Wegovy dosage: the complete escalation and maintenance guide

The Wegovy dose escalation schedule is a carefully designed 16-week programme that gradually increases the dose to minimise side effects.

The BNF and the manufacturer both recommend following this schedule precisely.

Escalation timetable:

| Weeks | Dose | Pen colour |

|---|---|---|

| Weeks 1 to 4 | 0.25 mg once weekly | Green |

| Weeks 5 to 8 | 0.5 mg once weekly | Red |

| Weeks 9 to 12 | 1 mg once weekly | Orange |

| Weeks 13 to 16 | 1.7 mg once weekly | Blue |

| Week 17 onwards | 2.4 mg once weekly (maintenance) | Black |

Why is dose escalation important?

The gradual increase allows your gastrointestinal system to adapt to the effects of semaglutide. Starting at the full dose would cause much more severe nausea, vomiting, and diarrhoea.

Clinical trials confirmed that patients following the escalation schedule experienced significantly fewer and less severe side effects.

If you experience persistent gastrointestinal side effects at any stage, your prescriber may recommend staying at the current dose for an additional four weeks before increasing.

However, the dose should not be increased more quickly than the recommended schedule.

Wegovy is supplied as a pre-filled, single-use injection pen.

Each pen contains one weekly dose, and the needle is hidden inside the device, making it straightforward to use even if you have never self-injected before.

Step-by-step injection guide:

1. Remove the pen from the fridge 30 minutes before use to allow it to reach room temperature
2. Check the solution through the pen window. It should be clear, colourless, and free from particles
3. Choose your injection site: abdomen (at least 5 cm from the navel), front of thigh, or upper arm
4. Clean the injection site with an alcohol swab if desired
5. Remove the pen cap
6. Place the pen flat against your skin and press the injection button
7. Hold the pen in place for at least 10 seconds until you hear a click, confirming the dose has been delivered
8. Dispose of the used pen in a sharps bin

Important tips:

• Rotate injection sites each week to reduce the risk of skin reactions
• You can inject at any time of day, but try to keep it consistent
• The injection can be given with or without food
• Do not inject into areas of skin that are tender, bruised, or scarred
• Store unused pens in the fridge between 2 and 8 degrees Celsius. Once in use, a pen can be kept at room temperature (below 30 degrees) for up to 28 days.

Missing a dose of Wegovy occasionally is unlikely to significantly affect your treatment, but it is important to know the correct approach to get back on track.

If fewer than 5 days have passed since your missed dose:

• Take the missed dose as soon as possible
• Then continue with your regular weekly schedule

If 5 or more days have passed:

• Skip the missed dose entirely
• Take your next dose on the usual scheduled day
• Continue with your regular weekly schedule from that point

If you miss doses for two or more consecutive weeks:

• Contact your prescriber before resuming treatment
• You may need to restart at a lower dose and repeat part of the escalation schedule to reduce the risk of gastrointestinal side effects

To avoid missing doses:

• Set a weekly reminder on your phone for your injection day
• Keep a spare pen available in case of breakage or loss
• Plan ahead for holidays or travel by discussing cold storage options with your pharmacist

Never take a double dose to make up for a missed one, as this increases the risk of side effects including severe nausea and vomiting.

The standard Wegovy dosing schedule applies to most adults, but there are situations where adjustments may be necessary.

No dose adjustment is required for:

• Mild to moderate kidney impairment
• Mild to moderate liver impairment
• Older adults (65 years and over), though experience in those over 75 is limited

Wegovy should not be used in:

• Severe liver impairment (limited data)
• End-stage renal disease (eGFR below 15 mL/min)
• Pregnancy or breastfeeding
• Patients under 12 years of age

Adolescents (12 years and older):

• The same dose escalation schedule is used as in adults
• The maintenance dose is 2.4 mg once weekly, or the maximum tolerated dose
• Treatment should be supervised by a specialist with experience in adolescent obesity

Switching from other GLP-1 agonists:

• If switching from Ozempic (semaglutide for diabetes), the dose escalation schedule for Wegovy should still be followed from the beginning
• If switching from another GLP-1 agonist such as liraglutide, consult your prescriber for guidance on transitioning

The BNF advises that treatment with Wegovy should be discontinued if a patient has not lost at least 5 per cent of their initial body weight after 6 months on the maintenance dose.

Correct storage of Wegovy pens is essential to ensure the medication remains effective and safe to use.

Before first use:

• Store in the fridge at 2 to 8 degrees Celsius
• Keep the pens in their original carton to protect from light
• Do not freeze. If a pen has been frozen, do not use it
• Pens stored in the fridge are usable until the expiry date printed on the packaging

After first use or when carrying out of the fridge:

• Can be stored at room temperature (below 30 degrees) for up to 28 days
• After 28 days at room temperature, the pen must be discarded even if it has not been used
• Keep the pen cap on when not in use

Travelling with Wegovy:

• Use an insulated cool bag with ice packs for transport
• Do not place pens in checked luggage on flights due to temperature extremes
• Carry a letter from your prescriber confirming the medical necessity of the injection pens
• Sharps disposal: carry a travel sharps bin and check local disposal regulations at your destination

Disposal:

• Used pens should be placed in a sharps bin, available free from most NHS pharmacies
• Never dispose of pens in household waste
• Full sharps bins can be returned to your pharmacy or local council collection point