The Wegovy schedule in the label: 0.25, 0.5, 1 and 1.7 mg, four weeks each, then 2.4 mg maintenance. Educational only, not medical advice.
Key points
- 01Four step-ups, four weeks each, then maintenance. The Wegovy (semaglutide) label sets out a fixed escalation: 0.25 mg in weeks one to four, 0.5 mg in weeks five to eight, 1 mg in weeks nine to twelve, 1.7 mg in weeks thirteen to sixteen, and the maintenance dosage from week seventeen. Sixteen weeks of ramp is the design, not a delay.
- 02Weeks one to four: 0.25 mg is a tolerance dose. The first strength is there to let the gut adapt. It is not expected to produce the effect the medication is prescribed for, and the label does not present it as a maintenance dosage. Judging the medication on the first month is judging the on-ramp.
- 03Weeks five to eight: 0.5 mg. The second step doubles the milligrams but not the procedure. The pen looks the same, the site rotation is the same, and the injection is still once weekly on the same day. Nausea often reappears briefly after a step-up and then settles, which is why the label spaces the steps four weeks apart.
- 04Weeks nine to twelve: 1 mg. The third step is where many people notice both the effect and the side effects most clearly. If a step is not tolerated, the decision to hold at the current strength for longer rather than climb on schedule belongs to your prescriber, and the label supports slower escalation for tolerability.
- 05Weeks thirteen to sixteen: 1.7 mg. The fourth step is also one of the recognised maintenance dosages, which matters: it means stopping here is a listed outcome rather than an unfinished titration. The label names 1.7 mg alongside 2.4 mg as a maintenance option for weight reduction in adults.
- 06Week seventeen onward: 2.4 mg is the recommended maintenance dose. For weight reduction in adults, the label names 2.4 mg once weekly as the recommended maintenance dosage, with 1.7 mg as the alternative. That is the end of the standard escalation, and no further weekly step is built into the schedule.
- 07Other indications carry their own maintenance wording. The same label covers cardiovascular risk reduction, weight reduction in patients aged twelve and older, and noncirrhotic MASH with moderate to advanced fibrosis, each with its own named maintenance dosage. The escalation to get there is the same, so ask which indication yours was written for.
- 08The current label lists more than one presentation. Alongside the familiar single-dose pens, the current US label lists single-dose syringes, a higher-strength 7.2 mg single-dose pen, and a multi-strength single-patient-use FlexTouch pen. Which one you get changes the handling, not the schedule, so read the instructions for use that arrived in your box.
- 09The single-dose pen has nothing to dial. A single-dose Wegovy pen is fixed at the printed strength and delivers the whole weekly dose in one activation. There is no counter to set and no partial dose. Stepping up means a new prescription at the new strength, and the old pens are not adjustable to reach it.
- 10A missed dose turns on a two-day gap. The label describes taking a missed dose as soon as possible if the next scheduled dose is more than two days away. If the next dose is less than two days away, it directs you to skip the missed one and resume on the regular day. The reference point is the next dose, not the missed one.
- 11Two or more missed doses in a row is a different rule. The label addresses consecutive missed doses separately, describing reinitiating the escalation at a lower dosage. That is a prescriber decision and not something to reconstruct at home, which is exactly why a written injection record earns its keep across a disrupted month.
- 12The supplies do not change as the milligrams do. Needle, site rotation, sharps handling and the room-temperature allowance are the same at 0.25 mg and at 2.4 mg. The only thing that changes at a step-up is the carton, so record the new strength, lot number and expiry on the day the new box is opened.
- 13What to bring to the step-up appointment. Bring how many days of nausea followed the last step, whether it settled, what your injection record shows about missed or shifted doses, and any site reaction that keeps returning. That is the material a clinician needs to decide between holding, climbing and slowing down.
- 14Why the steps are four weeks apart. Each increase brings a fresh wave of gastrointestinal adjustment, and four weeks is long enough for that to settle before the next one lands. Compressing the interval stacks two adjustments on top of each other, which is how a side effect that would have faded gets mistaken for intolerance of the medication itself.
- 15Holding a step is not falling behind. The escalation is a maximum pace, not a schedule you owe anyone. Prescribers routinely hold people at 1 mg or 1.7 mg for an extra month, and the label supports slower escalation for tolerability. The destination is the same, the route just takes longer.
- 16Two strengths in the fridge at once is normal. A step-up arrives while the previous pens are still in the house, and the cartons differ by a printed number. Read the strength on the pen against your record before every injection. This is the single most likely place a real dosing error happens during a titration.
- 17Plan the prescription before the last pen. Each step is a new fill and sometimes new authorisation paperwork. People who ask on the day the last pen empties discover the administration is slower than the medication. Start the conversation about a week ahead of running out.
- 18The schedule assumes you are keeping the same day. The label does not describe moving the weekly day around freely the way the tirzepatide label does, so treat a planned change as a question for your prescriber rather than a scheduling preference. Whatever you agree, write down the actual dates you inject.
