The maximum dose of Wegovy as a weekly injection is 2.4 mg, which is the recommended maintenance dose for most adults. A newer oral (pill) form of Wegovy has a maximum daily dose of 25 mg. Both versions require a gradual dose increase over several months before reaching their highest levels.
Wegovy Injection: The Dose Escalation Schedule
Wegovy injections aren’t prescribed at the max dose right away. You start low and increase every four weeks to give your body time to adjust and reduce the chance of nausea and other stomach-related side effects. The schedule looks like this:
- Weeks 1 through 4: 0.25 mg once weekly
- Weeks 5 through 8: 0.5 mg once weekly
- Weeks 9 through 12: 1 mg once weekly
- Weeks 13 through 16: 1.7 mg once weekly
- Week 17 and beyond: 1.7 mg or 2.4 mg once weekly (maintenance)
That means it takes at least 16 weeks, roughly four months, before you reach the full maintenance dose. Some people stay at 1.7 mg if that’s effective enough or if they don’t tolerate the higher dose well. The 2.4 mg dose is the one used in major clinical trials, including the SELECT trial that showed a 20% reduction in major cardiovascular events in people with obesity and pre-existing heart disease.
Wegovy Pills: A Different Dosing Structure
The oral version of Wegovy follows a daily dosing schedule rather than weekly injections. You take a pill every day, and the escalation happens over 90 days:
- Days 1 through 30: 1.5 mg daily
- Days 31 through 60: 4 mg daily
- Days 61 through 90: 9 mg daily
- Day 91 and beyond: 25 mg daily (maintenance)
The numbers look much higher than the injection because oral semaglutide is absorbed far less efficiently through the digestive system than a dose injected under the skin. The 25 mg daily pill and the 2.4 mg weekly injection are not interchangeable on a milligram-for-milligram basis.
Side Effects at the Highest Dose
Gastrointestinal side effects are the most common reason people stop taking Wegovy. In clinical trials, 4.3% of people on Wegovy permanently discontinued treatment because of stomach-related problems, compared to just 0.7% on placebo. The specific reactions that drove people to quit were nausea (1.8%), vomiting (1.2%), and diarrhea (0.7%).
These side effects tend to be worst during dose increases, which is exactly why the titration schedule exists. If you experience significant nausea at a given dose, your prescriber may keep you at that level for longer than four weeks before moving up. Eating smaller meals and avoiding high-fat foods can also help manage symptoms during the adjustment period.
What to Do If You Miss a Dose
For the injectable version, the rule is straightforward. If your next scheduled dose is more than 48 hours away, take the missed dose as soon as you remember. If your next dose is less than 48 hours away, skip the missed one and pick back up on your regular day.
If you miss two or more consecutive weekly doses, you can either resume on schedule or restart the titration from the beginning. Restarting the gradual escalation is worth considering because jumping back to a high dose after a gap increases the likelihood of nausea and vomiting.
Who Should Not Take Wegovy
Wegovy is contraindicated in people with a personal or family history of medullary thyroid cancer or a condition called multiple endocrine neoplasia type 2 (MEN-2). In animal studies, drugs in this class caused thyroid tumors, and while the relevance to humans isn’t fully established, the contraindication stands as a precaution. If you have a history of either condition, this medication is not an option at any dose.
Storing Your Wegovy Pen
Wegovy pens should be refrigerated, but if that isn’t possible, they can stay at room temperature for up to 28 days as long as the temperature stays between 46°F and 86°F. You’ll need to throw away a pen if it has been frozen, exposed to direct light, left above 86°F, or kept out of the fridge for longer than 28 days. Each pen is single-use, so once you’ve given yourself an injection, dispose of it according to your pharmacy’s instructions for sharps disposal.