The Wegovy titration schedule: what happens after your first pen

Your first pen has arrived, here is what the schedule actually looks like

Picture the moment your first pen lands through the letterbox. You are at 0.25 mg, and the temptation is to assume something should feel dramatic almost immediately. It usually does not, and that is by design. The 0.25 mg dose exists to introduce semaglutide to your system gently, reducing the likelihood of nausea, vomiting or the digestive disruption that can catch people off guard at higher doses. Most people find this early phase manageable precisely because the starting level is modest.

After four weeks on 0.25 mg, the schedule moves to 0.5 mg, then after another four weeks to 1.0 mg, then 1.7 mg, and finally to the standard 2.4 mg maintenance dose. That is five distinct levels, each roughly a month apart, and if you want to understand what each of those levels involves, the guide to Wegovy medication doses explains what changes at each step and why those thresholds were chosen. The full Wegovy dose schedule lays out each step clearly if you want to map the timeline against real calendar weeks.

The NHS patient information for semaglutide confirms this stepped approach and explains that the gradual increase is intended to reduce gastrointestinal side effects (nausea in particular) while your body acclimatises to the medicine. The NHS semaglutide medicines page covers the full titration in plain terms and is worth bookmarking alongside your treatment information.

What happens if you cannot tolerate a particular dose level

Tolerability varies from person to person. Some people sail through each step; others find one particular level (often the move to 1.0 mg or 1.7 mg) brings a return of nausea or stomach upset they thought they had left behind. This is not a sign that the medicine is wrong for you.

Spending an extra four weeks at the dose you are currently on before moving up is a well-recognised approach within the titration framework. Your prescriber may suggest this if your side-effect picture warrants it. What you should not do is adjust the schedule yourself without clinical input, that includes delaying, skipping or doubling doses, all of which sit outside the licensed guidance. Details about managing the schedule when things do not go smoothly are covered in the guidance on how to titrate Wegovy carefully and safely.

A practical note worth raising with your prescriber early: if your titration steps fall around a bank holiday, a holiday abroad, or a month where your order timing shifts (payday weeks often mean order clusters that affect delivery windows) plan one step ahead so you are not caught without a pen at a step-up moment. It is a small logistical detail that matters more than it might seem.

The 7.2 mg option and the wegovy maintenance dose decision

For most people, 2.4 mg is where the Wegovy titration schedule ends. The MHRA approved the 2.4 mg dose as the standard maintenance level, and the STEP 1 clinical trial, published in the New England Journal of Medicine, showed an average weight reduction of around 15% at 68 weeks on this dose.

In January 2026 a higher maintenance dose of 7.2 mg was first licensed, and by April 2026 the MHRA had approved a dedicated single-dose 7.2 mg pen. Trial data reported average weight loss of around 20.7% at 72 weeks at this higher dose, narrowing the gap with tirzepatide 15 mg. The 7.2 mg option is approved for adults with a BMI of 30 or above (not for lower BMI thresholds or the cardiovascular licensed indication) and titration still begins at 0.25 mg. Whether 7.2 mg is appropriate is a clinical decision; the Wegovy maintenance dose schedule explores how that upper tier is reached and what the evidence looks like in more detail.

If you are weighing up whether to discuss the higher maintenance dose with a prescriber, or simply want to understand where your current titration is heading, the Wegovy treatment overview sets the wider clinical picture alongside the scheduling detail. For a sense of what private Wegovy treatment involves in terms of cost, the Wegovy price page gives transparent context without any hidden extras to decode.

Missed doses and what the schedule means for your treatment review

Life interrupts. A missed injection here or there does not mean your titration restarts from scratch, but the right course of action depends on how much time has passed since your last dose. The Patient Information Leaflet that comes with your pen covers the specific missed-dose guidance, and that is always the authoritative reference point rather than general information online. Your prescriber at nume (a real clinician, reviewing your case personally) can also advise if you are unsure whether your schedule needs adjusting after a gap.

One thing the schedule does not accommodate well is large unplanned gaps, particularly around step increases. If more than two weeks have passed since a dose, contact your prescriber before resuming. NHS England's guidance on weight management injections also covers key practical points around continuity of treatment, including what to do before any surgical procedure while on semaglutide.

Speak to our prescribers if you are unsure where you sit in your titration, if side effects are making the schedule hard to follow, or if you are considering moving to a higher maintenance dose. A free clinical consultation is the starting point, and every review is carried out the same day by a GPhC-registered Independent Prescriber.