Semaglutide Dosage Chart for Weight Loss (Wegovy)
An evidence-based semaglutide dosage chart for weight loss, including weekly titration to 2.4 mg, missed-dose rules, side-effect management, and key safety information from FDA labeling and major clinical trials.
Dr. Michael Thompson, M.D.
Board-Certified Urologist
Last updated on January 20, 2026
An evidence-based semaglutide dosage chart for weight loss, including weekly titration to 2.4 mg, missed-dose rules, side-effect management, and key safety information from FDA labeling and major clinical trials.
Evidence-Based Guide (Updated Jan 2026)
Medical Review and Editorial Policy
This article is for educational purposes only and does not replace medical advice. Prescription decisions are made by licensed clinicians based on your history, labs, and risk factors.
Important Safety Information
Semaglutide is a prescription medication. Do not start, stop, or change your dose without a licensed clinician.
Boxed Warning (Wegovy): Risk of thyroid C-cell tumors. Wegovy is contraindicated if you or a family member has had medullary thyroid carcinoma (MTC) or if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
Other important risks and precautions in prescribing information include pancreatitis, gallbladder disease, acute kidney injury (often related to dehydration from GI side effects), hypersensitivity reactions, and hypoglycemia risk when used with insulin or insulin secretagogues in people with diabetes. Discuss your full medication list and medical history with your clinician.
Pregnancy: Wegovy is not recommended during pregnancy; discuss pregnancy planning with your clinician.
Most people using FDA-approved semaglutide for weight loss (Wegovy) follow a gradual dose escalation to improve tolerability. The standard Wegovy schedule increases every 4 weeks from 0.25 mg weekly to 0.5 mg, 1.0 mg, 1.7 mg, and then 2.4 mg weekly for maintenance, as tolerated. If 2.4 mg isn't tolerated, the label allows reducing to 1.7 mg weekly and considering re-escalation later. Missed-dose rules depend on how close you are to the next scheduled dose (48-hour rule).
Update Jan 2026
FDA requested removal of suicidal ideation/behavior warnings from GLP-1 RA labels after a large review found no increased risk. Patients should still report mood changes to a clinician.
What This Guide Covers
- The FDA-labeled semaglutide dosage chart for weight loss (Wegovy)
- Why dosing is escalated ("start low, go slow")
- Missed-dose rules and restart considerations
- Side effect management (what clinicians often adjust)
- What results to expect from clinical trials (without guarantees)
- FAQ + references (FDA label + major peer-reviewed trials)
Why Semaglutide Dosing Is Escalated
Semaglutide (Wegovy) is a GLP-1 receptor agonist. It can reduce appetite and increase fullness, helping many patients lower calorie intake. The most common side effects are gastrointestinal and tend to occur at the start of therapy or after a dose increase. For that reason, Wegovy is intentionally titrated upward over several months to improve tolerability and long-term adherence.
Semaglutide Dosage Chart for Weight Loss
Below is the standard Wegovy dose escalation schedule used for chronic weight management. Your clinician may delay an increase if side effects are limiting.
Wegovy Weekly Titration Schedule
| Weeks | Dose (mg) | Frequency | Clinical Purpose |
|---|---|---|---|
| 1–4 | 0.25 mg | Once weekly | Starter dose to improve tolerability |
| 5–8 | 0.5 mg | Once weekly | Step-up if tolerated |
| 9–12 | 1.0 mg | Once weekly | Continued escalation as directed |
| 13–16 | 1.7 mg | Once weekly | Pre-maintenance step; some may remain here if needed |
| 17+ | 2.4 mg | Once weekly | Maintenance; if not tolerated, label allows 1.7 mg maintenance |
If You Can't Tolerate 2.4 mg
The Wegovy label states that if patients do not tolerate 2.4 mg once weekly, the dosage can be decreased to 1.7 mg once weekly and clinicians may consider re-escalation to 2.4 mg later.
Wegovy vs Ozempic — Same Ingredient, Different FDA-Approved Use
Both Wegovy and Ozempic contain semaglutide, but they are labeled for different primary indications and dosing goals.
- Wegovy: FDA-approved for chronic weight management; standard titration to 2.4 mg weekly maintenance (or 1.7 mg if not tolerated).
- Ozempic: FDA-approved for type 2 diabetes (and certain risk-reduction indications); dosing and pen strengths differ, and weight loss use may be off-label depending on context and clinician judgment.
"Units" vs "mg" — Avoid Dose Confusion
Some clinics or pharmacies may describe injections in "units" based on concentration. "Units" are not universally interchangeable across products or vial concentrations. For patient education and safety, dosing should be communicated in milligrams (mg) using the exact product instructions from your prescriber.
How to Take Semaglutide
Wegovy is injected subcutaneously (under the skin). Common injection sites include abdomen, thigh, or upper arm, rotating sites over time. Take it on the same day each week.
Missed Dose Rules (Wegovy)
Wegovy prescribing information provides a clear missed-dose rule based on how close you are to the next scheduled dose.
Missed Dose and Restart Guidance
| Scenario | What the Label Generally Says | Why It Matters |
|---|---|---|
| You miss 1 dose and your next scheduled dose is more than 48 hours away | Take the missed dose as soon as possible | Helps maintain weekly routine |
| You miss 1 dose and your next scheduled dose is less than 48 hours away | Skip the missed dose; take next dose on your regular day | Avoids doses too close together |
| You've missed 2 or more consecutive doses (or a longer gap) | Resume on your scheduled day or speak with a clinician about restarting escalation | May reduce GI side effects when restarting |
Expected Results and Timeframes
In STEP 1 (NEJM 2021), adults with overweight or obesity receiving semaglutide 2.4 mg weekly plus lifestyle intervention had substantially greater average weight loss at 68 weeks than placebo plus lifestyle intervention. Individual results vary, and tolerability, adherence, and baseline health factors matter.
