Wegovy Dosing Schedule: Complete Titration Guide

Wegovy (semaglutide 0.25-2.4mg weekly) requires a five-step dose escalation spanning five months to reach therapeutic maintenance dosing. This comprehensive guide details each dose phase, timing considerations, side effect management at each level, strategies for slower titration, and maintenance optimization to achieve maximum weight loss while maintaining tolerability.

Why Wegovy Requires Gradual Dose Escalation

Wegovy's five-step dose escalation protocol exists for a crucial reason: rapid dose escalation would cause severe gastrointestinal side effects that most people cannot tolerate. By gradually increasing semaglutide doses over 20 weeks, the gastrointestinal system adapts, the body upregulates GLP-1 receptors, and the central nervous system adjusts to appetite suppression effects. This gradual adaptation process allows individuals to reach doses producing optimal weight loss (2.4mg) while maintaining tolerability.

If Wegovy could be dosed aggressively (jumping to 2.4mg immediately), it would cause severe nausea, vomiting, and diarrhea in the vast majority of users, leading to treatment discontinuation within days. The titration schedule represents a carefully designed compromise: slower onset of weight loss benefits (5 months to reach full therapeutic dose) in exchange for tolerability allowing long-term therapy maintenance.

The dose escalation also serves safety purposes. Clinical trials establishing Wegovy's safety and efficacy used the standardized four-week escalation intervals. Faster escalation lacks safety data and likely increases serious adverse event risk. The FDA-approved dosing schedule represents evidence-based optimization of the safety-efficacy-tolerability triad.

Understanding that slow escalation is a feature (not a bug) of Wegovy therapy helps individuals approach titration with realistic expectations. The gradual weight loss during titration (approximately 0-5% body weight in first five months) represents expected progression, not treatment failure. Once at therapeutic dose, weight loss accelerates substantially.

Detailed 5-Step Dose Escalation: Month by Month

Wegovy follows a standardized escalation protocol with doses increasing every four weeks. Understanding what to expect at each phase helps you prepare for and optimize response at each dose level.

Month 1 - Dose 0.25mg: Wegovy initiation begins with the 0.25mg dose administered once weekly (same day each week). At this very low dose, most individuals experience minimal appetite suppression—appetite reduction of perhaps 10-20%. Weight loss during month 1 is usually minimal, approximately 0-2 pounds. Gastrointestinal side effects are generally absent or very mild at this dose. This low starting dose serves primarily to introduce semaglutide to the body and trigger initial GLP-1 receptor upregulation. Most individuals tolerate the 0.25mg dose with minimal difficulty. For some individuals (particularly those with baseline GI sensitivity), even 0.25mg can cause mild nausea, but severe side effects are rare.

The 0.25mg pen contains one dose per pre-filled pen. After injecting, you can typically feel something has been delivered but the sensation is minimal. First injection should occur in a healthcare setting where you can be monitored, though most patients self-inject at home after initial instruction. Injection sites rotate among abdomen, thighs, and upper arms—rotating sites prevents lipohypertrophy (fatty deposits).

Month 2 - Dose 0.5mg: After four weeks at 0.25mg, the dose increases to 0.5mg weekly. At this dose, appetite suppression becomes noticeably stronger for most individuals—approximately 30-40% appetite reduction compared to baseline. Weight loss typically increases to 1-3 pounds weekly. Gastrointestinal side effects become more common at 0.5mg: mild nausea affects approximately 15-25% of users, mild constipation affects 10-15%. These effects are usually manageable. The 0.5mg dose represents a notable increase in efficacy compared to 0.25mg.

For individuals experiencing significant nausea at 0.5mg, several strategies help: eating small frequent meals rather than large ones, avoiding fatty or greasy foods, increasing water intake to 3+ liters daily, and consuming ginger tea or ginger supplements. For most, side effects begin improving in weeks 2-3 of 0.5mg dosing as the body adapts.

