Wegovy semaglutide 2.4 mg: what the evidence says about the maintenance dose

What the STEP 1 trial established about semaglutide 2.4 mg

The STEP 1 trial randomised adults with obesity or overweight plus at least one weight-related condition (none of whom had type 2 diabetes) to either weekly semaglutide 2.4 mg or placebo alongside lifestyle guidance. Over 68 weeks, the treatment group lost an average of around 15% of body weight, compared with roughly 2.4% in the placebo group. That difference was large enough that NICE subsequently recommended Wegovy for NHS use, though with strict criteria around specialist services and a maximum treatment duration of two years.

It matters what that 15% figure represents: it is the average across all participants who stayed on treatment. Individual results varied. Some people lost considerably more; others less. Weight loss typically plateaued somewhere between weeks 60 and 68, which is partly why the maximum dose carries clinical significance. Reaching and tolerating 2.4 mg gives most people their best chance of approaching the trial's average outcome. You can read more about how different doses compare on the Wegovy dose overview page.

Since those trial results were published, a higher maintenance option (semaglutide 7.2 mg, initially given as three 2.4 mg pens weekly) has been approved by the MHRA. Early trial data suggested around 20.7% average weight loss at 72 weeks. That does not make 2.4 mg obsolete: not every patient will be offered the higher dose, and tolerability, comorbidities and individual response all factor into the clinical decision.

The titration schedule that leads to 2.4 mg semaglutide

Nobody starts on 2.4 semaglutide. The licensed schedule begins at 0.25 mg weekly and steps up (roughly every four weeks, guided by the prescriber) through 0.5 mg, 1.0 mg and 1.7 mg before reaching 2.4 mg maintenance. The purpose of the gradual increase is tolerability: the gastrointestinal side effects that some people experience (nausea is the most common, followed by changes in bowel habit) tend to be most noticeable after a dose step and generally settle within one to two weeks.

If a step causes significant side effects, a prescriber may pause the increase or stay at a lower level for longer. This is not a failure, it is how the medicine is designed to be used. The NHS patient information page for semaglutide explains what to expect at each stage, and it is worth scanning before your first pen arrives. Checking the injection date on your pen before use takes under a minute and is a habit worth building: the date stamp is printed on the cartridge label, and confirming it against your dosing record keeps your titration on track.

Pages covering the earlier steps (including semaglutide 1 mg and the 5 mg step for tirzepatide users looking to compare) give more detail on each phase. For the semaglutide steps specifically, the 2 mg dose context page is also worth reading alongside this one.

Who is licensed to use this dose in the UK?

Under the Wegovy UK licence, adults with a BMI of 30 or above, or 27 to 29.9 with at least one weight-related condition (such as hypertension, dyslipidaemia, obstructive sleep apnoea or type 2 diabetes) may be considered for treatment. Lower BMI thresholds apply for some ethnic backgrounds under UK clinical guidance. BMI alone, though, is not enough: a prescriber weighs the full clinical picture, including medical history, current medicines and contraindications, before approving a prescription.

Wegovy is not recommended during pregnancy, while breastfeeding, or when trying to conceive. It is not licensed for under-18s. People with a history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2 should not use it. If you take an oral contraceptive, the NHS advises discussing your contraception method with your prescriber before starting semaglutide, since gastric emptying changes can theoretically affect pill absorption, though current evidence suggests the effect is less marked than for tirzepatide.

The Wegovy overview page covers eligibility in full, including the NICE criteria that apply on the NHS and how private routes differ. For a cost context before deciding, the Wegovy price comparison page sets out what UK private treatment typically involves.

What happens if 2.4 mg semaglutide is not tolerated?

Some people reach 1.7 mg and find the move to 2.4 mg brings a return of side effects they'd rather not manage. The prescriber's options include staying at 1.7 mg for longer before re-attempting the step, or, in some cases, remaining at a lower maintenance level. NICE's guidance for the NHS version of this treatment notes that if less than 5% weight loss is seen after six months at the highest tolerated dose, continuing should be reviewed, a useful marker for anyone monitoring their own progress.

GI effects at the maintenance dose typically mirror what happened at earlier steps: nausea, loose stools or constipation, and reduced appetite. For most people these are mild and transient. Serious but infrequent effects, including acute pancreatitis, are the reason urgent medical attention is warranted for severe stomach pain that reaches the back. The MHRA flagged this specifically in a Drug Safety Update for GLP-1 medicines in January 2026. Our frequently asked questions page covers common queries about managing side effects during treatment, and our prescribers are available for aftercare queries seven days a week.

If you are currently on a lower step and want to understand the landscape before your next review, results data from the 0.5 mg phase puts early-stage outcomes in context. For those exploring whether semaglutide or tirzepatide might suit them better, our treatment overview sets out both options plainly.