More than 1 billion people worldwide are living with obesity, a condition that increases risks for diabetes, heart disease, and other chronic illnesses. It affects not only adults but also children and adolescents. While diet and exercise remain essential, many people need medical support to reach sustainable goals.
One option is Wegovy (semaglutide), a once-weekly injection that mimics the GLP-1 hormone. This hormone helps regulate appetite and promotes feelings of fullness. By supporting healthier eating patterns, Wegovy can make lifestyle changes more effective for people struggling with weight management.
Like any prescription, Wegovy must be taken at the right dose. Patients don’t start at full strength; instead, the dose is slowly increased to help the body adjust and reduce side effects. This guide explains the Wegovy dosing schedule step by step, from the starting dose to maintenance.
Key Takeaways
- Wegovy (semaglutide) is a once-weekly GLP-1 receptor agonist designed to help with long-term weight management.
- The drug has a half-life of about one week and is >99% bound to albumin, supporting steady weekly dosing.
- Titration phase: start at 0.25 mg weekly and increase step by step every four weeks (0.5 mg → 1.0 mg → 1.7 mg).
- Maintenance phase: either 1.7 mg or 2.4 mg weekly, both approved; 2.4 mg offers maximum effect, while 1.7 mg suits those with tolerability concerns or who meet goals earlier.
- Side effects may include nausea, vomiting, or digestive discomfort, which improve with gradual dose escalation.
- For missed doses, patients should consult their healthcare provider; guidance varies by country and may involve restarting at a lower dose.
- Injection-day flexibility rules also differ regionally (≥48 hours in US labeling, ≥72 in some markets).
- Lifestyle choices matter. Moderation is recommended with Wegovy and alcohol to avoid worsening stomach discomfort.
- Regular provider check-ins help tailor dosing, manage side effects, and track weight-loss progress.
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Pharmacokinetics & Onset of Action of Wegovy
Wegovy (semaglutide) is a long-acting GLP-1 receptor agonist with a half-life of about 155 hours (roughly one week). More than 99% of the drug binds to albumin, which slows its breakdown and maintains stable levels in the bloodstream. This design allows patients to take just one injection per week, simplifying therapy and supporting steady exposure.
Steady-state concentrations are usually reached after several weeks on the same dose. The onset of action is gradual: some appetite suppression may be felt within the first few weeks, while the most noticeable weight-loss benefits emerge after patients reach their maintenance dose. This gradual effect helps reduce side effects and supports a more sustainable approach to weight management.
Key benefits of this pharmacokinetic profile include:
- Stable Drug Levels: Minimizes peaks and troughs, keeping appetite suppression consistent.
- Weekly Dosing: A convenient routine that supports adherence.
- Gradual Benefits: Reduces the risk of sudden side effects while allowing steady progress.
Recommended Initiation and Titration for Wegovy
To limit gastrointestinal side effects such as nausea, Wegovy is started at a low dose and increased gradually over several weeks. Importantly, the early doses (0.25 mg, 0.5 mg, 1.0 mg) are only for escalation and not intended as long-term maintenance.
The schedule generally follows five steps:
- Weeks 1–4: Start at 0.25 mg weekly to allow the body to adjust.
- Weeks 5–8: Increase to 0.5 mg weekly if tolerated.
- Weeks 9–12: Move up to 1.0 mg weekly for stronger appetite control.
- Weeks 13–16: Escalate to 1.7 mg weekly if earlier doses are well tolerated.
- After week 16: Advance to 2.4 mg weekly, or remain at 1.7 mg if that dose meets clinical goals or provides better tolerability.
If side effects occur, providers may recommend extending a dose level for several more weeks before escalating further. This structured titration helps patients reach their maintenance dose more comfortably.
Maintenance Dose Options of Wegovy
After titration, patients continue with a long-term maintenance dose of either 1.7 mg or 2.4 mg weekly. Both are fully approved, with 2.4 mg generally delivering the strongest weight-loss results. However, many patients remain on 1.7 mg if they experience side effects at higher doses or if their weight-management goals are already achieved.
