Wegovy Starting Dose: What Your Doctor Will Prescribe

Your doctor will start you on Wegovy at 0.25 mg injected once weekly. This is universal. Every patient begins at the same dose regardless of body weight, BMI, or how much weight they want to lose. The 0.25 mg phase lasts four weeks and serves as a tolerability window, giving your body time to adjust to semaglutide before moving through four additional dose increases over the following months. It’s a deliberately slow start, and there are very good reasons for that.

Wegovy’s Five-Step Dosing Schedule

Wegovy has the most structured escalation of any GLP-1 weight loss medication currently available. Each step uses a separate, pre-filled auto-injector pen:

• Step 1 (Weeks 1 through 4): 0.25 mg weekly
• Step 2 (Weeks 5 through 8): 0.5 mg weekly
• Step 3 (Weeks 9 through 12): 1 mg weekly
• Step 4 (Weeks 13 through 16): 1.7 mg weekly
• Step 5 (Week 17 and beyond): 2.4 mg weekly (maintenance dose)

That’s 16 weeks, or roughly four months, to reach the full therapeutic dose. Each step lasts exactly four weeks in the standard protocol, though your provider can extend any step if side effects need more time to settle.

The five-step design came directly from the STEP clinical trial program. Researchers tested this escalation schedule across multiple large trials and found it produced the optimal balance between tolerability and efficacy. Patients who followed the gradual approach had significantly lower dropout rates from GI side effects compared to accelerated protocols tested in earlier phase studies.

One thing that catches people off guard: each dose step requires a different pen. Wegovy pens are single-dose auto-injectors, and they’re not adjustable. Your 0.25 mg pen only delivers 0.25 mg. When you move to 0.5 mg, you get a completely new set of pens. This is different from Ozempic, which uses a multi-dose dial pen. It’s a minor logistical detail, but worth knowing so you’re not confused when your pharmacy sends you what looks like a different product every month.

What 0.25 mg Does (and Doesn’t Do)

At the starting dose, semaglutide is active in your body but working at a fraction of its full capacity. Think of it as the medication introducing itself to your system.

What it does: Semaglutide begins binding to GLP-1 receptors in your gut, pancreas, and brain. Gastric emptying starts to slow slightly. Insulin signaling becomes marginally more efficient. The appetite-regulating centers in your hypothalamus start receiving new input. Your body begins the process of adjusting to these changes at a cellular level.

What it doesn’t do at this dose: Produce significant appetite suppression for most people. Drive meaningful weight loss. Dramatically change your relationship with food. Eliminate cravings. These effects develop progressively as the dose increases.

Some people do notice changes at 0.25 mg. You might feel a bit less hungry between meals, find that rich foods are slightly less appealing, or notice you’re satisfied with less at dinner. But if you feel absolutely nothing different, that’s the more common experience at this dose and it’s completely normal.

The purpose of Step 1 isn’t results. It’s preparation. Your GI tract is learning to function with slower motility. Your metabolic systems are recalibrating. When you jump to 0.5 mg in week five, your body will handle that increase far better than it would have if 0.5 mg had been your very first dose.

What Each Dose Step Feels Like

Since Wegovy’s escalation is so structured, it helps to know what most people experience at each level. Everyone’s response is individual, but broad patterns emerge consistently from clinical data and real-world patient reports.

Step 1 (0.25 mg): The adjustment period. Mild side effects or none at all. Minimal appetite changes. This is your baseline-setting phase. The biggest challenge is often psychological, wanting to see results and not seeing them yet.

Step 2 (0.5 mg): Things start to click. Most people notice appetite reduction here. Portions naturally decrease. The first consistent weight loss often begins during this step. GI side effects may bump up briefly after the dose change but usually settle within a week. This is where many people first feel that the medication is “doing something.”

Step 3 (1 mg): The momentum builder. Appetite suppression strengthens further. Weight loss typically accelerates. Food noise continues to quiet. This is also where some people experience their most challenging side effect adjustment, since the jump from 0.5 mg to 1 mg is a doubling of the dose. Nausea, if it occurs, tends to be more noticeable at this step than at previous ones.

Step 4 (1.7 mg): Approaching full strength. Strong appetite control. Consistent weekly weight loss for most people. GI adjustment is usually milder at this step because your body has already adapted through three previous increases. Some people find this dose provides enough benefit that they discuss staying here rather than advancing to 2.4 mg.

