A semaglutide weight loss dosage chart looks simple on paper, but the schedule behind it does real clinical work. Semaglutide for weight management is not dosed at full strength on day one. It climbs slowly over roughly four months, and that slow climb is the main reason most people tolerate it. This guide lays out the standard Wegovy titration schedule, explains why each step exists, and covers what to do when side effects show up.
The standard semaglutide titration schedule
For Wegovy, the FDA-approved semaglutide for weight management, the labeled schedule steps the weekly dose up every four weeks. Each injection is given once a week under the skin.
- Weeks 1 to 4: 0.25 mg once weekly. This starting dose is not meant to drive weight loss. It is meant to let your gut adjust.
- Weeks 5 to 8: 0.5 mg once weekly.
- Weeks 9 to 12: 1.0 mg once weekly.
- Weeks 13 to 16: 1.7 mg once weekly.
- Week 17 onward: 2.4 mg once weekly, the maintenance dose.
The full escalation takes about 16 weeks before you reach 2.4 mg. That maintenance dose is the one studied in the largest trials, and it is where the strongest results were seen.
Why the dose steps up so slowly
The slow titration is not caution for its own sake. It directly reduces gastrointestinal side effects, which are the most common reason people stop early.
Semaglutide slows gastric emptying. Start too high and the result is nausea, vomiting, diarrhea, or constipation strong enough to make people quit. Stepping the dose up over months gives the digestive system time to adapt at each level. You can read more about the underlying biology in our breakdown of how semaglutide works.
This is also why your clinician may hold you at a given step longer than four weeks. The schedule is a default, not a mandate. A slower climb is a legitimate clinical choice.
The adaptation is real, not imagined. The nausea that hits hard in week one at a new dose often fades over the following weeks at that same dose, as gastric emptying recalibrates. That is the entire logic of titration. You are not just waiting out side effects, you are giving the gut time to reset its baseline before you ask more of it. People who quit semaglutide in the first month often quit during a dose jump, before that adaptation had a chance to happen.
What 2.4 mg actually does
The 2.4 mg maintenance dose is the one backed by the STEP trial program. In STEP 1, published in the New England Journal of Medicine in 2021, adults on semaglutide 2.4 mg lost an average of about 15 percent of body weight over 68 weeks, compared with roughly 2.4 percent on placebo. That is the efficacy the full titration is climbing toward.
It is worth saying plainly that not everyone reaches or needs 2.4 mg. Some people respond well at 1.0 mg or 1.7 mg and stay there. The target dose is whatever balances results against tolerability for you, which is a clinical decision, not a fixed number on a chart.
When 2.4 mg is not reached
There are a few common reasons the full dose never becomes the right dose.
- Side effects cap the climb. If 1.7 mg produces good results without intolerable nausea, there may be no reason to push to 2.4 mg. The lower dose becomes the maintenance dose.
- Supply or formulation differences. Compounded products may not offer the exact milligram steps the branded schedule uses, so the practical ladder looks different.
- Adequate response at a lower step. Some people meet their goals before reaching the top of the schedule and hold steady there.
None of these is a failure. The schedule is a tool for finding your dose, not a finish line you have to cross. A plateau at a lower step that you tolerate well is often a better outcome than a top dose you cannot sustain.
What to do if side effects hit
Side effects are most common in the days after a dose increase. The right response is rarely to push through at full speed.
- Hold, do not jump. If a new dose is rough, staying at your current dose for an extra few weeks is often the fix. There is no rule that you must increase exactly on week four.
- Never skip then double. If you miss a weekly dose, do not take two to catch up. Doubling concentrates the side effects without improving results.
- Manage GI symptoms. Smaller meals, eating slowly, and avoiding greasy or very large meals reduce nausea for many people.
- Flag the serious stuff. Severe abdominal pain, persistent vomiting, or signs of dehydration are reasons to contact your clinician promptly, not to wait out.
Semaglutide carries a boxed warning regarding thyroid C-cell tumors based on rodent studies. It should not be used by people with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2. Your intake review exists to catch exactly these contraindications.
Notes on compounded semaglutide dosing
Compounded semaglutide does not always follow the Wegovy milligram schedule. Concentrations and units can differ between pharmacies, and some are dosed in units rather than milligrams, which creates room for error if a patient self-adjusts. If you are using a compounded product, the dosing instructions from your specific clinician and pharmacy override any general chart, including this one. We cover the wider context in our look at compounded GLP-1 options.
The unit-versus-milligram point deserves emphasis. A vial labeled in units, with a draw-up instruction on a syringe, is a different mental model from a fixed-dose pen, and confusing the two is a real way people end up dosing wrong. If your compounded plan ever feels ambiguous, that is a question for your clinician before your next injection, not a guess to make on your own.
Choosing between semaglutide and other options
Semaglutide is one of two leading GLP-1 medications for weight. Tirzepatide follows a different titration ladder and showed larger average weight loss in its trials. Neither is automatically better for every person. Our comparison of tirzepatide vs semaglutide walks through the trade-offs, and our GLP-1 cost guide covers the price differences that often shape the decision.
However your plan takes shape, the dosing should be individualized. A chart gives you the map. A clinician reading your labs, history, and response is what turns it into a route. The broader framework for medically supervised weight loss is built around that supervision, and our overview of GLP-1 therapy ties it together.
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This article is educational. It is not medical advice and does not substitute for a provider-patient relationship. A KAYU clinician will evaluate your individual history before recommending any treatment.