Month 3 - Dose 1mg: The dose escalates to 1mg weekly. At this dose, appetite suppression is clearly pronounced—most users experience 50-70% appetite reduction. Weight loss accelerates to 2-4 pounds weekly for many individuals. Gastrointestinal side effects peak around this dose for many users: nausea affects 25-35%, diarrhea or loose stools affect 20-30%, and constipation affects 15-20%. These effects are typically dose-dependent and improve over 2-4 weeks at this dose level.

The 1mg dose represents the dose used in Ozempic (diabetes indication), so research data on side effects and safety is substantial. The 1mg dose is where many individuals first experience meaningful appetite suppression. Some users find 1mg sufficient for good weight loss and choose not to escalate further, which is absolutely acceptable.

Month 4 - Dose 1.7mg: The dose increases to 1.7mg weekly. Appetite suppression becomes very pronounced—80%+ appetite reduction is common, with many describing food as "uninteresting." Weight loss often accelerates to 3-4 pounds weekly. Gastrointestinal side effects continue in similar prevalence to 1mg dose, rarely exceeding it. The 1.7mg dose represents an intermediate step toward the full 2.4mg therapeutic dose.

Some individuals achieve excellent weight loss results at 1.7mg and choose to remain at this dose indefinitely. The advantage is slightly reduced side effects compared to 2.4mg while maintaining substantial weight loss benefits. This is a reasonable individualized approach if 1.7mg produces desired results.

Month 5 - Dose 2.4mg: The final dose escalation brings semaglutide to 2.4mg weekly—the full therapeutic dose used in STEP clinical trials. At 2.4mg, appetite suppression is maximal for most individuals. Food desire often decreases dramatically with many users describing eating as purely fuel delivery rather than pleasurable activity. Weight loss typically continues at 3-4 pounds weekly during month 5, with momentum continuing toward the maximum average weight loss of approximately 22% body weight at one year.

Side effects at 2.4mg usually don't exceed those at 1mg-1.7mg levels. Most users remain at 2.4mg for ongoing therapy. This represents the dose associated with the STEP trials' impressive weight loss results, so the clinical evidence for efficacy and safety is most robust at this dose.

After month 5, you remain at 2.4mg weekly unless intolerable side effects develop or weight loss goals are achieved. Many individuals continue 2.4mg indefinitely to maintain weight loss; discontinuation typically results in weight regain over subsequent weeks/months.

Standard vs. Slower Titration Protocols

While the four-week escalation represents standard FDA-approved dosing, some individuals benefit from slower titration—extending each dose phase to six, eight, or even ten weeks. Understanding slower titration options helps manage side effects while still achieving therapeutic dosing.

Standard titration (four-week intervals): This is the FDA-approved escalation, reaching 2.4mg by week 20. Benefits include reaching therapeutic dose faster and demonstrating weight loss trajectory sooner. Disadvantages include potentially experiencing greater side effects during rapid escalation.

Slower titration at 6-week intervals: This schedule extends each dose phase to six weeks before escalating, reaching 2.4mg by approximately week 30 (7.5 months). The slower progression gives the gastrointestinal system more time to adapt at each dose level, often reducing peak side effect severity. For individuals experiencing moderate nausea at standard rate, slowing to six-week intervals frequently makes the difference between manageable symptoms and intolerable severity.

Extended slow titration at 8-10 week intervals: For individuals with severe baseline GI sensitivity or those experiencing intolerable nausea at standard titration rates, extending to eight or even ten weeks per dose dramatically reduces side effects. This approach reaches 2.4mg over 8-10 months rather than 5 months. While taking longer to reach full dose, the improved tolerability often results in better adherence and fewer treatment discontinuations.

Customized titration: Many healthcare providers individualize escalation schedules based on real-time side effect feedback. You might follow standard four-week increases until experiencing significant nausea, then stay at that dose for six weeks before attempting next increase. This flexible approach provides data-driven titration matched to your tolerability.

The key principle: you should communicate with your healthcare provider about side effect severity and discuss whether slower titration would improve tolerability. Many patients suffer through preventable side effects due to not knowing slower escalation is an option. Discussing this before initiating therapy prepares you for individualized dosing if needed.

