Semaglutide Dosage for Weight Loss: Complete Titration Schedule (2026)
Wegovy (semaglutide injection) starts at 0.25 mg once weekly and steps up every four weeks through four dose increases until reaching 2.4 mg — the standard maintenance dose — at week 17. The total titration takes 16 weeks. A higher-dose option (Wegovy HD, 7.2 mg weekly) was FDA-approved in March 2026 for people who tolerate 2.4 mg but want more weight loss. Oral Wegovy follows its own four-step schedule starting at 1.5 mg daily.
- Wegovy injection titration: 0.25 → 0.5 → 1.0 → 1.7 → 2.4 mg, one step every 4 weeks
- You can stay at any step longer than 4 weeks if side effects are difficult — this does not mean treatment is failing
- 1.7 mg is an approved permanent maintenance dose if 2.4 mg isn’t tolerated
- Wegovy HD (7.2 mg) requires tolerating 2.4 mg for at least 4 weeks first
- Oral Wegovy (25 mg/day) has its own 4-step titration starting at 1.5 mg daily
Wegovy Injection Titration Schedule
Five dose steps, one every four weeks, from first injection to standard maintenance.
| Weeks | Dose | Step |
|---|---|---|
| 1–4 | 0.25 mg once weekly | Initiation (below therapeutic range — purpose is tolerance) |
| 5–8 | 0.5 mg once weekly | Step 2 |
| 9–12 | 1.0 mg once weekly | Step 3 |
| 13–16 | 1.7 mg once weekly | Step 4 (also an approved permanent maintenance dose) |
| 17+ | 2.4 mg once weekly | Standard maintenance |
| 21+ (optional) | 7.2 mg once weekly | Wegovy HD — approved Mar 2026 for those who tolerate 2.4 mg for ≥4 weeks |
The 0.25 mg starting dose is deliberately below the therapeutic range. It is not a treatment dose — it is there to let the body adjust to the drug before the gastrointestinal effects hit harder at higher doses. Most people see very little appetite suppression in the first four weeks, which is expected.
Missing a dose: If fewer than 5 days have passed since your scheduled dose, take it as soon as you remember. If more than 5 days have passed, skip it and resume your regular weekly schedule. Do not take two doses to make up for one missed.
Delaying escalation: The prescribing information explicitly allows staying at a lower dose for an additional 4 weeks before moving up if GI side effects are bothersome. This is built into the label, not a workaround. Slower escalation does not hurt the final outcome.
Why Does the Dose Start So Low?
Semaglutide’s main mechanism — slowing gastric emptying — is also the source of its most common side effects.
Nausea, vomiting, and stomach discomfort from semaglutide come from the same place the weight-loss effect comes from: the drug slowing down how fast food moves through the digestive tract. At full dose, that effect is significant, and hitting it all at once causes most people severe nausea.
The step-up schedule exists to build GI tolerance gradually. The stomach and gut adapt to each dose level over the four-week period, so the jump to the next one is smaller than it would feel if you started at 2.4 mg cold. By the time most people reach the maintenance dose, the worst of the GI effects has passed.
Nausea peaks around dose increases and typically eases within the next two to four weeks at the new dose. For a breakdown of which side effects show up at which point in treatment, see semaglutide side effects: timeline and what eases them.
Semaglutide Doses Across All Brands
Same molecule, different forms and dose ceilings depending on what the product is approved for.
| Brand | Form | Titration | Max Approved Dose | Indication |
|---|---|---|---|---|
| Wegovy (injection) | Weekly subcutaneous injection | 0.25 → 0.5 → 1.0 → 1.7 → 2.4 mg (every 4 weeks) | 2.4 mg/week (or 7.2 mg with Wegovy HD) | Chronic weight management |
| Wegovy (oral tablet) | Daily oral tablet | 1.5 → 4 → 9 → 25 mg (every 4 weeks) | 25 mg/day | Chronic weight management (adults, approved Dec 2025) |
| Ozempic | Weekly subcutaneous injection | 0.25 mg (4 wks, initiation only) → 0.5 mg → 1.0 mg → 2.0 mg | 2.0 mg/week | Type 2 diabetes; cardiovascular risk reduction |
| Rybelsus | Daily oral tablet | 3 mg (30 days) → 7 mg (30+ days) → 14 mg if needed | 14 mg/day | Type 2 diabetes; cardiovascular risk reduction |
Ozempic is sometimes prescribed off-label for weight loss, but its dose ceiling (2.0 mg) is lower than Wegovy’s (2.4 mg), and it is not FDA-approved for that use. The dose difference matters clinically: the STEP trials showed a dose-response relationship, with higher doses producing greater weight loss. For the practical differences between Ozempic and Wegovy, see is Wegovy the same as semaglutide.
What If You Can’t Tolerate a Dose Increase?
The label gives you two options. Neither one is giving up on treatment.
Option 1: Delay escalation. Stay at your current dose for an extra four weeks. The FDA prescribing information for Wegovy explicitly includes this as a labeled option, not an off-label workaround. For people with more sensitive GI systems, a 32-week titration to 2.4 mg is as valid as the standard 16-week path.
Option 2: Permanently stay at 1.7 mg. The Wegovy label lists 1.7 mg weekly as an approved maintenance dose for people who cannot tolerate 2.4 mg. Clinical trials showed meaningful weight loss at 1.7 mg — not as much as 2.4 mg, but the drug is still working. This is not a failure; it is a labeled alternative.
What is not in the label is dropping back to a previous dose mid-titration. That tends to reset the tolerance the body had built up, which can make re-escalating harder. If side effects are severe enough that you are thinking about stopping, that is a conversation for your prescribing provider rather than a self-managed step back.
For context on what the nausea and other GI effects typically feel like and how long they last, the side effects timeline page walks through it week by week: semaglutide side effects.
When Does the Weight Loss Actually Show Up?
Appetite suppression comes early. Significant weight loss takes longer.
Most people on Wegovy notice reduced appetite within the first few weeks, sometimes as early as week two or three, even at the low initiation dose. But the scale tends to move more slowly than the appetite change would suggest, especially early in titration when nausea is blunting calories in and also making it harder to eat enough protein and stay active.
Meaningful weight loss — the kind visible in trial data — builds across the full titration and continues at maintenance. The landmark STEP 1 trial showed approximately 5–9% body-weight loss by week 20, reaching a mean of about 15% at week 68. The curve does not flatten until well past the point when most people expect results to plateau.
Wegovy HD’s STEP UP trial, published before the March 2026 approval, showed a mean 20.7% body-weight loss at 72 weeks, with roughly one in three participants losing 25% or more. That trial enrolled people who had already been on standard semaglutide, which is why the HD dose requires ≥4 weeks at 2.4 mg before stepping up.
For the week-by-week breakdown of what to expect from the first injection through the maintenance phase, see how long does semaglutide take to work.