What's the starting dose for semaglutide, and why does it begin so low?

Why does semaglutide start at such a small dose?

Semaglutide works by activating GLP-1 receptors in the gut and brain, slowing gastric emptying and reducing appetite. That slowing effect is also what drives the most common side effects (nausea, loose stools, indigestion) and they tend to arrive hardest when the body first meets the medicine.

Starting at 0.25 mg gives your digestive system roughly four weeks to adapt before the dose moves. Most people find the early weeks manageable precisely because the exposure is modest. The 0.25 mg dose does almost nothing to your appetite in most people, and that is by design. Thinking the medicine isn't working at week one is one of the questions our prescribers hear regularly; the answer is that week one isn't supposed to feel like much.

The NHS patient information on semaglutide describes this graduated approach clearly, as does the Summary of Product Characteristics published on the eMC. A prescriber may slow titration further (staying at 0.25 mg or 0.5 mg for longer) if side effects make an earlier step feel premature. That flexibility is the point of clinical review rather than a fixed protocol.

What does the full titration schedule look like for Wegovy?

Once the body has settled, the dose climbs in four-weekly steps: 0.25 mg, then 0.5 mg, then 1.0 mg, then 1.7 mg, arriving at the 2.4 mg maintenance dose around month five. Some people reach 2.4 mg and stay there comfortably; others need a slower journey. A useful habit at each stage is to check the date on your pen's packaging against the titration timeline your prescriber gave you, it takes under a minute and catches any timing confusion before the next injection.

The Wegovy dosing page on this site goes through each dose step in more detail, including what the 1.7 mg step is for. NICE's appraisal of semaglutide for weight management (TA875) notes that treatment should be reconsidered if less than 5% weight loss has been achieved after six months at the maintenance dose, another reason the schedule and clinical oversight matter.

In January 2026 the MHRA approved a 7.2 mg maintenance dose for Wegovy, following evidence of around 20.7% average weight loss over 72 weeks in trials at that level. The starting dose and titration route leading to 7.2 mg remain the same 0.25 mg beginning; the higher ceiling is reached through the same graduated steps, extended. Specific dose availability is always confirmed at consultation rather than assumed.

Does the starting dose differ between the Wegovy injection and the Wegovy tablet?

Yes, and the distinction matters if you are weighing up the two formats. The injection begins at 0.25 mg weekly, as described above. The Wegovy tablet, approved by the MHRA on 11 June 2026 as the first oral GLP-1 medicine licensed in the UK for weight management, starts at a different dose entirely: 1.5 mg once daily, taken first thing on an empty stomach with a small amount of plain water, at least thirty minutes before food or other medicines.

The oral tablet's maintenance dose is 25 mg daily, a number that looks very different from 2.4 mg weekly but reflects the much lower bioavailability of the swallowed route compared with the injected one. Clinical trial data from the OASIS 4 study reported around 13.6% average weight loss over 64 weeks for the tablet, rising to roughly 17% among participants who adhered fully throughout. Both formats are prescription-only, and a prescriber assesses which suits you before any prescription is issued.

There is a separate oral semaglutide medicine (Rybelsus) that uses 3 mg, 7 mg and 14 mg tablet strengths. Those are licensed for type 2 diabetes, not weight loss, and the dose numbers should not be confused with the Wegovy tablet schedule. If you are reading about semaglutide tablets for weight management, the licensed starting dose for weight loss is 1.5 mg via the Wegovy tablet, not any Rybelsus strength.

What if you have moved from another provider, does titration reset?

Not automatically, but a prescriber will want to see evidence of your current dose and treatment history before continuing. Jumping straight to a higher dose after a gap, or without clinical confirmation of what you have actually been taking, carries a real risk of the side effects that the slow titration schedule was designed to prevent in the first place.

If you are already established on 2.4 mg weekly injection and a prescriber agrees you are a candidate for the oral tablet, the guidance from the MHRA's approval notes that patients moving from the injection to the 25 mg tablet may do so directly, subject to clinical assessment rather than repeating the full titration. That assessment covers your weight trajectory, tolerability history and any relevant health changes. You can read more about how Wegovy's starting dose fits into the transfer process, or explore the broader range of licensed weight-loss treatments available through a regulated UK pharmacy. The cost of Wegovy treatment is worth factoring into the decision alongside the clinical picture. When you are ready, speaking to our prescribers is the right next step, the consultation is free, and a named clinician reviews every application the same day.