Wegovy uses a five-step dosing schedule that starts low and gradually increases over about four months. The starting dose is 0.25 mg once per week, and the final maintenance dose is 2.4 mg once per week. Each step lasts four weeks, giving your body time to adjust before the dose goes up.
The Five Dose Steps
Every Wegovy prescription follows the same escalation pattern. You inject once per week at each level for four weeks before moving to the next:
- Month 1: 0.25 mg per week
- Month 2: 0.5 mg per week
- Month 3: 1.0 mg per week
- Month 4: 1.7 mg per week
- Month 5 and ongoing: 2.4 mg per week (maintenance dose)
Each dose level comes as a separate prefilled pen, so you’ll pick up a new pen strength roughly every month during the escalation phase. The 2.4 mg dose is where the significant weight loss effects occur, but the earlier steps are essential for tolerability.
Why the Dose Increases Gradually
The gradual ramp-up exists because of how Wegovy works in your body. It mimics a natural gut hormone that slows stomach emptying and signals fullness to your brain. That slower digestion is part of why it reduces appetite, but it’s also the main reason for side effects. Nausea affects about 44% of people on Wegovy. Diarrhea hits around 30%, vomiting 24%, and constipation 24%. Stomach pain occurs in roughly 20% of users.
These side effects tend to be worst at the beginning of treatment and when your dose jumps up. Starting directly at the full 2.4 mg dose would make those effects far more intense for most people. The four-week windows at each level let your digestive system adapt gradually. If side effects are particularly rough at a given dose, your prescriber may keep you at that level for longer than four weeks before moving up.
What the Maintenance Dose Achieves
The 2.4 mg maintenance dose is the target because that’s where clinical trials demonstrated meaningful weight loss. In a major 68-week trial of adults with overweight or obesity and type 2 diabetes, participants on the 2.4 mg dose lost an average of 9.6% of their body weight, compared to 3.4% in the placebo group. That’s a net difference of about 6.2 percentage points attributable to the medication itself. Results tend to be even larger in people without type 2 diabetes.
Weight loss at the lower escalation doses is minimal. Those steps are building blocks, not therapeutic doses in their own right. If you stop escalating at 1.0 mg or 1.7 mg, you won’t see the same results the drug was designed to deliver.
Who Qualifies for Wegovy
Wegovy is FDA-approved for adults with a BMI of 30 or higher (obesity), or a BMI of 27 to 29.9 (overweight) with at least one weight-related health condition such as high blood pressure, type 2 diabetes, or high cholesterol. It’s also approved for adolescents aged 12 and older with obesity. The prescription is meant to be used alongside a reduced-calorie diet and increased physical activity.
What to Do If You Miss a Dose
If you miss your scheduled injection day, take it as soon as you can within a few days. Then adjust your next dose so your injections stay about a week apart. The key rule: never take two doses in the same week.
If you’ve gone more than two weeks without a dose, don’t just resume at the same level. After that long a gap, restarting at your current dose can trigger a wave of gastrointestinal side effects, similar to what you’d feel jumping to a higher dose too quickly. Contact your prescriber to discuss whether you need to step back down and re-escalate.
Injection Sites and Storage
You inject Wegovy under the skin in one of three areas: the front of your thigh, your lower stomach (at least two inches from your belly button), or the back of your upper arm. You can use the same general area each week, but rotate the exact spot to avoid skin irritation or tissue changes. Skip any skin that’s bruised, red, hard, or scarred.
Store your pens in the refrigerator between 36°F and 46°F in their original carton. If you’re traveling or otherwise can’t refrigerate them, Wegovy pens can stay at room temperature for up to 28 days, as long as the temperature stays below 86°F and the pen is kept away from direct light. Don’t use a pen that has been frozen.