Step 7 Semaglutide: Reaching the 2.4 mg Maintenance Dose

Six months in, and the question shifts

Picture this: you started on the 0.25 mg pen, felt queasy after a handful of injections, wondered whether it was working, and then (slowly) noticed the difference in how hungry you felt. Each step up brought a small recalibration. Now you're here, at 2.4 mg, and the question changes. You're no longer asking "when do I go up?" You're asking "what happens now?"

This is the intended destination for most people on Wegovy. The earlier doses exist largely to let your digestive system adjust without making you miserable. The 2.4 mg level is where the medicine is designed to exert its full effect on appetite signalling, gastric emptying, and the GLP-1 receptors involved in how your body registers fullness. You can read a broader account of how semaglutide works as a medicine if the mechanism interests you, but the short version is that you've reached the dose the clinical trials were built around.

One thing our prescribers hear fairly often at this stage: people assume that because they've reached the "top" dose, they should be losing weight faster than before. That's not quite how it works. The rate of loss often steadies at maintenance. Consistency matters more than speed.

What the trial evidence actually shows at this dose

The STEP 1 trial, which we cover in detail including what its findings mean for people starting treatment, (the landmark phase 3 study published in the New England Journal of Medicine) followed adults with obesity or overweight and at least one weight-related condition for 68 weeks. Those who reached and sustained the 2.4 mg maintenance dose lost an average of around 15% of their body weight. That figure comes from a real-world-ish population: people with varying starting weights, varying adherence to lifestyle changes, varying biology.

What the trial also showed is that results spread widely around that average. Some participants lost considerably more; others less. Which is a useful reminder that population averages describe a group, not a guarantee for any individual. Your starting weight, your diet, your activity, your other health conditions, all of it shapes the outcome. The Wegovy overview page covers the evidence in more depth, including what happens if the 2.4 mg dose doesn't produce a meaningful response.

NICE's recommendation for semaglutide (TA875) includes a review point: if you haven't achieved at least 5% weight loss after six months at the maintenance dose, continuing treatment should be reassessed. That's a clinical decision, not an automatic stop, your prescriber considers the full picture.

Side effects to be aware of at 2.4 mg

The most common side effects of semaglutide are gastrointestinal. Nausea, loose stools, constipation, reflux and fatigue sit at the top of the list, as the NHS semaglutide medicine page sets out clearly. For most people these are at their worst during a dose increase, then settle. By the time you reach 2.4 mg, some people find they've already met and moved past the worst of it.

That said, the maintenance dose is still the highest dose, so some people do notice a fresh wave of GI symptoms after stepping up to it. Eating smaller portions, avoiding very fatty or rich meals, and staying well hydrated tends to help. If symptoms are severe or persistent, contact your prescriber, reducing the pace of titration or adjusting other aspects of your plan is always an option.

There is one symptom pattern worth knowing about specifically. The MHRA highlighted acute pancreatitis as a known, if infrequent, side effect of GLP-1 medicines: severe stomach pain that radiates to the back, with or without vomiting, warrants urgent medical attention rather than a wait-and-see approach. It's uncommon, but it's the right thing to act on quickly.

If you're also taking an oral contraceptive pill, your prescriber will have noted the guidance around semaglutide and absorption. The evidence for reduced pill efficacy with semaglutide is less clear-cut than it is for tirzepatide, but it's worth discussing your contraception at your next review regardless.

What comes after the maintenance dose, and where cost fits in

Since January 2026, there's actually been a step beyond 2.4 mg. The MHRA approved a 7.2 mg maintenance dose of semaglutide (Wegovy), with a dedicated single-dose pen approved in April 2026. Trial data placed average weight loss at around 20.7% over 72 weeks at the higher dose, closer to the results seen with tirzepatide at its maximum. Not everyone will need or be suited to the higher dose, and your prescriber is the right person to explore whether it makes sense for you.

Reaching the maintenance phase is also a natural moment to think about cost over the longer term. Private treatment pricing for Wegovy in the UK has changed since Novo Nordisk updated its list prices, and what's included in a quoted price varies between providers. If you want to understand where to find Wegovy at the most competitive price without compromising on clinical oversight, it's worth doing that research before committing to any provider for the months ahead. At this stage of treatment, aftercare quality and clinical re-review before every repeat matter as much as the monthly figure.

The titration steps that got you here are documented in our guide to the semaglutide titration schedule, if you want to trace the full journey, and if you're curious about the earlier part of the dose progression, our guide to step 2 semaglutide explains what that phase involves. And if you're considering what's next (whether that's staying at 2.4 mg, discussing the 7.2 mg pen, or reviewing your plan entirely) check your eligibility with our prescribers. It's a free consultation, reviewed the same day by a real clinician.