- 19Side effects have a shape, and the shape is the useful information. Nausea that begins the day after a step and fades over four or five days reads very differently from nausea that starts in week three and keeps building. Record when it starts, how long it lasts and whether it is settling, because that pattern is what decides hold, climb or slow down.
- 20Other injectables and other glucose-lowering medicines matter here. If you also take insulin or a sulfonylurea, an increase can change how those behave and the prescriber is expected to account for it. Bring the whole list, not just this medication, and see our guide to injecting with other medications for the practical side.
Common mistakes
Treating week four as the verdict
FixThe first strength is a tolerance dose and the escalation runs sixteen weeks before the maintenance dosage begins. Judging the medication on the first month is judging the on-ramp rather than the treatment.
Stepping up on the calendar rather than on tolerability
FixFour weeks per step is the label's pattern, but a prescriber can hold you longer when a step is not tolerated. A slower ramp is a recognised path to the same maintenance dose, not a failure.
Applying the missed-dose rule to the wrong reference point
FixThe rule turns on how far away the next scheduled dose is, not on how long ago the missed one was. More than two days away means take it as soon as possible, less than two days away means skip it.
Restarting at the strength you had reached after several missed weeks
FixThe label handles consecutive missed doses separately and describes reinitiating the escalation at a lower dosage. That is a prescriber decision, so call rather than resuming where you left off.
Trying to make a single-dose pen deliver a partial dose
FixIt is fixed at the printed strength and delivers everything in one activation. A lower dose means a prescription for a lower-strength pen, not a shortened press.
Not recording the new lot number at a step-up
FixThe strength changes and so does the carton, which is often recycled before a device problem shows up. One line with strength, lot number and expiry on the day the new box is opened covers it.
When to call a clinician
- Severe upper abdominal pain that may radiate to the back, with or without vomiting, which can indicate pancreatitis.
- A lump or swelling in the neck, hoarseness or trouble swallowing. Semaglutide carries a boxed warning for thyroid C-cell tumours.
- Swelling of the face, lips, tongue or throat, or difficulty breathing, which can indicate a serious allergic reaction. Seek emergency care.
- Vomiting or diarrhoea you cannot keep ahead of, which raises the risk of dehydration and kidney problems, particularly after a step-up.
- Sudden changes in vision, which are worth reporting promptly rather than waiting for the next appointment.
- Severe pain in the upper right abdomen with fever, nausea or yellowing of the skin, which can indicate gallbladder disease.
Frequently asked questions
What is the Wegovy dosing schedule?+
The label sets 0.25 mg weekly for weeks one to four, 0.5 mg for weeks five to eight, 1 mg for weeks nine to twelve, 1.7 mg for weeks thirteen to sixteen, then the maintenance dosage from week seventeen. Your prescriber sets yours. Educational information only, not medical advice.
What is the maintenance dose of Wegovy?+
For weight reduction in adults the label names 2.4 mg once weekly as the recommended maintenance dosage, with 1.7 mg as the other listed option. Other indications on the same label carry their own maintenance wording.
How long does it take to reach the full dose?+
The escalation as written runs sixteen weeks, with the maintenance dosage starting at week seventeen. A prescriber can move slower if a step is not tolerated, so a longer ramp is a normal variation rather than a setback.
What if I miss one Wegovy dose?+
The label describes taking it as soon as possible if the next scheduled dose is more than two days away, and skipping it if the next dose is less than two days away. Never take two doses close together to catch up.
What if I miss two or more doses in a row?+
The label handles that separately and describes reinitiating the escalation at a lower dosage. That is a decision for your prescriber, so call rather than restarting at the strength you had reached.
Can I dial a smaller dose on the pen?+
Not on a single-dose pen. It is fixed at the printed strength and delivers the whole dose in one activation. A lower dose means a prescription for a lower-strength pen.
Does the injection technique change as the dose goes up?+
No. Site rotation, needle handling and the injection itself are identical at every strength. Our guide to using Wegovy covers the device steps, and the rotation guide covers the sites.
Is it a problem if I stay on a step for longer than four weeks?+
No. Four weeks is the minimum interval, not a deadline, and the label supports slower escalation when a step is not tolerated. Your prescriber decides the pace.
Why do I have two different strengths at home?+
Because a step-up is dispensed while the previous pens are still in the fridge. Read the strength printed on the pen against your record before every injection, since the cartons differ by a single number.
Can I change which day of the week I inject?+
Treat that as a question for your prescriber rather than a preference, and write down the actual dates you inject either way. Different medications in this class handle day changes differently.
Sources
- Novo Nordisk. Wegovy (semaglutide) Prescribing Information, DailyMed listing.
- Novo Nordisk. Wegovy (semaglutide) prescribing information and instructions for use.
- European Medicines Agency. Wegovy (semaglutide) Summary of Product Characteristics.
- Frid AH et al. 2016. New Insulin Delivery Recommendations. Mayo Clinic Proceedings 91(9):1231-1255.