How the semaglutide injection dose works: the Wegovy titration schedule

Step 1, Starting at 0.25 mg: why the first dose is lower than you might expect

When Wegovy treatment begins, the first four weeks sit at 0.25 mg once weekly. A question our prescribers hear most weeks is why the starting dose seems so low. The honest answer is that it is a settling-in period for your digestive system, not a therapeutic target. Semaglutide slows gastric emptying and acts on appetite-regulating pathways in the brain; introducing it at a lower level significantly reduces early nausea, vomiting and other gastrointestinal effects that are more likely if the body is pushed straight to a higher dose.

Think of this first pen as doing groundwork. You are unlikely to notice dramatic appetite changes, and that is expected. What matters at this stage is tolerability. You should inject on the same day each week, rotating between the abdomen, thigh and upper arm, and store the pen in the fridge between 2 and 8°C. For the precise storage window and handling instructions, the Mounjaro and Wegovy SmPCs on the eMC are the definitive reference, always defer to the patient information leaflet that comes with your pen for storage detail specific to your batch.

If the 0.25 mg period is hard going (persistent nausea, significant vomiting) talk to your prescriber before moving up rather than pushing through. The schedule can be paused at any stage.

Steps 2 and 3, Building through 0.5 mg and 1.0 mg

After four weeks at 0.25 mg, the dose moves to 0.5 mg for the following four weeks, then 1.0 mg for the four weeks after that, and you can find out more about what to expect from semaglutide at the 1 mg dose before you reach that stage. The Wegovy injection dosage chart breaks down exactly what to expect at each rung of the schedule.

Side effects are most likely to appear after a dose increase and then ease over days to a couple of weeks as your body adjusts. The most common are nausea, loose stools, constipation, reflux and fatigue. These are not a sign that the medicine is wrong for you; they are the GI tract adapting to a medicine that changes how quickly food moves through it. Staying well hydrated and eating smaller, lower-fat meals tends to help.

Dose increases are never automatic. At nume (at nume) every repeat order is clinically re-reviewed before dispatch. If a prescriber sees signs that a move up is not appropriate, the titration stays where it is. This matters because moving through the schedule too quickly is one of the most common reasons people stop treatment early due to side effects.

Steps 4 and 5, From 1.7 mg to the 2.4 mg maintenance dose (and beyond)

The step to 1.7 mg follows the same four-week minimum, and 2.4 mg is the standard maintenance target for most adults on Wegovy. This is the dose used in the STEP 1 clinical trial, which reported an average weight reduction of around 15% over 68 weeks alongside lifestyle changes, published in the New England Journal of Medicine and the evidence base on which the UK licence rests.

A higher maximum dose is now licensed. In January 2026 the MHRA approved 7.2 mg as the maximum semaglutide injection dose for weight management, initially delivered as three 2.4 mg injections per week, followed on 14 April 2026 by approval of a dedicated single-dose semaglutide 5 mg injection that forms part of the pathway to the full 7.2 mg target. Trials at this dose reported average weight loss of around 20.7% over 72 weeks, narrowing the gap with tirzepatide's highest dose results. The 7.2 mg dose is for adults with a BMI of 30 or above only; it is not licensed for lower BMI thresholds or for cardiovascular indications. Whether it is right for you is a clinical decision, not something to request based on numbers alone.

You can read more about how the semaglutide dose translates into real-world weight-loss outcomes and what the evidence shows at different stages of treatment.

What affects which dose you end up on, and how long you stay there

Not everyone reaches 2.4 mg, and that is fine. The licensed framework says that if you have lost less than 5% of your body weight after six months on the highest tolerated maintenance dose, your prescriber will review whether continuing makes sense. NICE's appraisal of semaglutide for weight management, TA875, includes the same checkpoint. This is not a failure; it is the clinical system working as designed, making sure treatment effort is going where it is genuinely effective.

Some people tolerate the full schedule comfortably and reach 2.4 mg within about 16 weeks. Others need longer at one step, or find that 1.7 mg is where they stay. The right maintenance dose is the highest one you can tolerate that is also helping you. Dose decisions belong to your prescriber, not to online forums, not to comparison of what a friend is taking.

If you are thinking about the cost side of treatment and what a full course looks like financially, the context around Wegovy pricing in the UK is worth reading before you make any decisions. For a broader view of what treatment involves, our Wegovy overview covers eligibility, how the medicine works and what to expect from private prescribing. And if you are already on treatment and have questions about your specific situation, the team is reachable seven days a week.

Semaglutide injection doses are a clinical framework, not a self-managed ladder. If you are ready to find out whether Wegovy is suitable for you, start your free consultation and a GPhC-registered prescriber will review your case the same day.