What is the recommended dose escalation schedule for Wegovy?

A typical schedule is once weekly stepping from 0.25 mg → 0.5 mg → 1.0 mg → 1.7 mg → 2.4 mg in staged intervals. The step-ups reduce stomach-related side effects and allow your routine to bed in. If symptoms persist, clinicians may extend a step or pause before moving on; some people remain at 1.7 mg if that’s the best balance of benefit and comfort. Follow the plan your service provides — don’t jump steps or compress intervals.

Why dose escalation matters

Wegovy (semaglutide) is introduced gradually so the body can adjust. NICE TA875 and NHS England’s 2025 weight-management framework explain that stepwise increases balance effectiveness with tolerability. Semaglutide mimics the GLP-1 hormone, which slows digestion and reduces appetite; increasing too quickly can intensify nausea or vomiting. The STEP clinical trials used the same gradual method that informed UK approval and showed higher adherence when the dose ladder was followed carefully.

The standard titration schedule

Most people start on 0.25 mg once weekly for four weeks, then move through 0.5 mg, 1.0 mg, 1.7 mg, and finally 2.4 mg as maintenance. This pattern reflects NICE and MHRA guidance as well as the STEP-1 and STEP-5 trial designs, where participants typically reached 2.4 mg by week 17. The ladder is flexible: clinicians may hold or extend a step if symptoms persist, or if life circumstances make adjustment difficult. Many people remain at 1.7 mg long-term when that provides steady benefit without extra side effects.

What happens at each stage

Each stage gives the body time to adapt. Early on, some people feel mild nausea, early fullness, or light reflux, which usually settle after a few weeks. By 1.0–1.7 mg, appetite control becomes more noticeable and side effects ease. At 2.4 mg, most people reach stable effectiveness. NICE highlights that taking longer between steps does not reduce long-term results, since weight loss continues steadily once the maintenance phase is achieved.

The importance of pacing and review

Clinicians personalise timing based on how you feel. If nausea or reflux appear, they might pause escalation, adjust meal timing, or recommend symptom support. NHS and SMC guidance emphasise that tolerability and consistency matter more than speed. STEP-5 trial results confirm that slower escalation achieved similar outcomes to the standard timetable. NHS services review progress around week 16 and again at six months to confirm benefit and comfort before continuing. Reviews cover appetite, digestion, energy, and general wellbeing, not only weight.

Avoiding common mistakes

The main pitfalls are skipping steps, doubling doses after a missed injection, or rushing ahead when symptoms are mild. These missteps often cause nausea, dehydration, or vomiting. The MHRA and NHS both advise following the plan exactly and using official missed-dose guidance instead of guessing. Higher doses do not guarantee faster progress; many people remain comfortable and successful at 1.7 mg for months or longer.

Practical tips for smooth progression

Small lifestyle habits make step-ups easier. Eat smaller, balanced meals, stay hydrated, and avoid very heavy or spicy foods around injection days. Plan dose increases during calmer weeks so your body can adjust. Rotating injection sites and using a new needle each time helps reduce irritation. Keeping a brief dose diary can also make clinic discussions quicker and more precise.

How clinicians judge readiness for maintenance

Before confirming 2.4 mg as your steady dose, your team will review side effects and benefits. NICE TA875 and NHS commissioning guidance outline continuation checks after about 16–20 weeks, looking for meaningful progress such as improved appetite control, lower blood pressure, or reduced waist circumference. If 1.7 mg remains comfortable and effective, that dose can be maintained long term. Success is defined by improved health and adherence, not by reaching the top of the ladder.

What the evidence shows overall

The STEP-1 and STEP-5 trials found that supervised, gradual escalation of semaglutide led to average weight loss of about 15% at 68 weeks. SELECT (Lancet, 2024) confirmed additional cardiovascular benefits in people with existing heart disease. These findings underpin NICE and NHS recommendations: climb the dose ladder patiently, communicate with your team, and let your body guide the pace. Safe escalation, steady monitoring, and lifestyle balance make Wegovy’s results both effective and sustainable.