You've finished your first Wegovy pen — what happens after 4 doses?

The first pen's job was adjustment, here's why that matters now

Picture the scene: you ordered your first pen on a Monday, it arrived Tuesday, and you've now done four injections spread across the month. The pen is empty. You might have felt some nausea in the first couple of weeks, perhaps a little less appetite than usual, and you're wondering whether the medicine is actually working yet. This is completely normal at 0.25 mg, and the reason is intentional design. The starting dose exists to give your body time to get used to how semaglutide affects gastric emptying and appetite signalling. Weight loss is rarely the story at this stage, tolerability is.

The licensed progression for Wegovy runs 0.25 mg for the first four weeks, then 0.5 mg, then 1.0 mg, then 1.7 mg, and finally 2.4 mg as the standard maintenance dose. A higher 7.2 mg dose is now also approved by the MHRA, making it the maximum available in the UK. Each step takes roughly four weeks, and a prescriber may hold you at any rung longer if side effects are still prominent. That decision belongs to your clinical team, not to a schedule on a packet.

So after four doses you are at a natural transition point: the first pen is done, and if you want a closer look at what finishing a Wegovy pen after just one dose means for your progress, that page walks through exactly where you stand. At nume, that re-assessment happens before every repeat order, a real prescriber reads your update, not software.

Side effects at week four: what's expected and when to get help

Gastrointestinal effects are the most commonly reported experience in the first weeks of Wegovy: nausea, loose stools, constipation, reflux, and a general feeling of fullness arriving earlier than it used to. For most people these are mild to moderate and tend to settle as the body acclimates. By week four at 0.25 mg, many people notice that the nausea that troubled weeks one and two has quietly faded.

That said, some symptoms warrant more than patience. Get medical help promptly if you experience severe stomach pain that reaches into your back, with or without vomiting, that combination can signal acute pancreatitis, which the MHRA flagged as a known but infrequent risk in a Drug Safety Update issued in January 2026. Dehydration from persistent vomiting or diarrhoea, signs of an allergic reaction, or anything that feels sudden and severe should also be assessed by a doctor without delay.

You can report suspected side effects directly at the MHRA's Yellow Card scheme, patients and carers can submit reports, not just healthcare professionals. If you're unsure whether something warrants a call, our FAQs or aftercare team can help you work out the next step.

Moving to the next dose, the process at this juncture

Assuming week four has gone reasonably smoothly, the conventional next step is to move to 0.5 mg. That's the next pre-filled pen in the sequence. But two things need to happen first: you need to reorder (the prescription isn't auto-renewed), and a prescriber needs to confirm the increase is appropriate for you specifically. It isn't a formality. If you've been struggling with persistent nausea, or if something in your health picture has changed, staying at 0.25 mg for another four weeks is a legitimate clinical choice.

Timing is worth a practical thought here. If your four-week supply ran out over a bank holiday weekend or your reorder fell around payday, you might face a short gap. Aim to request your next supply before you take your final dose of the current pen, so there's no break in the weekly rhythm. Gaps can occasionally lead to gastrointestinal side effects resurfacing when you restart, and your prescriber should know about any interruption.

For a broader look at how the whole titration sequence fits together, the Wegovy doses overview covers each step from 0.25 mg to the current maximum. And if you're curious what the picture tends to look like a pen earlier in the journey, the after three doses page and the after two doses page each cover that ground.

Thinking ahead: what the rest of the schedule looks like

Four doses is one month in. The full titration to standard maintenance typically takes around four to five months, reaching 2.4 mg. Clinical trial data from the STEP 1 study, published in the New England Journal of Medicine, showed that adults with obesity lost an average of around 15% of body weight over 68 weeks at the 2.4 mg maintenance dose alongside lifestyle changes. That average is a useful reference point, but individual results differ considerably, and any weight loss at maintenance doses earlier in the sequence is a positive sign.

The 7.2 mg pen approved by the MHRA in April 2026 is now the licensed maximum, and some people will eventually be assessed for that step. Whether it's the right direction depends on response at 2.4 mg, tolerability, and a prescriber's clinical judgement. You don't need to think about that at week four. What matters right now is that you've navigated the adjustment phase, your prescriber reviews how it's gone, and the next pen arrives before you need it.

If you're considering starting Wegovy rather than continuing it, the Wegovy treatment page and weight-loss overview cover eligibility and what to expect from the beginning. For cost context, our Wegovy pricing page explains what's included in a private prescription and how to read the numbers honestly. When you're ready to speak to a prescriber, you can start your free consultation and have a clinician review your case the same day.