Side Effect Management at Each Dose Level

Side effects vary by dose level and individual. Understanding what's typical at each dose and how to manage it helps distinguish normal adaptation from serious adverse effects.

0.25mg Phase: Most individuals experience no side effects at this very low dose. Rare mild nausea affects <5% of users. This phase is usually well-tolerated with minimal management needed. If experiencing any side effects at 0.25mg, they almost certainly will improve with time and are not predictive of intolerance at higher doses.

0.5mg Phase: Nausea becomes more common (15-25% prevalence) and is usually mild. Constipation begins affecting 10-15% of users. Management includes small frequent meals (preventing stomach distension), avoiding fatty foods, staying hydrated, and possibly adding fiber. Side effects usually peak in week 1-2 of 0.5mg dosing then improve significantly by week 3-4 as the body adapts.

1mg Phase: Nausea peaks for many users (25-35% prevalence) and typically becomes the most bothersome side effect at this dose. Diarrhea becomes more common (20-30%). Headaches occur in some individuals (10-15%). The good news: most side effects improve by week 3-4 of 1mg dosing for those who tolerate past initial effects. Management strategies: anti-nausea medications prescribed by healthcare provider (ondansetron, promethazine) can provide relief during peak symptom week; small frequent meals; ginger supplements; adequate hydration. Some individuals find anti-nausea medication for 1-2 weeks sufficiently improves side effects to allow continuing therapy.

1.7mg Phase: Side effect severity usually doesn't increase further at this dose. Nausea remains 20-30% prevalent but typically doesn't worsen versus 1mg dose. Diarrhea remains common but often improves as the body fully adapts. By 1.7mg phase, most individuals have passed peak side effect period and experience gradually improving tolerability.

2.4mg Phase: Many individuals experience minimal additional side effect worsening at final dose escalation. Some experience transient nausea increase for 1-2 weeks then improvement. By 2.4mg phase, those who tolerated earlier doses usually successfully tolerate full dose with manageable side effects.

Across all phases: constipation is often underreported but common (15-20% at higher doses). Prevention is easier than treatment: adequate fiber (vegetables, whole grains despite reduced overall eating), water intake (>3 liters daily), and physical activity all prevent constipation. Weight loss itself can predispose to constipation through reduced food volume, so maintaining fiber intake despite lower total calories is important.

Managing Missed Doses and Injection Timing

Occasionally missing injections happens to most Wegovy users. Understanding how to handle missed doses prevents treatment disruption and unrealistic anxiety about single missed injections.

Missing injection by 1-2 days: If you skip your scheduled injection day and remember within 1-2 days, simply take the injection when you remember. Continue your regular schedule the following week from that day (i.e., if you normally inject Friday and forget until Sunday, inject Sunday and resume Friday schedule next week). Missing by 1-2 days produces negligible impact on treatment.

Missing injection by 2-4 days: If more than 2 days have passed, consider skipping that dose and resuming your normal schedule the following week. Taking a dose that's 3-4 days late changes the weekly dosing interval and is less helpful than skipping and resuming schedule. You'll experience temporary appetite increase in the missed week as semaglutide levels decline, but it's not dangerous.

Missing injection by more than 4 days: Skip the missed dose and resume your regular weekly schedule the following week. Taking severely delayed injections disrupts the consistent weekly dosing interval more than skipping. You may experience temporary increased appetite that day/week but this resolves without consequences.

Never double-inject to compensate: If you miss a dose, never inject double the amount or more frequently to "make up" the missed dose. Double injection simply concentrates side effects without improving efficacy. Single dose per week is the only safe approach.

Injection timing: While consistency matters (same day each week optimizes steady levels), one-day variation is inconsequential. If you normally inject Friday but inject Thursday or Saturday due to scheduling, this is fine. Consistent timing is ideal, but occasional variation doesn't require corrective action or dose adjustments.

