How semaglutide dosing works — the weekly schedule from first injection to maintenance

Step 1, Starting at 0.25 mg: four weeks of adjustment, not treatment

The first pen in the Wegovy schedule contains 0.25 mg per dose. People sometimes feel disappointed by this, it sounds tiny compared with the 2.4 mg maintenance dose they've read about. But the starter dose has a specific purpose: settling your digestive system before the medicine is pushed to a level where it meaningfully suppresses appetite. Nausea, the most reported early side effect, is far more common when the dose climbs too quickly.

During this opening month most people notice little in the way of appetite change, and that is expected. The prescriber's job at this point is to confirm you're tolerating the injections well, not to track weight loss. If you have questions about how your body is responding, the right place to bring them is your aftercare team, not a forum.

Injection technique matters from week one. Pinch the skin gently at the chosen site, insert the needle at a 90-degree angle, and hold for a few seconds after pressing the plunger. Rotating between the abdomen, thigh and upper arm reduces the small risk of lipodystrophy at a single site. The Wegovy overview page covers device handling in more detail.

Step 2, Titrating up: 0.5 mg, 1.0 mg and 1.7 mg over three months

After the first four weeks a prescriber reviews your response and, if you're tolerating 0.25 mg, moves you to 0.5 mg. The pattern then repeats: four weeks at each rung, a clinical check, then the next increase. By the time you reach 1.7 mg (roughly twelve weeks in) most people are noticing a clear reduction in appetite, earlier feelings of fullness and often some weight change.

Side effects during titration are mostly gastrointestinal: nausea, loose stools, constipation, reflux or burping. They tend to peak in the first few days after a dose increase and then ease. Staying well hydrated and eating smaller, lower-fat meals during those first days helps considerably. If symptoms persist beyond two weeks at a new dose, the prescriber may pause the increase rather than push through, slow titration is not a setback.

This is also when people occasionally ask about the full Wegovy dosing schedule or how their pen's unit markings translate to the clinical milligram steps, something our guide to semaglutide dosing in units explains in practical terms. Both are genuinely useful things to understand, particularly when switching between pen formats.

Step 3 (Reaching and sustaining the 2.4 mg maintenance dose

The 2.4 mg weekly injection is where the STEP 1 trial evidence was generated) an average reduction of around 15% of body weight over 68 weeks, published in the New England Journal of Medicine. Maintenance is not a static plateau: your prescriber continues to monitor weight, any side effects and overall health, and a clinical review precedes every repeat.

The MHRA approved a higher 7.2 mg maintenance dose in January 2026, with a dedicated single-dose pen confirmed on 14 April 2026. That pen is for adults with a BMI of 30 or above only, and the titration still starts at 0.25 mg, you don't jump straight to 7.2 mg. Whether that higher dose is appropriate is a prescriber's call based on your response at 2.4 mg, not something to plan for at the outset.

It's also worth knowing that dosing for semaglutide varies by product. Ozempic (also semaglutide) uses a different schedule and is licensed for type 2 diabetes, not weight loss. If you've seen dosing figures online that don't match the Wegovy ladder, this is usually why, and our page on semaglutide peptide dosing explains how research-context figures differ from the licensed clinical steps. The differences between Ozempic and Wegovy dosing are worth reading before drawing comparisons.

Practical questions: timing, missed doses and what a prescriber actually checks

Pick one day of the week and stick to it. Most people anchor it to something fixed, a Sunday evening routine, the first day of a new working week. If you realise you've missed your usual day and it's been fewer than five days, you can take the dose then resume your normal schedule. If it's closer to the next planned injection, skip that missed dose entirely. Your patient information leaflet sets this out clearly, and the FAQ page covers the question we hear most often about timing.

One thing worth flagging on timing: if payday, a bank holiday or a pre-planned trip interrupts your usual order window, ordering a few days ahead protects your schedule. Running out mid-titration and taking an unplanned break can mean restarting at a lower dose. A clinical re-review happens before every repeat through nume, which catches these situations early.

At each review, the prescriber is asking three things: are you tolerating the current dose, is there enough clinical progress to continue, and are there any new health changes that affect the plan? If you haven't lost at least 5% of your starting weight after six months on the maintenance dose, NICE guidance suggests reviewing whether continuing is appropriate. That decision is made with your prescriber, not unilaterally. For anyone curious about how this plays out across a chart, a dosing chart for weight loss can help visualise the full schedule. Those considering the private route will find the full process on the treatment consultation page.