Semaglutide has also shown cardiovascular outcomes benefit in SELECT (NEJM 2023) in adults with overweight/obesity and established cardiovascular disease without diabetes, reducing major adverse cardiovascular events versus placebo.
Side Effects — What's Common, What's Serious
Common Side Effects
Nausea, vomiting, diarrhea, constipation, abdominal discomfort, and reflux-like symptoms are commonly reported. Symptoms often occur during initiation or dose escalation.
Serious Symptoms That Need Clinician Review
Seek medical evaluation for severe or persistent abdominal pain (with or without vomiting), signs of dehydration, severe allergic reaction, or other concerning symptoms listed in prescribing information. The Wegovy label includes warnings/precautions such as pancreatitis, gallbladder disease, and acute kidney injury (often in the setting of dehydration).
How Clinicians Manage Side Effects Without Derailing Progress
Clinicians often prioritize tolerability and adherence over "rushing" the dose, because intolerance leads to discontinuation.
Side Effects and Common Clinician Adjustments
| What You Notice | What It May Indicate | Common Clinician-Directed Adjustments |
|---|---|---|
| Nausea after each dose increase | Escalation pace too fast | Hold current dose longer; delay next step; review meal size/timing |
| Vomiting/diarrhea with low fluid intake | Dehydration risk; possible kidney stress | Hydration plan; assess severity; consider holding dose; rule out complications |
| Constipation | Reduced GI motility | Fluids/fiber strategy; review tolerability; adjust escalation pace |
| Reflux/heartburn | Slower gastric emptying + meal timing | Smaller meals; avoid late heavy meals; clinician-guided symptom support |
| Severe persistent abdominal pain | Potential pancreatitis/gallbladder issue (needs evaluation) | Stop and seek medical evaluation per clinician guidance |
Plateaus: What to Review Before Asking for "More Dose"
Weight loss plateaus happen. Evidence-aligned levers typically include:
- Confirm consistent weekly dosing and technique (same day weekly).
- If side effects are limiting, consider slower escalation (label-consistent) rather than forcing higher doses.
- Review nutrition and activity plan to support fat loss while protecting lean mass (especially adequate protein + resistance training).
- Evaluate contributing conditions/medications (sleep apnea, alcohol intake, certain antidepressants, insulin/sulfonylureas in diabetes, etc.) with a clinician.
Semaglutide "Stacking" with Peptides
You may see "peptide stacks" marketed online for weight loss. Many of these products are not FDA-approved for obesity and may lack robust human outcomes data compared with FDA-approved GLP-1 therapies. For an evidence-based and U.S. compliant approach, decisions about any adjunct therapies should be clinician-directed, individualized, and grounded in credible evidence and appropriate indications.
Mental Health Labeling Update
On January 13, 2026, FDA requested removal of suicidal behavior and ideation warnings from GLP-1 receptor agonist labels after concluding their evaluation did not identify an increased risk. Patients should still report mood changes or new psychiatric symptoms promptly.
FAQ
Q: What is the "best" semaglutide dose for weight loss?
A: For Wegovy, the FDA-labeled schedule escalates over 16 weeks to a recommended maintenance dose of 2.4 mg weekly, if tolerated. Some patients remain on 1.7 mg if 2.4 mg is not tolerated.
Q: Can I increase semaglutide faster to lose weight faster?
A: Escalating too quickly increases GI side effects and can reduce adherence. The label allows delaying escalation when a dose is not tolerated.
Q: I'm not losing weight at 0.25 mg — does that mean it won't work?
A: Not necessarily. Early doses are designed primarily for tolerability; many patients notice stronger appetite effects at later titration steps.
Q: Is Ozempic the same as Wegovy?
A: They contain the same active ingredient (semaglutide), but they are labeled for different indications and have different dosing goals and pen strengths.
Q: What should I do if I miss a dose?
A: For Wegovy, missed-dose guidance is based on whether your next scheduled dose is more than or less than 48 hours away. Follow the prescribing guidance and consult your clinician if you've missed multiple doses or have severe side effects.
Advanced Vitality Closing
At Advanced Vitality Hormone Replacement Therapy, weight loss care is built around medically supervised dosing, side-effect management, and long-term cardiometabolic health. If you're considering semaglutide—or you're already on it and want a safer, more tolerable plan—book a consultation to review your history, goals, and the most appropriate evidence-based options.
References
- FDA Wegovy Prescribing Information (dose escalation, maintenance, missed dose, boxed warning)
- DailyMed: Wegovy (contraindications: MTC/MEN2; safety information)
- STEP 1 Trial (NEJM 2021): Once-weekly semaglutide 2.4 mg in adults with overweight/obesity
- SELECT Trial (NEJM 2023): Semaglutide and cardiovascular outcomes in obesity without diabetes
- FDA Drug Safety & Availability (Jan 13, 2026): Removal of suicidal ideation/behavior warning for GLP-1 RAs
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References
- FDA Wegovy Prescribing Information (dose escalation, maintenance, missed dose, boxed warning). FDA Label
- DailyMed: Wegovy (contraindications: MTC/MEN2; safety information). DailyMed/NLM
- STEP 1 Trial: Once-weekly semaglutide 2.4 mg in adults with overweight/obesity. NEJM, 2021
- SELECT Trial: Semaglutide and cardiovascular outcomes in obesity without diabetes. NEJM, 2023
- FDA Drug Safety & Availability: Removal of suicidal ideation/behavior warning for GLP-1 RAs. FDA, Jan 13, 2026
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