Why Wegovy Uses a Stepwise Dose Escalation Approach
Gradual titration is essential for safety and tolerability. Semaglutide affects GLP-1 receptors in multiple tissues, particularly the gut and pancreas, which can cause gastrointestinal side effects. Slowly increasing the dose helps the body adapt and reduces risks of nausea, vomiting, diarrhoea, or more serious complications.
Reasons for Gradual Dose Escalation
- Individual response: Some patients benefit at lower doses, while others need the maximum 2.4mg or the new 7.2mg for optimal results.
- Personal preference: Some patients prefer gradual weight loss, while others want faster results within safe limits.
- Cost considerations: Lower doses may be chosen for affordability while still achieving benefits.
- Safety: Gradual escalation minimizes side effects and maximizes adherence to treatment.
The Science Behind Gradual Dose Increases
Semaglutide mimics the natural GLP-1 hormone, secreted by intestinal L-cells, pancreatic alpha cells, and the central nervous system. It binds to GLP-1 receptors with 60% of native hormone affinity, reducing appetite and slowing digestion. GI side effects occur in roughly 25% of patients initially but are mostly mild or moderate.
The Current Wegovy Dosing Schedule (Up to 2.4mg)
- 0.25mg – 4 weeks
- 0.5mg – 4 weeks
- 1mg – 4 weeks
- 1.7mg – 4 weeks
- 2.4mg – 4 weeks
It takes approximately 20 weeks to reach 2.4mg. Some patients remain on lower doses temporarily to manage side effects before escalating further.
Dose Escalation to 7.2mg
Step-Up Sequence
Patients can now move from 2.4mg directly to 7.2mg. Early STEP UP trial data supports the safety and effectiveness of this higher dose for patients who need additional weight loss or have plateaued at lower doses.
Safety Monitoring and Side Effects
The 7.2mg dose may increase GI side effects, though most remain mild. Serious complications are rare. Patients are monitored closely by clinicians to ensure a safe and effective escalation.
What Higher Doses Mean for Patients and Providers
Enhanced Efficacy and Plateau Management
Higher doses allow for greater weight reduction — many patients achieve over 20% weight loss. For some, weight may plateau at 2.4mg, while others benefit from the additional 7.2mg dose to continue progressing.
“Semaglutide 7.2 mg was superior to placebo and 2.4 mg for bodyweight reduction in adults with obesity, while retaining a favourable risk–benefit profile.” – Wharton et al., The Lancet Diabetes & Endocrinology, 2024
Key Takeaways
- Gradual dose escalation is the safest way to achieve long-term weight loss goals.
- Patients’ responses vary and dosing must be tailored individually.
- Side effects are common but manageable under medical supervision.
- Patients must be on 2.4mg before moving to 7.2mg.
- 7.2mg has shown superior efficacy in early trial data for plateau management.
Suggested External References & Sources
- NICE TA875 — Semaglutide for managing overweight and obesity
- NICE NG246 — Obesity: identification, assessment and management (2025)
- MHRA / GOV.UK — GLP-1 medicines for weight loss and diabetes
- Society for Endocrinology (UK) — Joint position statement on medical therapies for obesity
Disclaimer
This article is for informational purposes only and is not a substitute for professional medical advice. Always consult a qualified healthcare professional before starting or changing any medication.
