Your Wegovy step-up dosing schedule, explained clearly

Week one to four: why the starting pen feels underwhelming

You've collected your first Wegovy pen and injected it, and by the end of week two you're wondering if anything is actually happening. That's normal. The 0.25 mg dose is a tolerability phase, it's designed to introduce semaglutide to your system gradually so that the gastrointestinal effects common in the early weeks (nausea, loose stools, reflux) stay manageable rather than overwhelming. Most people notice very little appetite suppression at this level. The full picture of how Wegovy works makes more sense once you understand that the medicine's effect builds with dose.

After four weeks, if you've tolerated 0.25 mg without significant problems, your prescriber moves you to 0.5 mg. If you have had persistent nausea or vomiting, they may recommend an extra week at the starting level before escalating. The schedule is a guide, not a contract. One quick habit worth forming now: each time you inject, make a note of the date on your phone or the box. When your prescriber asks how many weeks you've been at the current dose, you'll know immediately, it takes ten seconds and avoids any confusion about when the next step falls.

The middle steps: where most of the adjustment happens

The 0.5 mg and 1.0 mg steps are where the majority of people experience the most noticeable side effects, because semaglutide's gastric-emptying effect becomes clinically meaningful at these levels. Nausea tends to peak in the first few days after moving up and then fades over the following week or two. Eating smaller portions, staying hydrated and avoiding very fatty meals during a step-up period helps considerably, your Patient Information Leaflet covers this in detail, and it's worth reading before each new pen rather than just at the start.

By 1.0 mg, appetite suppression is usually apparent. Some people lose a meaningful amount of weight before reaching the maintenance dose. The dose-step breakdown page goes through what each level typically feels like and what clinical evidence supports each escalation point. At 1.7 mg (the fourth step) you're one pen away from the standard maintenance dose. Many of the GI effects have settled by this point for most people, though individual variation is wide. The lower-dose semaglutide dosing guide has more on what to expect during these earlier steps if you want further reading.

Reaching 2.4 mg, and what comes next

The 2.4 mg weekly dose is where the headline clinical evidence sits. In the STEP 1 trial, published in the New England Journal of Medicine, adults with obesity who used semaglutide 2.4 mg alongside lifestyle changes achieved around 15% average body-weight reduction over 68 weeks. That figure is from a clinical trial, results in practice vary, and your prescriber will review your progress regularly. Stopping treatment if less than 5% weight loss is achieved after six months at the maintenance dose is part of the NICE-recommended approach for semaglutide.

From January 2026, the MHRA approved a higher 7.2 mg maintenance dose for adults with a BMI of 30 or above, initially delivered as three 2.4 mg pens per week, then via a dedicated single-dose pen approved in April 2026. This higher dose is not automatically the next step for everyone; it requires a fresh clinical assessment, and our 5mg semaglutide dosing chart can help you understand how the incremental steps leading up to higher doses are structured. If you're curious about the cost implications of different treatment stages, the Wegovy price comparison page gives useful context on what private treatment typically involves. The NHS semaglutide medicines page is also a reliable reference for storage guidance, missed-dose advice and what to do if side effects become severe, read it alongside your leaflet, not instead of it.

When the step-up doesn't go to plan

Side effects at any step can be reason enough to pause the escalation. That's not a failure. A prescriber may keep you at 1.0 mg for an extra four weeks, then try 1.7 mg once things have settled. Some people reach their maintenance dose at 1.7 mg rather than 2.4 mg because that's the highest level they tolerate well, and that is a legitimate clinical outcome. The step-up trial process explained covers what evidence says about slower titration and tolerability outcomes if you want the clinical background.

What matters is that each decision is made by a prescriber who knows your history, not by a fixed timetable. At nume, every repeat order goes through a fresh clinical review before anything is dispensed, so if your tolerability picture has changed, that conversation happens before the next pen arrives. If you have questions between reviews, our aftercare team is available seven days a week. And if you're still working out whether Wegovy is the right fit for your situation, the weight-loss treatment overview sets out the licensed options clearly.