Preventing missed doses: Setting phone reminders for injection day helps. Some individuals establish injection rituals (e.g., "every Friday morning with coffee") that make adherence automatic. Keeping pens in visible locations (not hidden in back of refrigerator) improves remembering. If frequently missing doses, discuss adherence strategies with your healthcare provider—they may suggest different approaches or even alternative medications if Wegovy adherence is problematic.

Determining Your Optimal Dose: When to Stay Below 2.4mg

While 2.4mg is the FDA-approved maximum and produces the greatest weight loss on average, many individuals achieve excellent results at lower doses. Understanding that staying at 1mg, 1.7mg, or another intermediate dose is acceptable prevents unnecessary escalation to less tolerated doses.

Key principle: the optimal Wegovy dose is the lowest dose producing your desired weight loss result while maintaining tolerability. If 1.7mg produces 15% weight loss with minimal side effects, escalating to 2.4mg for marginal additional benefit might not make sense.

Assessment criteria: After 8-12 weeks at a given dose, you and your healthcare provider should assess whether continuing escalation makes sense. Questions to evaluate: Am I achieving meaningful weight loss at current dose? Are side effects manageable? Would I accept somewhat slower weight loss in exchange for significantly better tolerability?

Staying at 1mg: Some individuals achieve 10-15% weight loss at 1mg monthly. If satisfied with this rate and experiencing minimal side effects, remaining at 1mg indefinitely is reasonable. The 1mg dose has extensive safety data (Ozempic diabetes indication) and is well-tolerated long-term by many users.

Staying at 1.7mg: This intermediate dose is where many individuals find excellent tolerability-efficacy balance. Average weight loss at 1.7mg approaches 15-17% body weight—meaningful and greater than earlier doses—while side effects typically don't exceed 1mg levels. For individuals at 1.7mg achieving good weight loss, remaining indefinitely is completely reasonable.

Escalating despite tolerability challenges: Conversely, if you're experiencing severe intolerable side effects at a given dose (e.g., severe daily vomiting), escalating further almost certainly worsens tolerability. Work with your healthcare provider to determine whether staying at current dose with weight loss management, dose reduction, or medication discontinuation makes sense. There's no value in suffering through severe side effects.

Discussing with your healthcare provider: Before starting Wegovy, discuss whether 2.4mg is truly your target or whether a lower dose producing adequate results would be preferable. Some individuals prefer targeting 1.7mg from the outset rather than escalating to 2.4mg. This advance discussion improves shared decision-making.

Timeline for Weight Loss Results at Each Dose

Understanding typical weight loss timing at each dose helps you recognize whether treatment is working and whether continued escalation is producing results.

0.25mg: Minimal weight loss expected, averaging 0-1 pound monthly. This dose is primarily for GLP-1 system initiation, not major weight loss.

0.5mg: Weight loss begins noticeably increasing, typically 1-3 pounds monthly. Many individuals see first meaningful appetite reduction at this dose.

1mg: Weight loss accelerates substantially for most individuals, averaging 4-8 pounds monthly (approximately 1-2 pounds weekly). This is often where individuals first experience dramatic appetite suppression and satisfying weight loss velocity.

1.7mg: Weight loss continues strong, averaging 8-12 pounds monthly for many individuals. Some experience plateau as metabolic adaptation occurs; others continue rapid loss.

2.4mg: Weight loss continues at similar pace to 1.7mg, averaging 8-12 pounds monthly, though this varies substantially by individual. By 6 months at 2.4mg, many individuals have achieved 10-20% weight loss.

Long-term weight loss plateau: Most individuals reach maximum weight loss around month 12-18 on Wegovy. Further weight loss typically requires increasing dietary adherence or exercise—medication effects plateau. This represents normal physiology where the body adapts to caloric deficit and medication effects. Average one-year Wegovy weight loss reaches approximately 15-22% body weight depending on dose and individual adherence.

Detailed Dosing Schedule Reference Table

The following represents standard FDA-approved Wegovy dosing. Slower titration extends these timeframes but uses same doses.

Transitioning Between Doses and Adjusting Schedules

Sometimes individuals need to adjust their titration schedule due to side effects, life circumstances, or changing treatment goals. Understanding how to adjust dosing helps optimize your personal Wegovy experience.

