Wegovy Dosage Guide
Wegovy (semaglutide) is FDA-approved for chronic weight management. It uses a 17-week titration schedule to reach the 2.4 mg weekly maintenance dose[FDA PI].
Wegovy Standard Titration (Subcutaneous)
| Weeks | Dose | Volume | Phase |
|---|---|---|---|
| 1 – 4 | 0.25 mg / wk | 0.5 mL pen | Escalation 1 |
| 5 – 8 | 0.5 mg / wk | 0.5 mL pen | Escalation 2 |
| 9 – 12 | 1.0 mg / wk | 0.5 mL pen | Escalation 3 |
| 13 – 16 | 1.7 mg / wk | 0.75 mL pen | Escalation 4 |
| 17+ | 2.4 mg / wk | 0.75 mL pen | Maintenance |
Source: Wegovy FDA prescribing information (Novo Nordisk). Escalation may be slowed if side effects are significant.
Wegovy HD (Higher Dose)
In December 2024, the STEP UP trial reported superior weight loss outcomes with semaglutide 7.2 mg/week in patients tolerating 2.4 mg[PubMed]. Availability of higher-dose Wegovy varies by pharmacy and approval status.
| Step | Dose | Duration |
|---|---|---|
| Complete standard Wegovy titration | up to 2.4 mg | 17 weeks |
| HD escalation 1 | 4.8 mg / wk | 4 weeks |
| HD maintenance | 7.2 mg / wk | ongoing |
Wegovy Oral (25 mg daily)
Oral semaglutide at higher doses than Rybelsus is under study/approval for chronic weight management (OASIS trial). Titrated over 12 weeks to a 25 mg daily maintenance dose, taken first thing in the morning on an empty stomach.
| Weeks | Dose |
|---|---|
| 1 – 4 | 3 mg daily |
| 5 – 8 | 7 mg daily |
| 9 – 12 | 14 mg daily |
| 13+ | 25 mg daily (maintenance) |
Dosage adjustments
Renal impairment
No dose adjustment is recommended for mild to severe renal impairment. Use with caution in end-stage renal disease; monitor hydration since volume depletion from GI effects can worsen renal function.
Hepatic impairment
No dose adjustment. Limited safety data in severe hepatic impairment — use with caution.
Pediatric (ages 12–17)
Same escalation schedule as adults. Approved in December 2022 following the STEP TEENS trial[PubMed].
Geriatric
No dose adjustment based on age, but consider higher risk of dehydration from GI side effects.
Common side effects by dose
- 0.25 – 0.5 mg (escalation): mild nausea (~20–30% of patients), occasional loose stools, fatigue. Usually resolves within 1–2 weeks of each step.
- 1.0 – 1.7 mg: nausea recurs briefly after step-up; constipation becomes more common. Some patients report reflux at these levels.
- 2.4 mg (maintenance): most patients are acclimated; side effects are mild. Vomiting, if it persists at maintenance, warrants prescriber discussion.
Seek medical attention for: severe upper abdominal pain (possible pancreatitis), persistent vomiting, signs of dehydration, rapid heart rate, or yellowing of skin/eyes. Wegovy carries a boxed warning for thyroid C-cell tumor risk based on rodent studies.
Off-label considerations
Wegovy at 2.4 mg has additional FDA-approved indications (2024) for reducing major adverse cardiovascular events in adults with known heart disease who are overweight or obese[FDA PI]. Off-label use for conditions such as NAFLD, PCOS, and insulin resistance is common — consult your prescriber for evidence review.
References
- Wegovy (semaglutide) FDA prescribing information. Current label PDF · Drugs@FDA overview (NDA 215256)
- Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity (STEP 1). NEJM 2021; 384:989–1002. NEJM · PubMed 33567185
- Rubino D, Abrahamsson N, Davies M, et al. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance (STEP 4). JAMA 2021; 325:1414–25. PubMed 35015037
- Rubino DM, Greenway FL, Khalid U, et al. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight (STEP 8). JAMA 2022. PubMed
- STEP TEENS — Once-weekly semaglutide in adolescents with obesity. PubMed search
- STEP UP trial — higher-dose semaglutide (7.2 mg) results. PubMed search