The Wegovy dosing schedule: how the semaglutide step-up works

Step 1: why treatment starts at 0.25mg and what the first four weeks are for

The first pen in the Wegovy schedule contains 0.25mg of semaglutide. That dose is not chosen for its weight-loss effect, it's there to let your body adjust. GLP-1 medicines slow gastric emptying and act on receptors throughout the gut and brain, which is why nausea, indigestion and loose stools are common early on. Starting low keeps those effects manageable while your system acclimatises.

Most people find the first four weeks relatively mild. Appetite does begin to shift, often noticeably, but the main job of this opening period is tolerance rather than transformation. The semaglutide overview on this site explains the mechanism in more detail if you want the background science. For now, the practical point is simple: inject once a week on the same day, rotate your injection site, and let the weeks pass at this dose before expecting an increase.

Injection sites are the abdomen, upper thigh or outer upper arm. Storage is refrigerated at 2–8°C; check the Patient Information Leaflet for exact room-temperature allowances, the window is specific and matters for the medicine's stability. The Wegovy treatment page has a summary of the basics for anyone just getting started.

Step 2: the four dose increases and the logic behind four-week intervals

After the first four weeks at 0.25mg, the standard semaglutide dosing schedule moves upward in this sequence: 0.5mg, then 1mg, then 1.7mg, then 2.4mg. Each level is held for approximately four weeks before the next increase. That pacing reflects how long it takes the body to reach a steady state at a given dose, rushing the schedule doesn't improve results, and it does increase the chance of significant nausea or vomiting.

The NHS medicines page for semaglutide sets out this schedule clearly and is worth bookmarking alongside whatever your prescriber provides. The full sequence from first injection to 2.4mg maintenance takes around 16 to 20 weeks for most people, though your prescriber may adjust timing based on how you're tolerating each step.

A detailed visual breakdown of the full five-step pathway is available on the Wegovy dosing chart page, which is useful to have to hand when you're tracking where you are in the schedule. The key principle is that the 2.4mg dose is where the main clinical effect is established, the earlier steps are preparation, not the destination.

Step 3: reaching maintenance, including the 7.2mg option approved in 2026

For most people on the standard Wegovy weight loss schedule, 2.4mg once weekly is the maintenance dose. The STEP 1 trial, published in the New England Journal of Medicine, reported an average body-weight reduction of around 15% over 68 weeks at this dose, alongside lifestyle changes. That figure comes from a clinical trial population and represents an average, individual results vary, and a prescriber reviews progress throughout.

Since January 2026 there has been a further option. The MHRA approved 7.2mg as a higher maintenance dose for adults with obesity (BMI 30 or above), initially supplied as three 2.4mg pens per week. On 14 April 2026, a dedicated single-dose 7.2mg pen was approved, one pre-set injection per week, designed specifically for this higher dose. Trials at 7.2mg reported average weight loss of around 20.7% over 72 weeks, narrowing the gap with the highest tirzepatide doses. The titration pathway to 7.2mg still begins at 0.25mg; the prescriber leads the decision on whether this higher dose is appropriate. You can read more about how the two main weight-loss injections compare on the Wegovy dosing for weight loss page.

If you're thinking about what treatment might cost across a longer schedule, the Wegovy price page gives honest context on what private treatment typically involves in the UK.

What can change the schedule, and when to talk to your prescriber

The four-week intervals are a guide. Your prescriber may keep you at a lower dose for longer if nausea or other GI effects are disruptive, or if a planned dose increase falls around surgery, in which case you should tell your surgical team and anaesthetist that you're on this medicine. The taper-off schedule page covers what happens at the other end, if and when stopping treatment becomes the plan.

There are also situations where a dose increase should be paused or reviewed: significant illness, pregnancy, or the start of a new medicine that may interact. Women using oral contraceptives alongside semaglutide should be aware that NHS guidance recommends discussing pill reliability with their prescriber, particularly if GI side effects are severe. A full list of situations where semaglutide may not be suitable is covered on the who shouldn't take semaglutide page.

One question our prescribers hear regularly: what if a dose increase makes side effects worse again? That's normal. Each step up can briefly bring back the GI symptoms you thought you'd moved past. They generally settle within the same one-to-two-week window as the initial ones. If they don't, or if you develop severe or persistent stomach pain that radiates to your back, seek medical help promptly and report any suspected side effects via the MHRA Yellow Card scheme. That symptom pattern, in particular, needs same-day medical assessment.

If you'd like a prescriber to review whether Wegovy is the right fit for you and talk through where you'd sit on the schedule, you can speak to our prescribers through a free consultation, reviewed the same working day by a GPhC-registered Independent Prescriber.