Semaglutide Dosing: The Complete Schedule (0.25mg to 2.4mg)

The semaglutide dose escalation schedule exists for one reason: if you skip ahead, you'll be so nauseous you'll quit. The people who have the worst time on GLP-1s are almost always the ones (or their providers) who tried to speed-run the dosing.

Here's the complete schedule, what happens at each step, and when it's OK to deviate.

The Standard Dose Escalation Schedule

Total time to maintenance: 16 weeks (4 months).

This schedule comes directly from the FDA prescribing information for Wegovy. It's the same schedule used in the STEP clinical trials that produced ~15% average body weight loss. Trust the process.

What to Expect at Each Dose

0.25mg (Weeks 1-4): The Intro

This is deliberately sub-therapeutic for weight loss. The purpose is to let your GI system adjust. Expect:

• Mild nausea in the first few days (manageable for most)
• Subtle appetite changes — nothing dramatic
• Maybe some mild constipation or looser stools
• Weight loss: minimal (0-2 lbs typical)

Don't panic if you don't feel anything dramatic. This dose is about adaptation, not results.

0.5mg (Weeks 5-8): Things Start Working

• Noticeable appetite reduction for most people
• Nausea may return for 2-3 days after the dose increase
• Portion sizes naturally decrease
• Weight loss: 2-5 lbs typical over these 4 weeks
• Cravings start fading, especially evening snacking

1.0mg (Weeks 9-12): Therapeutic Range

• Significant appetite suppression
• Many people notice they "forget to eat"
• Food noise (constant thinking about food) dramatically reduces
• Weight loss accelerates: 4-8 lbs typical over these 4 weeks
• Side effects may flare briefly then settle

Some providers keep patients here if results are good and side effects are manageable. Not everyone needs 2.4mg.

1.7mg (Weeks 13-16): Almost There

• Strong appetite control
• Side effects usually milder than earlier increases (your body has adapted)
• Consistent weight loss trajectory
• Some patients experience a slight plateau before the final increase

2.4mg (Week 17+): Full Maintenance

• Maximum therapeutic dose
• Most clinical trial data is at this level
• Side effects should be at their mildest (fully adapted)
• Weight loss continues for 40-50 more weeks before plateauing
• 15% average total body weight loss by week 68

Why You Absolutely Cannot Skip Steps

We see this constantly: impatient patients (or lazy providers) try to jump from 0.25mg straight to 1.0mg or higher. This is a terrible idea. Here's why:

1. Side effects are dose-dependent. The GI system needs weeks to adapt to each level. Jumping ahead causes severe nausea that can last weeks instead of days.
2. Severe nausea causes people to quit. The #1 reason people abandon GLP-1 treatment is intolerable side effects during escalation. Gradual dosing prevents this.
3. You lose weight at every dose. Even 0.5mg produces meaningful appetite suppression. There's no benefit to rushing — the weight comes off at every level.
4. Dehydration risk. Severe nausea → vomiting → dehydration → potential kidney issues. This cascade starts with skipping doses.

If your provider suggests skipping escalation steps, that's a red flag. Find a provider who follows the standard protocol. See our provider selection guide.

When Your Provider Might Adjust the Schedule

• Slowing down: If side effects are persistent at a dose, staying at that level for 6-8 weeks instead of 4 is common and smart.
• Stopping below max: If you're losing weight at 1.0mg or 1.7mg with minimal sides, there's no clinical reason to push to 2.4mg.
• Switching medications: If semaglutide isn't producing results by 1.0-1.7mg, your provider might suggest switching to tirzepatide instead of pushing to max dose.

Compounded Dosing Notes

Compounded semaglutide may come in slightly different dose configurations than brand-name Wegovy. Some compounders provide a multi-dose vial where you draw the correct amount. Others provide pre-measured doses.

The escalation schedule is the same regardless of source. If your compounded provider suggests a different schedule, ask why. The FDA's recommended escalation exists for a reason.

For tirzepatide dosing, see our tirzepatide dosing guide. For the full comparison between the two medications, check semaglutide vs tirzepatide.