The Wegovy dosage schedule is a five-step ladder. You start at 0.25 mg once a week — about one-tenth of the full dose — and climb every 4 weeks until you reach 2.4 mg at week 17. That slow ramp is written into the FDA prescribing information, and it exists for one reason: your gut needs time to adjust.
But the schedule is more than a medical detail. At some telehealth programs, your dose sets your bill — Ro’s Wegovy pen runs $199 to $399 a month depending on strength. So the same titration chart that manages your nausea also manages your budget. Here is the full ladder, the missed-dose rules, and the pricing fine print nobody reads.
The Wegovy Dosage Schedule at a Glance
Wegovy is semaglutide 2.4 mg, FDA-approved in June 2021 for chronic weight management — the first new weight-loss drug approval since 2014, per the FDA’s announcement. The label lays out the titration in five fixed steps, each lasting 4 weeks.
Here is the schedule straight from the FDA prescribing information:
| Step | Weeks | Once-weekly dose | Share of full dose |
|---|---|---|---|
| 1 | Weeks 1-4 | 0.25 mg | ~10% |
| 2 | Weeks 5-8 | 0.5 mg | ~21% |
| 3 | Weeks 9-12 | 1 mg | ~42% |
| 4 | Weeks 13-16 | 1.7 mg | ~71% |
| 5 | Week 17 onward | 2.4 mg (maintenance) | 100% |
Do the math: 16 weeks of climbing before a single week at the full dose. Each strength comes as its own prefilled, single-dose pen, so a dose change means a different pen — and often a different price. The 2.4 mg maintenance dose is the one that produced an average 14.9% body-weight loss over 68 weeks in the STEP 1 trial published in the New England Journal of Medicine.
Why Wegovy Starts Low and Climbs Slowly
Semaglutide is a GLP-1 receptor agonist. Cleveland Clinic explains that these drugs slow stomach emptying and act on appetite signals — which is exactly why they cause nausea, vomiting, and diarrhea when the dose jumps too fast.
The titration is the built-in fix. Starting at 0.25 mg — roughly 10% of the maintenance dose — lets your digestive system adapt before each increase. The FDA label is explicit that the 0.25 mg dose is for treatment initiation only; it is not intended to control weight by itself.
That last point matters for expectations. Your first month is priming, not peak effect. If the scale barely moves in weeks 1-4, you are not failing — you are on step one of five, at a tenth of the studied dose.
Missed Dose Rules: The 48-Hour Cutoff
Life happens. The FDA label has three clean rules for a missed Wegovy shot, and they all hinge on 48 hours.
Rule 1: If your next scheduled dose is more than 2 days (48 hours) away, take the missed dose as soon as you remember. Then return to your regular day.
Rule 2: If your next scheduled dose is less than 2 days away, skip the missed one entirely. Never double up to catch up — two doses inside 48 hours is exactly what the label is built to prevent.
Rule 3: If you miss more than 2 weekly doses in a row, the label says you can resume as scheduled — or your prescriber may restart you on the escalation schedule to keep gastrointestinal side effects down. After a multi-week gap, jumping straight back to 2.4 mg can feel like week one all over again, so make that call with your clinician, not alone.
Bonus flexibility: you can switch your injection day whenever you want, as long as at least 2 days pass between doses. Moving from Sunday shots to Friday shots is fine — just keep the 48-hour spacing.
When the Wegovy Dosage Schedule Needs Adjusting
The 4-week steps are the default, not a deadline. The FDA label builds in two escape valves for people who struggle at a given step.
Valve 1 — pause the climb. If a new dose is rough, the label says to consider delaying the next escalation by 4 weeks. That can stretch the ladder from 16 weeks to 20 or more. Slower is allowed; there is no penalty for taking 5 or 6 months to reach maintenance.
Valve 2 — step down temporarily. If the full 2.4 mg dose is intolerable, the label allows a drop back to 1.7 mg for a maximum of 4 weeks, then a return to 2.4 mg. If you still cannot tolerate 2.4 mg after that, the original label’s instruction is blunt: discontinue Wegovy.
