How to Titrate Wegovy: Moving Through the Doses Safely

Step 1, Starting at 0.25 mg: what this dose actually does

The first four weeks on Wegovy are not about weight loss. At 0.25 mg, the dose is too low to produce meaningful fat reduction, its job is to let your body adjust to semaglutide before the therapeutic levels kick in. Nausea, loose stools and reflux are most common when the medicine is new to your system, and starting low significantly reduces how bad those early side effects feel.

Practically speaking, you inject 0.25 mg on the same day each week for four consecutive weeks. Most people pick a day that suits their routine (a Monday evening, say, or a Sunday morning) and stick to it. The 0.25 mg starting dose comes pre-set in the pen; there is nothing to dial or measure. Inject into the abdomen, thigh or upper arm, rotating sites to avoid irritation. For full injection guidance, the patient information leaflet that comes with your pen is the definitive reference, and the NHS semaglutide page has a plain-English overview of how the medicine works.

A question our prescribers hear most weeks: "Can I stay on 0.25 mg longer if I'm nervous about side effects?" The honest answer is yes, in discussion with your prescriber, but there is no therapeutic benefit in staying at the starter dose indefinitely. Once your system has settled, moving up is the point.

Step 2, Doses 0.5 mg through 1.7 mg: the escalation phase

After four weeks at 0.25 mg, the schedule moves to 0.5 mg for another four weeks, then 1.0 mg, then 1.7 mg. Each level builds on the last. By 0.5 mg most people start to notice appetite changes; by 1.0 mg and 1.7 mg, the appetite-suppressing effect of semaglutide is more pronounced, gastric emptying slows more noticeably, and early weight loss typically becomes clearer.

The four-week minimum at each dose is not arbitrary. It gives the medicine time to reach a steady state in your system and gives your prescriber meaningful data (weight change, side effect pattern, any safety signals) before deciding whether to proceed. You can read more about what to expect at each stage in the Wegovy titration schedule overview.

If nausea or vomiting at a new dose level is severe, your prescriber may hold you at the current dose for an extra four weeks rather than moving up. This is a clinical pause, not a failure. Forcing the pace to get to the maintenance dose faster does not improve long-term outcomes and can make the medicine feel unpleasant enough that people stop using it altogether. Slow and steady is a legitimate strategy. Full details of what each pen contains and how to use it are covered in the Wegovy four-dose pen guide.

Step 3 (Reaching 2.4 mg: the licensed maintenance dose

After roughly sixteen to twenty weeks of gradual escalation, most patients reach 2.4 mg) the dose at which the pivotal STEP 1 trial ran for 68 weeks, reporting an average body-weight reduction of around 15% against lifestyle changes alone. That figure comes from the STEP 1 trial, published in the New England Journal of Medicine, and it is the basis on which NICE recommended semaglutide for weight management.

At 2.4 mg you are at the top of the standard schedule, but not necessarily the ceiling. From January 2026 the MHRA approved a 7.2 mg maintenance dose for adults with obesity (BMI 30 or above). This higher dose is reached through further prescriber-directed titration and was initially provided as three 2.4 mg pens weekly; a dedicated single-dose 7.2 mg pen received approval in April 2026. Not every patient will be a candidate, clinical suitability is assessed individually. For a full breakdown of all the dose options, the Wegovy doses page sets out the details.

If weight loss after six months at the highest tolerated dose is less than 5%, NICE guidance suggests reviewing whether continuing treatment is appropriate. That review sits with your prescriber, not with you alone.

When the schedule changes: slowing down, pausing or stopping

The four-week steps are a minimum, not a timetable written in stone. There are several reasons a prescriber might adjust the pace. Persistent gastrointestinal side effects (nausea that isn't settling, vomiting more than once or twice after a dose increase, significant fatigue) are the most common grounds for a pause. Illness, surgery or a period when you cannot inject can also interrupt the schedule; how to restart safely is a clinical conversation, not a self-management decision.

Missing a dose is covered in the patient information leaflet: broadly, if it has been five days or fewer since the missed dose, take it as soon as possible; if it has been longer, skip that dose and continue from the next scheduled day. The Wegovy minimum dose page explains what the starter dose phase involves for people considering how to begin. For questions about a specific missed dose or a gap in treatment, speak to your prescriber rather than estimating.

One practical note on cost at this stage: the total price of a course of Wegovy across five dose levels is worth understanding clearly before you start. The Wegovy pricing guide sets out what a full titration course typically involves financially in the UK private market, including what a single transparent price should cover. For anyone ready to discuss suitability with a clinician, speak to our prescribers, consultations are free, with same-day clinical review by a GPhC-registered prescriber.