The stages of Wegovy: how the dose escalation schedule works

How the five-stage titration was designed around the evidence

The Wegovy dose schedule was not arbitrary. Semaglutide slows gastric emptying and reduces appetite through GLP-1 receptor activation, and both effects can trigger nausea, particularly in the first weeks of treatment. If you want to understand what semaglutide is and how it works at a pharmacological level, that page goes into the mechanism in detail. The staged approach (0.25 mg for four weeks, then 0.5 mg, 1.0 mg and 1.7 mg, each held for roughly a month) was the titration used in the STEP programme trials and is what the licensed prescribing information specifies. The NHS medicines page for semaglutide describes this schedule in patient-level detail.

The 0.25 mg starting dose does very little therapeutically. Its job is adjustment: your system gets used to the medicine before any meaningful appetite suppression kicks in. Many people feel mild nausea or loose stools during weeks one and two, then find things settle considerably. That pattern repeats, to a lesser degree, each time the dose steps up. Knowing this in advance helps people stay with the programme rather than stopping because of early discomfort.

By the time a patient reaches 2.4 mg, the therapeutic dose, appetite suppression is typically well established and the body has had nearly four months to adapt. If you are curious about what the levels of Wegovy mean and how each one is defined, that page explains the distinctions clearly. The trial data reflects this: most of the weight-loss benefit in the STEP 1 study accumulated over the full 68 weeks, not just the first few.

What happens at the maintenance stage, and the newer 7.2 mg option

For most patients, 2.4 mg once weekly is where the schedule ends. This is the dose at which the published STEP trials measured outcomes, and it remains the standard maintenance target. If you would like a closer look at what the doses of Wegovy are and how each one fits into the schedule, that page covers every strength in detail. If a patient cannot tolerate escalation to 2.4 mg, a prescriber may decide that 1.7 mg is an appropriate maintenance dose for them instead, that decision is clinical, not one to make independently.

Since January 2026, a higher maintenance dose has been available. The MHRA approved 7.2 mg semaglutide (Wegovy) initially delivered as three 2.4 mg pens weekly, then (on 14 April 2026) as a dedicated single-dose 7.2 mg pen. Trials reported roughly 20.7% average weight loss at this level over 72 weeks, closing the gap with tirzepatide results. The 7.2 mg dose is licensed for adults with a BMI of 30 or above and is reached by the same stepwise titration; the prescriber decides whether you are a candidate for it. Specific pen availability at any given time is confirmed at consultation.

If you are thinking about what Wegovy costs as a private prescription, the treatment pricing page sets out what is included at each stage of the nume service.

Side effects across the stages, and when to get medical help

Gastrointestinal symptoms are the most common experience across all five stages: nausea, indigestion, burping, loose stools or constipation. They tend to peak in the first two weeks of each new dose and ease from there. Most people find the early stages harder than the later ones, a question our prescribers hear most weeks is whether the nausea means something is wrong. Usually it does not, but it does mean the dose escalation is having its intended biological effect.

A small number of people experience more serious reactions. Get medical help promptly if you develop severe, persistent stomach pain that radiates towards your back, with or without vomiting, this can be a sign of pancreatitis, which the MHRA highlighted in a Drug Safety Update for GLP-1 medicines as an infrequent but serious risk. Gallbladder symptoms, signs of dehydration from severe vomiting or diarrhoea, or any allergic reaction also warrant prompt attention. You can report suspected side effects through the Yellow Card scheme.

The stage-by-stage nature of Wegovy matters here too: your prescriber reviews your progress at each repeat, which is the point at which dose changes are assessed and any concerns discussed. That review is not a box-ticking exercise, it is where the clinical judgement about your next stage actually happens. To understand the full picture of how Wegovy is used in practice, the Wegovy overview page covers the medicine's licensing, mechanism and eligibility in one place.

How a prescriber decides your stage, and what to do if you want to start

Starting at the lowest stage is always the rule; moving up depends on tolerability and clinical review. Reading about the stages of Wegovy and what each one involves clinically can help you prepare for those conversations with your prescriber. A prescriber will not escalate a dose if a patient is still experiencing significant side effects, has medical reasons that warrant a longer period at the current level, or if there are other clinical factors in play. Under-18s are not licensed for Wegovy, and the medicine is not recommended during pregnancy, while breastfeeding, or for anyone trying to conceive.

Private access does not require a referral or a waiting list. At nume, a GPhC-registered Independent Prescriber reads your consultation the same day, a real clinician, not software. If your application is approved, dispatch happens the same day for orders placed before 12pm, with free tracked delivery arriving the next working day. Repeat orders are clinically re-reviewed before every dispatch; no auto-renewals. If you want to explore the potential downsides of Wegovy before deciding, that is worth reading alongside this page. When you are ready to take the next step, check your eligibility with our prescribers.