Real-world prescribing can be more flexible than the label text, but that is a prescriber decision. What you should not do is self-adjust — splitting doses, stretching pens, or skipping weeks to save money changes both your side-effect risk and your results. Roughly 1 in 5 weeks of your first four months is a dose-change week; keep your clinician in the loop for each one.
Higher Dose, Higher Bill: The Pricing Fine Print
Here is what the titration chart does not tell you: at several telehealth programs, every step up the ladder can raise your monthly price.
Ro is the clearest example. Its Wegovy pen costs $199 the first month, then $199 to $399 a month depending on dose, and Ro’s own site FAQ states that the price of Wegovy increases for higher doses. Since the FDA schedule pushes everyone toward 2.4 mg, the top-dose price is the realistic long-term number — a potential $200/month (100%) jump from the intro rate, before Ro’s $149/month membership.
Hers works the same way: Wegovy pens are listed from $199 a month, with from-pricing that climbs by dose and a $149/month membership on top — about $303 a month all-in at the cheapest medication tier, per third-party pricing reports. Meanwhile, some compounded-semaglutide sellers advertise the opposite model: bmiMD promotes the same price at every dose from $99 a month on a 12-month prepaid plan, and MEDVi charges flat $299 refills — though those are compounded products, not Wegovy, and they are not FDA-approved.
The takeaway: never budget off month one. Price the 2.4 mg maintenance dose — the full breakdown is in our guide to Wegovy cost without insurance.
Wegovy vs Zepbound: Two Different Ladders
Wegovy’s main rival climbs differently. Zepbound (tirzepatide), FDA-approved for chronic weight management in November 2023, starts at 2.5 mg weekly for 4 weeks, then moves to 5 mg, with further increases in 2.5 mg steps after at least 4 weeks each.
The biggest structural difference: Zepbound has three maintenance doses — 5, 10, or 15 mg — while Wegovy’s label targets a single 2.4 mg maintenance dose (with 1.7 mg only as a temporary step-down). That gives Zepbound prescribers more places to park a patient who is losing well at a middle dose.
The trial numbers differ too. STEP 1 reported an average 14.9% body-weight loss at 68 weeks for semaglutide 2.4 mg; the SURMOUNT-1 trial reported up to 20.9% at 72 weeks on tirzepatide’s highest dose. Different drugs, different trials, different timeframes — not a head-to-head. For the full week-by-week tirzepatide ladder, see our Zepbound dosage schedule guide.
Compounded Semaglutide Doses Are a Different Story
One more fine-print warning. Compounded semaglutide — the versions sold for $99 to $299 a month by many telehealth programs — is not FDA-approved, and the FDA has not reviewed it for safety, effectiveness, or quality.
Dosing is where that gap bites. Wegovy ships in fixed-dose pens; many compounded products ship as multi-dose vials with syringes, and concentrations vary from pharmacy to pharmacy. The FDA’s alert on unapproved GLP-1 drugs reports dosing errors with compounded semaglutide, including patients drawing several times the intended amount.
If you choose the compounded route to save money, treat the dose math as a safety task. Confirm the milligrams — not just the units on the syringe — at every titration step, and vet the seller as carefully as the price. Our ranking of the best semaglutide programs flags which programs disclose their pharmacies and which do not.
What Results to Expect Along the Way
Set your expectations to the calendar, not the ads. In STEP 1, the average 14.9% loss took 68 weeks — and the first 16 of those weeks were spent below the full dose. NIDDK’s guidance on prescription weight-loss drugs frames these medications the same way: tools that work over months alongside diet and activity, not quick fixes.
A realistic arc looks like this. Weeks 1-8 at 0.25-0.5 mg: appetite quiets for many people, but weight change is usually modest. Weeks 9-16 at 1-1.7 mg: effects build as the dose approaches 71% of maintenance. Week 17 onward at 2.4 mg: the dose that generated the trial results — and trial averages are averages, not guarantees; plenty of people lose more or less.
Two practical rules to finish. First, judge the drug at maintenance, not during titration — quitting at week 6 tests 21% of the dose. Second, track your response monthly with your prescriber, because dose tweaks, pauses, and step-downs are all normal parts of the schedule. For the week-by-week timeline across every GLP-1, see how fast GLP-1s work.