovy delays stomach emptying, which increases risk of aspiration during anesthesia even with fasting 7
• Inform your surgeon and anesthesiologist that you take Wegovy 7

Cost and Insurance

• Average retail cost is approximately $1,557-$1,619 per month without insurance 5, 7
• Many insurance plans require prior authorization 7
• Patient assistance programs may be available through the manufacturer 7

When Treatment May Need to Be Stopped

Your doctor may recommend discontinuing Wegovy if: 2

• You experience serious adverse effects that don't resolve 2
• You develop contraindications (such as pregnancy) 2
• You have not lost at least 4-5% of your body weight after 16 weeks at the full dose 2
• You develop pancreatitis or severe gallbladder disease 2

Questions to Ask Your Doctor

• Should any of my other medications be adjusted now that I'm increasing to 2.4 mg? 1, 7
• What specific weight loss goal should I aim for? 2
• How often do I need follow-up appointments? 2
• What are my options if I can't tolerate the 2.4 mg dose? 1
• Am I a candidate for the cardiovascular benefits of this medication? 2