Wegovy Dose Escalation After 0.5 mg
After tolerating the 0.5 mg weekly dose of Wegovy, the next dose is 1.0 mg once weekly, maintained for 4 weeks before any further escalation.
Standard FDA-Approved Titration Schedule
The FDA-approved Wegovy titration follows a structured 16-week protocol designed to minimize gastrointestinal adverse effects while reaching the therapeutic maintenance dose 1, 2:
- Weeks 1-4: 0.25 mg once weekly
- Weeks 5-8: 0.5 mg once weekly (current dose)
- Weeks 9-12: 1.0 mg once weekly (next dose)
- Weeks 13-16: 1.7 mg once weekly
- Week 17 onward: 2.4 mg once weekly (maintenance dose) 1, 2
Critical Implementation Points
The gradual 4-week intervals at each dose level are essential for developing gastrointestinal tolerance. Nausea occurs in 44% of patients, diarrhea in 32%, vomiting in 25%, and constipation in 23%, but these rates are significantly reduced through slow titration 2. Slower, flexible titration improves adherence and reduces adverse events—only 2% of patients withdraw due to gastrointestinal side effects with gradual escalation versus 19% with faster titration 3.
Each dose level must be maintained for at least 4 weeks before advancing to allow tolerance to develop 1, 2. Rushing the escalation markedly increases nausea, vomiting, and treatment discontinuation 3.
When to Remain at 1.0 mg Long-Term
Some patients achieve adequate weight loss at submaximal doses and can remain at 1.0 mg long-term rather than continuing escalation 2. In real-world practice, 33-48% of patients continue with the 1.0 mg dosage from the fourth prescription onward, never reaching the 2.4 mg maintenance dose 4. If a patient achieves ≥5% weight loss after 3 months at 1.0 mg with good tolerability, continuing at this dose is a reasonable strategy 2.
Missed Dose Considerations
If doses are missed at the 0.5 mg level before advancing:
- ≤2 consecutive missed doses: Resume at 0.5 mg if previously tolerated, then advance to 1.0 mg after completing the appropriate 4-week duration 1, 2
- ≥3 consecutive missed doses: Restart the entire titration schedule from 0.25 mg to minimize gastrointestinal adverse effects 1, 2
Essential Concurrent Interventions
Wegovy must be combined with lifestyle modifications to achieve optimal efficacy 2:
- Caloric deficit of at least 500 kcal/day below total energy requirements 2
- Minimum 150 minutes weekly of structured exercise 2
- Ongoing behavioral counseling for dietary and behavioral changes 2
Long-Term Treatment Expectations
Semaglutide should be considered lifelong therapy to maintain weight loss. Discontinuation results in significant weight regain, with participants in clinical trials regaining most of their lost weight after stopping the medication 1, 2. At the 2.4 mg maintenance dose, patients achieve mean weight loss of 14.9% at 68 weeks, with 64.9% achieving ≥10% weight loss 5.
Common Pitfalls to Avoid
- Do not advance to 1.0 mg before completing 4 weeks at 0.5 mg—premature escalation increases gastrointestinal side effects and discontinuation rates 1, 2, 3
- Do not skip the 1.0 mg dose level—each step is necessary for tolerance development 1, 2
- Do not continue escalation if gastrointestinal symptoms are severe—remaining at a lower effective dose is preferable to discontinuation 2
- Do not prescribe Wegovy without concurrent lifestyle modifications—medication alone without dietary changes yields suboptimal results 2