Step 5 (2.4 mg): Maintenance dose. Maximum appetite suppression and full therapeutic effect. This is where the STEP trials measured their primary outcomes, and it’s where the average 15% body weight loss was achieved over 68 weeks. Not everyone needs 2.4 mg. Your provider will help determine whether the maintenance dose that’s right for you is 2.4 mg or something lower.

Why You Can’t Rush the Escalation

The desire to skip ahead is understandable. Four months to reach full dose feels like a long time when you’re motivated and ready for change. But the escalation schedule exists to protect you, not to slow you down unnecessarily.

Semaglutide’s most common side effects are gastrointestinal: nausea, vomiting, diarrhea, and constipation. These effects are dose-dependent, meaning they get more intense at higher doses. They’re also adaptation-dependent, meaning your body handles them better when it’s had time to adjust gradually.

The STEP 1 trial data is instructive here. Even with the gradual escalation, about 44% of participants on Wegovy reported nausea at some point during the study. Most cases were mild to moderate and resolved with time. But the rate of treatment discontinuation due to GI side effects was only about 7%. That relatively low dropout rate is directly attributable to the slow titration schedule.

When patients in earlier studies were escalated more aggressively, discontinuation rates were substantially higher. The math is simple: a patient who quits treatment in month one because the side effects were unbearable loses zero weight. A patient who spends four months gradually escalating and then stays on treatment for a year or more can lose 15% or more of their body weight. The slower start leads to a better finish.

Practical Tips for the Starting Dose Phase

These strategies work at 0.25 mg and remain relevant through every dose increase.

Pick your injection day thoughtfully. You’ll inject Wegovy on the same day each week. Some people choose a day when they can take it easy the following day, just in case side effects are noticeable. Others prefer midweek so they feel their best on weekends. There’s no medically superior choice. Pick whatever fits your life.

Eat before you learn not to. At 0.25 mg, you probably won’t need to modify your eating much. Use this month to observe your baseline habits. Notice your meal timing, portion sizes, snacking patterns, and trigger foods. This awareness becomes valuable when higher doses start suppressing your appetite and you need to make deliberate choices about what to eat with a smaller appetite window.

Start a protein habit now. One of the most common concerns with GLP-1 weight loss is muscle loss. Eating adequate protein (at least 25 to 30 grams per meal) helps protect lean mass. Building this habit during the low-dose phase, when your appetite is still mostly normal, is much easier than trying to prioritize protein after higher doses have drastically reduced your hunger.

Begin or maintain an exercise routine. Resistance training is particularly important during GLP-1 treatment to combat the muscle loss that can accompany rapid weight loss. You don’t need an intense program. Even two to three sessions per week of basic strength work makes a meaningful difference. The results patients see over three months and beyond are strongly influenced by whether they incorporate activity alongside the medication.

Don’t weigh yourself obsessively. Once a week is plenty during the starting phase. Daily weigh-ins at 0.25 mg will show normal fluctuations that have nothing to do with the medication, and they’ll just create frustration.

Wegovy vs. Compounded Semaglutide: Starting Dose Flexibility

Brand-name Wegovy locks you into the five fixed dose steps. Compounded semaglutide offers the same active ingredient with significantly more dosing flexibility, since it’s drawn from a vial rather than delivered through a pre-set auto-injector.

This flexibility matters in a few ways. If you’re especially sensitive to GI medications, your provider could start you below 0.25 mg. If the jump from 0.5 mg to 1 mg is too aggressive, they could add an intermediate 0.75 mg step. If you find your ideal maintenance dose is somewhere between 1.7 mg and 2.4 mg, compounded semaglutide lets you land there precisely.

The cost difference is also significant. Wegovy’s list price without insurance is over $1,300 per month. Compounded semaglutide through TrimRx is a fraction of that, making sustained treatment financially realistic for more people.

Getting Started

Whether you choose brand-name Wegovy or compounded semaglutide, the path begins with a provider evaluation. Checking your eligibility takes a few minutes and connects you with a provider who can determine the right medication and dosing approach for your goals and health history.

The 0.25 mg starting dose is small, and the first month will test your patience. But every person who’s achieved significant results on Wegovy started exactly where you’re starting. The dose escalation is the process, and trusting it is the first step toward the results you’re after.

This information is for educational purposes and is not medical advice. Consult with a healthcare provider before starting any medication. Individual results may vary.