How to Taper Off Wegovy

Does the Wegovy label include a taper schedule?

No. The label's dose schedules run in one direction, up. Wegovy injection starts at 0.25 mg once weekly for weeks 1 to 4, then 0.5 mg for weeks 5 to 8, 1 mg for weeks 9 to 12, 1.7 mg for weeks 13 to 16, and maintenance from week 17. For weight reduction in adults the recommended maintenance dose is 2.4 mg (1.7 mg is the alternative), and adults who tolerate 2.4 mg for at least 4 weeks and need more weight loss can go to a maximum of 7.2 mg [1]. For the tablets the ladder is 1.5 mg for days 1 to 30, 4 mg for days 31 to 60, 9 mg for days 61 to 90, then 25 mg from day 91 [1].

The injection comes in several strengths, but the label does not say which doses to use when stopping or how long to stay at each lower dose [1]. The tablets come in 1.5, 4, 9 and 25 mg, and the label says to swallow them whole, not split, crush or chew [4][1].

The two withdrawal studies tested something different from a step-down. In STEP 4, participants either continued semaglutide 2.4 mg or switched to placebo [2]. In the STEP 1 extension, treatment (including lifestyle intervention) was discontinued at week 68 and participants were followed for another year [5].

What the withdrawal trials found

STEP 4 is the closest thing to evidence about taking Wegovy away. In it, 803 adults who reached 2.4 mg during a 20-week run-in, with a mean weight loss of 10.6%, were randomized to keep taking 2.4 mg (n=535) or switch to placebo (n=268), both with lifestyle intervention, for 48 more weeks [2]. From week 20 to week 68, the continuing group lost another 7.9% of body weight while the placebo group gained 6.9%, a 14.8 percentage-point difference [2].

The STEP 1 extension followed people after treatment ended. In 327 participants, mean weight loss at week 68 was 17.3% on semaglutide versus 2.0% on placebo. A year after stopping, the semaglutide group had regained 11.6 percentage points, about two-thirds of what they had lost, for a net loss of 5.6% from baseline versus 0.1% on placebo, and most cardiometabolic measures had moved back toward baseline [5].

What happens as the drug clears

Semaglutide is a GLP-1 receptor agonist that binds and activates the GLP-1 receptor, including receptors in brain areas that regulate appetite and calorie intake, and it delays gastric emptying [1]. Its elimination half-life is about one week, and the label states that the drug remains in the body for roughly 5 to 7 weeks after the last 2.4 mg or 7.2 mg injection or 25 mg tablet [1]. In STEP 4 the weight trajectory reversed within the 48 weeks after the switch to placebo [2].

Missed doses and restarting

For the weekly injection, the label's missed-dose rule is that a missed dose is given if the next scheduled dose is more than 2 days away, and that after 2 or more consecutive missed doses dosing re-escalates from a lower dose [1]. For the tablets, the label says a missed dose is skipped and the next one taken the following day [1].

Label points that apply to stopping

Pregnancy. For weight reduction or cardiovascular risk reduction, the label says to discontinue Wegovy when pregnancy is recognized, and to stop at least 2 months before a planned pregnancy because of the long half-life [1].

Stopping because of side effects. In the pooled 2.4 mg trials, 6.8% on Wegovy versus 3.2% on placebo stopped treatment for adverse reactions, most often nausea (1.8% versus 0.2%) [1]. Nausea (44% versus 16%), diarrhea (30% versus 16%) and vomiting (24% versus 6%) were the most frequent adverse reactions [1].