Semaglutide is never started at full strength. Every form of it, from the Ozempic pen to the newer Wegovy pill, begins low and climbs in steps. That slow climb is called titration, and it is the main reason most people can tolerate the drug. Below are the official schedules from each FDA label, laid out week by week, plus what the labels say about missed doses and slowing down.
Key takeaways
- Wegovy injection steps up every 4 weeks: 0.25, 0.5, 1, 1.7, then 2.4 mg once weekly. Full dose is reached at week 17.
- Wegovy HD (7.2 mg weekly) is an optional higher step for adults who have tolerated 2.4 mg for at least 4 weeks.
- Ozempic (for type 2 diabetes) starts at 0.25 mg and can go up to a maximum of 2 mg weekly.
- The Wegovy pill is taken daily and moves through 1.5, 4 and 9 mg before reaching 25 mg.
- Staying longer at a step is common when side effects are rough. Your prescriber decides the pace.
Why titration exists
Semaglutide slows stomach emptying and acts on appetite centers in the brain. Jumping straight to a high dose overwhelms the gut, which is why nausea, vomiting and diarrhea cluster in the days after each increase. Starting low lets the body adapt. The first step, 0.25 mg, is a starter dose. It is not expected to do much for weight or blood sugar on its own.
Wegovy injection schedule (weight management)
| Weeks | Weekly dose | Purpose |
|---|---|---|
| 1 to 4 | 0.25 mg | Starter dose |
| 5 to 8 | 0.5 mg | Escalation |
| 9 to 12 | 1 mg | Escalation |
| 13 to 16 | 1.7 mg | Escalation |
| 17 onward | 2.4 mg (or 1.7 mg) | Maintenance |
| Optional, after at least 4 weeks on 2.4 mg | 7.2 mg (Wegovy HD) | Higher maintenance if more weight loss is clinically indicated |
In adults, the label recognizes 2.4 mg as the standard maintenance dose and allows 1.7 mg for people who can’t tolerate 2.4 mg. A new prescription is needed for each pen strength. The 7.2 mg dose, approved in 2026 as Wegovy HD, produced about 20.7% average weight loss at 72 weeks in the STEP UP trial, compared with about 15% for 2.4 mg in earlier trials.
Ozempic schedule (type 2 diabetes)
| Step | Weekly dose | Minimum time at step |
|---|---|---|
| Start | 0.25 mg | 4 weeks |
| First treatment dose | 0.5 mg | At least 4 weeks before increasing |
| If more glucose control is needed | 1 mg | At least 4 weeks before increasing |
| Maximum | 2 mg | Ongoing |
Ozempic and Wegovy contain the same molecule but are approved for different purposes and come in different pens. They are not interchangeable without a prescriber’s direction.
Wegovy pill schedule (oral semaglutide for weight)
| Days | Daily dose |
|---|---|
| 1 to 30 | 1.5 mg |
| 31 to 60 | 4 mg |
| 61 to 90 | 9 mg |
| 91 onward | 25 mg (maintenance) |
The pill must be taken on an empty stomach in the morning with a small sip of water (no more than 4 ounces), then you wait at least 30 minutes before eating, drinking anything else or taking other pills. Food in the stomach sharply cuts how much semaglutide gets absorbed. The tablets are not equivalent milligram for milligram to the injection.
When to slow down
The 4-week steps are a minimum, not a deadline. Prescribers commonly hold a dose for an extra 4 weeks, or drop back one step, if side effects are hard to manage. Signs that a pause may make sense:
- Nausea or vomiting that keeps you from eating or drinking normally
- Diarrhea lasting more than a few days
- Feeling dizzy or lightheaded, which can signal dehydration
Seek care right away for severe, persistent belly pain that may spread to the back (a possible sign of pancreatitis), pain in the upper right abdomen with fever or yellowing skin (possible gallbladder problems), or signs of dehydration such as very little urine.
Missed doses
- Weekly injections (Wegovy, Ozempic): if it has been 5 days or less since the missed dose, take it as soon as you remember. If more than 5 days have passed, skip it and take the next dose on your usual day.
- Wegovy, several missed doses: the label says that if more than 2 consecutive doses are missed, you may resume as scheduled or, if needed, restart the escalation from a lower step. Ask your prescriber which applies to you.
- Wegovy pill: if you miss a daily dose, skip it and take the next one the following day. Don’t double up.
What about “microdosing”?
Some clinics and social media accounts promote very low weekly doses below the labeled schedule. No large trial has tested this approach for weight loss, so its benefits and risks are not established. Measuring tiny amounts from multi-dose vials also adds room for error. If you are thinking about it, read our peptide math guide to understand units, and talk to your prescriber.
For how semaglutide compares with tirzepatide and retatrutide, see GLP-1s explained. For where to inject, see our GLP-1 injection sites guide.
Frequently asked questions
How long does it take to reach the full Wegovy dose?
On the standard schedule you reach 2.4 mg at week 17, after four 4-week steps. Stepping up to 7.2 mg requires at least 4 more weeks on 2.4 mg.
Can I stay on a lower semaglutide dose?
Yes, with your prescriber. Holding a step longer is common for tolerability, and the Wegovy label allows 1.7 mg as maintenance in adults who cannot tolerate 2.4 mg.
Does 0.25 mg semaglutide cause weight loss?
The 0.25 mg dose is a starter dose meant to help your body adjust. Some people notice reduced appetite, but it is not considered a treatment dose.
What is the maximum dose of semaglutide?
For weight management, the highest approved injection dose is 7.2 mg weekly (Wegovy HD). For type 2 diabetes, Ozempic tops out at 2 mg weekly. The Wegovy pill maintenance dose is 25 mg daily.
What happens if I miss a Wegovy dose?
If 5 days or less have passed, take it when you remember. If more than 5 days have passed, skip it and resume on your regular day.
Sources
- Wegovy (semaglutide) injection and tablets U.S. prescribing information, Novo Nordisk
- Ozempic (semaglutide) injection U.S. prescribing information, Novo Nordisk
- Novo Nordisk, Prescribing Wegovy (NovoMedLink), 2026
- Healio, FDA approves high-dose Wegovy 7.2 mg for adults with obesity, 2026
- Wilding JPH et al., STEP 1, N Engl J Med, 2021
Medical disclaimer: Pep Guide is for educational purposes only. It is not medical advice, diagnosis or treatment. Research changes over time. Talk to a licensed healthcare provider before starting, stopping or changing any medication or compound.