Slowing your titration mid-schedule: If you're experiencing unmanageable side effects at the standard four-week escalation timing, discuss with your healthcare provider about extending your dose phase. For example, if experiencing severe nausea at 1mg after 3 weeks, you could remain at 1mg for 6-8 weeks before attempting escalation rather than continuing on schedule.

Stepping back to a lower dose temporarily: Some individuals find that temporarily stepping back to a lower dose provides side effect relief while still maintaining weight loss momentum. For example, if experiencing severe nausea at 1.7mg, stepping back to 1mg for 2-4 weeks often alleviates side effects significantly. You can then attempt re-escalation to 1.7mg or higher when ready. This flexible approach prevents unnecessary treatment discontinuation.

Remaining at maintenance doses below 2.4mg: As discussed previously, if you're achieving desired weight loss at 1mg or 1.7mg, there's no requirement to escalate further. Remaining indefinitely at a lower dose is completely reasonable if producing good results and tolerability.

Escalating at non-standard intervals: For some individuals, four weeks is insufficient time to fully adapt to a new dose. Escalating every 5-6 weeks or even 8 weeks instead of strictly every four weeks can improve tolerability while still eventually reaching therapeutic dose.

Pausing Wegovy therapy: Occasionally, individuals need to pause Wegovy temporarily (illness, surgery, life circumstances). Brief pauses (1-2 weeks) produce minimal weight regain. Longer pauses (4+ weeks) typically result in appetite return and some weight regain. When resuming after a pause, you can typically resume at your previous dose without re-titration, though some individuals find their tolerability has changed (either improved or worsened) after a pause.

Long-term Maintenance and Ongoing Optimization

After reaching maintenance dose (whether 1mg, 1.7mg, 2.4mg, or another dose), ongoing therapy optimization helps sustain weight loss and manage any emerging side effects.

Ongoing weight loss: Weight loss typically continues for 12-18 months at steady dose levels. Most individuals reach maximum weight loss around month 12-18 before plateauing. If weight loss continues strong at month 12, continue therapy unchanged. If weight plateau develops, dietary adherence and exercise intensification usually produce additional loss rather than further dose increases.

Side effect emergence: Some individuals experience new or worsening side effects after months on Wegovy. Nausea emerging after months of good tolerability might reflect lifestyle changes, medication interactions, or other factors unrelated to Wegovy. Discuss new symptoms with your healthcare provider rather than assuming Wegovy is suddenly no longer tolerated.

Weight regain during therapy: Some individuals experience weight regain despite continued Wegovy therapy. This usually reflects relaxed dietary adherence rather than medication failure. Wegovy suppresses appetite, but ultimately you control food choices. If weight increases despite Wegovy, reassessing dietary pattern, portion sizes, and behavioral triggers often identifies the cause.

Discontinuation: Some individuals achieve weight loss goals and discontinue Wegovy. Research shows approximately 25-30% weight regain over 1-2 years after discontinuation, suggesting ongoing therapy helps maintain weight loss. However, individual preferences vary—some accept weight regain as acceptable trade-off for discontinuing injections. This should be a shared decision between you and your healthcare provider.

Conclusion: Optimizing Your Wegovy Dosing Strategy

Wegovy's five-step dose escalation represents the most evidence-based approach to GLP-1 therapy for obesity. Understanding each dose phase, side effect expectations, and your option to personalize escalation timing empowers you to optimize your specific Wegovy experience.

Key takeaways: Standard four-week escalation reaches 2.4mg by week 20—slower titration is an option if side effects warrant; staying at doses below 2.4mg is completely acceptable if achieving desired results; side effect management improves most individuals' ability to continue therapy; and most individuals reach maximum weight loss within 12-18 months.

Discussing your specific titration preferences with your healthcare provider before starting Wegovy enables personalized dosing matching your tolerability profile and weight loss goals. Flexibility in dosing—the ability to slow titration, step back to lower doses, or maintain intermediate doses long-term—makes Wegovy accessible to most individuals if initiated thoughtfully.