The decision depends on several factors:
- Response to Treatment: Weight-loss progress and clinical outcomes guide the choice.
- Side Effect Tolerance: Some patients do better at lower doses without sacrificing results.
- Provider Judgment: Individual health history, lifestyle, and concurrent medications all play a role.
Regardless of the chosen dose, Wegovy is injected once weekly into the abdomen, thigh, or upper arm, keeping the schedule consistent and simple.
Monitoring Response and Adjusting the Wegovy Dose
Ongoing monitoring helps personalize therapy. Providers often review weight trends, appetite changes, and side effects to decide whether adjustments are needed.
- Weight Progress: Regular check-ins confirm whether current dosing supports expected outcomes.
- Side Effect Management: If nausea, vomiting, or digestive discomfort are significant, dose adjustments or slower escalation may be considered.
- Lifestyle Influences: Habits like diet, exercise, and even Wegovy and alcohol use can impact comfort and results. Alcohol may worsen stomach discomfort or hinder weight-loss progress, so moderation is advised.
- Medical History Updates: Changes in health conditions or other medications may require adjustments.
- Patient Preference: Some individuals stay at a lower maintenance dose if that balances efficacy with comfort.
If two or more doses are missed, patients should consult their healthcare provider. The provider may recommend restarting at a lower dose and re-escalating to minimize side effects. Guidance on missed doses and injection-day flexibility can vary by country (for example, ≥48 hours in the US, ≥72 hours in some regions).
Conclusion
The Wegovy dosing schedule uses a stepwise escalation plan to balance effectiveness with tolerability. Starting at 0.25 mg and gradually increasing every four weeks allows the body to adjust while reducing side effects like nausea.
After titration, most patients transition to 2.4 mg weekly, though 1.7 mg remains a valid long-term option for those who cannot tolerate the higher dose or who meet goals earlier. Regular follow-ups and open communication with providers help tailor dosing to each individual’s needs.
Note: Dosing instructions, especially for missed doses and schedule changes, may differ by country. Patients should always confirm guidance with their local prescribing information.
FAQs
1. Can I start Wegovy directly at 2.4 mg?
Beginning treatment at 2.4 mg isn’t recommended because gradual dose escalation helps your body adjust and minimizes uncomfortable side effects.
2. How flexible is the injection day?
You can adjust your weekly injection schedule if the previous dose was administered at least forty-eight hours earlier.
3. What if I miss a dose?
Missed doses are managed differently depending on whether the next scheduled dose is more than or less than two days away.
4. What happens if I miss more than two weekly doses in a row?
Missing two or more consecutive doses may require restarting the titration schedule to minimize gastrointestinal side effects and maintain safety.
5. Why does dosing escalate every four weeks?
Dose escalation occurs every four weeks to let your body adapt gradually and reduce unpleasant gastrointestinal side effects during treatment.
6. Is once-weekly dosing safe?
Yes, weekly dosing is considered safe because semaglutide’s long half-life maintains therapeutic levels throughout the entire dosing interval.
7. Can the maintenance dose be reduced if not tolerated?
If 2.4 mg causes side effects, your provider may recommend staying at or reducing to 1.7 mg weekly.
References
World Health Organization: WHO. Obesity and overweight. Published May 7, 2025. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
Berman R. Wegovy weight loss benefits sustained for 4 years, doubling prior estimates. Medical News Today. Published May 20, 2024. https://www.medicalnewstoday.com/articles/wegovy-weight-loss-four-years-study
Higher Dose of Wegovy Provided Average Weight Loss of 21% in People with Obesity With a Third Achieving 25% or More. Drugs.com. https://www.drugs.com/clinical_trials/higher-wegovy-provided-average-weight-loss-21-obesity-third-achieving-25-more-22079.html
Wegovy® Dosing Schedule | Wegovy® (semaglutide) Injection 2.4 mg. https://www.wegovy.com/taking-wegovy/dosing-schedule.html