Wegovy Dosing Schedule: The Five-Step Titration

The five steps in the Wegovy injection label

Wegovy injection is given once weekly, on the same day each week, at any time of day, with or without meals, into the abdomen, thigh or upper arm [1]. The label starts treatment at 0.25 mg once weekly for 4 weeks and then titrates every 4 weeks until the maintenance dose is reached [1]. The escalation table:

• Weeks 1 to 4: 0.25 mg once weekly
• Weeks 5 to 8: 0.5 mg
• Weeks 9 to 12: 1 mg
• Weeks 13 to 16: 1.7 mg
• Week 17 onward: maintenance, which is 2.4 mg (recommended) or 1.7 mg [1]

Two details matter. First, 1.7 mg is a destination and not only a waypoint: the label lists it as a maintenance dose for weight reduction and for cardiovascular risk reduction, and for MASH the dose is 2.4 mg, which may be reduced to 1.7 mg [1]. Second, the sequence is no longer capped at five strengths. The label now permits a maximum of 7.2 mg weekly in adults who tolerate 2.4 mg for at least 4 weeks and need further weight loss; patients aged 12 to 17 stay at 2.4 mg [1].

What the first months tend to involve

Gastrointestinal effects dominate the tolerability picture. In the three pooled placebo-controlled trials of Wegovy 2.4 mg in adults with obesity or overweight (2,116 on Wegovy, 1,261 on placebo, treatment up to 68 weeks), nausea occurred in 44% versus 16%, diarrhea in 30% versus 16%, vomiting in 24% versus 6% and constipation in 24% versus 11% [1]. Treatment was stopped for adverse reactions by 6.8% versus 3.2%, most often for nausea (1.8% versus 0.2%), vomiting (1.2% versus 0%) and diarrhea (0.7% versus 0.1%) [1]. Severe gastrointestinal reactions were reported in 4.1% versus 0.9% [1].

Where the numbers came from: STEP 1

STEP 1 enrolled 1,961 adults with a body-mass index of 30 or higher, or 27 or higher with at least one weight-related condition, and no diabetes [2]. Participants were randomly assigned 2:1 to semaglutide 2.4 mg weekly or placebo for 68 weeks, both alongside a lifestyle intervention, and the trial included 16 weeks of dose escalation [2][3]. Mean weight change from baseline to week 68 was -14.9% with semaglutide versus -2.4% with placebo, a difference of -12.4 percentage points, and 86.4% versus 31.5% lost at least 5% of body weight [2].

The STEP 1 escalation ran 16 weeks to reach 2.4 mg, the same span as the label's steps of 0.25, 0.5, 1 and 1.7 mg at 4 weeks each [1][3].

Is 2.4 mg the highest dose?

No longer. The 7.2 mg option comes from STEP UP, a 72-week trial of 1,407 adults with a body-mass index of 30 or higher and no diabetes, randomized to semaglutide 7.2 mg (n=1,005), 2.4 mg (n=201) or placebo (n=201) [4]. Mean weight change was -18.7% on 7.2 mg, -15.6% on 2.4 mg and -3.9% on placebo [4].

Altered skin sensation was more common at 7.2 mg than at 2.4 mg — 22% versus 6%, and 0% on placebo — while 5% in each group stopped treatment because of adverse reactions, 2% on placebo [1]. The label notes that dysesthesia rises with dose and that 18% of those affected on 7.2 mg had not recovered by the end of the trial [1].

Semaglutide's elimination half-life is about one week, and the drug remains in the body for roughly 5 to 7 weeks after the last 2.4 mg or 7.2 mg injection [1].

If an injection is missed

For Wegovy injection, the label says a missed dose can be taken when the next scheduled dose is more than 2 days away; otherwise it says to skip that dose and resume on the usual day [1]. It also addresses re-escalation from a lower dose after 2 or more consecutive missed doses [1].

Ozempic, the diabetes product, uses a different rule: a 5-day window for a missed dose [5].

What happens when the schedule stops

STEP 4 answered this directly. After a 20-week run-in in which 902 adults received semaglutide and 803 reached the 2.4 mg maintenance dose (mean weight loss 10.6%), participants were randomized to continue 2.4 mg or switch to placebo for 48 weeks [6]. From week 20 to week 68, weight changed by -7.9% in those who continued versus +6.9% in those switched to placebo, a difference of -14.8 percentage points [6].

The STEP 1 extension tracked 327 participants for a year after treatment stopped. Mean loss at week 68 was 17.3% on semaglutide versus 2.0% on placebo; after withdrawal, semaglutide participants regained 11.6 percentage points, leaving a net loss of 5.6% at week 120 versus 0.1% on placebo [3].

Other safety items from the label

Acute kidney injury attributed to volume depletion occurred at 0.4 versus 0.2 cases per 100 patient-years (7 versus 4 adults), more often in people with prior kidney impairment and during dose titration, often after gastrointestinal fluid loss [1]. The label also warns about acute pancreatitis (discontinue if suspected), gallbladder disease (cholelithiasis 1.6% versus 0.7% and cholecystitis 0.6% versus 0.2% in adult injection trials), hypersensitivity reactions, heart rate increase, and pulmonary aspiration during general anesthesia or deep sedation [1]. The boxed warning covers thyroid C-cell tumors seen in rodents at clinically relevant exposures, with the human risk unknown, and lists a personal or family history of medullary thyroid carcinoma or MEN 2 as a contraindication [1].

Wegovy tablets run on a different clock

Wegovy also exists as daily tablets, approved on 2025-12-22 and indicated for adults only [7][1]. The tablet schedule is measured in days, not weeks: 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 as maintenance [1]. The tablet label says to take them on an empty stomach in the morning with up to 4 ounces of plain water, swallow them whole, wait at least 30 minutes before food, drink or other oral medicines, and skip a missed dose rather than make it up [1].

Tablet and injection doses are not interchangeable. The label lists 25 mg daily as the tablet maintenance dose and 2.4 mg weekly as the recommended injection maintenance dose [1].

Compounded semaglutide and this schedule

The steps above describe Wegovy, an FDA-approved product. Compounded semaglutide is a different product: FDA says compounded drugs are not FDA approved and are not reviewed for safety, effectiveness or quality before marketing [8].