Titration on Wegovy - the 0.25mg to 7.2mg journey

Semaglutide (Wegovy) is titrated up over 16-20 weeks, in more gradual steps than Mounjaro. The current UK doses are 0.25mg, 0.5mg, 1.0mg, 1.7mg, 2.4mg, and since January 2026, 7.2mg. This article walks through what happens at each step.

Why Wegovy titrates more gradually than Mounjaro

The semaglutide molecule has slightly slower pharmacokinetics. The effect builds more slowly, so the titration can be gentler. This is partly why Wegovy is often better tolerated in the first month.

The six-step escalation is intentional: each step allows the gut to adapt before the next increase.

Week 1-4: Wegovy 0.25mg

The starting dose. Pure tolerance; below therapeutic level.

What to expect: very mild appetite effect. Possible light nausea. Most patients feel nothing for the first two weeks; subtle effects start week 3-4.

If you tolerate 0.25mg poorly, we extend this phase for another 2-4 weeks rather than escalate.

Week 5-8: Wegovy 0.5mg

First therapeutic dose. Clear appetite effect becomes noticeable in most patients.

What to expect: food noise quieter, smaller portions more satisfying, sweet foods lose some appeal. Weight loss 2-4kg by end of week 8.

Common side effect window begins. Nausea 3-5 days a week for some patients in this block. Constipation becomes noticeable.

Week 9-12: Wegovy 1.0mg

Step up if well-tolerated. Stronger satiety effect. Most patients report this is where the treatment "really feels like it is working".

What to expect: weight loss 4-7kg by end of week 12 (cumulative). Appetite for sweet or fatty foods markedly reduced. Some patients find they spontaneously prefer simpler meals.

Week 13-16: Wegovy 1.7mg

For patients continuing towards a larger weight-loss goal.

What to expect: further weight loss at 1-1.5kg per month. Side effects usually less prominent now that the body has adapted, though escalation itself can trigger a brief period of renewed nausea.

This is a common hold point for patients targeting 10-15 percent weight loss.

Week 17-20: Wegovy 2.4mg

The standard maintenance dose for most patients on weight management. Roughly equivalent to Mounjaro 10-12.5mg in expected weight loss outcome.

What to expect: cumulative weight loss of 12-17 percent of starting body weight by 68 weeks. Appetite effect is clear and steady.

Most patients reach 2.4mg and stay there. For many this is the right final dose.

The new 7.2mg dose (from January 2026)

Novo Nordisk secured MHRA approval for a higher-dose Wegovy pen (7.2mg weekly) in January 2026, based on the STEP 5 extension data showing an average weight loss of 20.7 percent at 72 weeks at this dose.

This brings semaglutide's efficacy close to tirzepatide's 15mg dose (22.5 percent) and matters for:

Patients who have plateaued at 2.4mg and still have 5-10 percent of their starting weight to lose.

Patients who started on Wegovy rather than Mounjaro but want the higher-end weight-loss outcome.

Patients with cardiovascular indication where semaglutide's CV-benefit evidence (SELECT trial) is preferred, but who also need the stronger weight-loss effect.

We escalate to 7.2mg only if 2.4mg has been held for 3-4 months and there is still clinically meaningful weight loss remaining to achieve.

Comparing with Mounjaro titration schedules

For patients weighing up the two:

Wegovy titration is longer (16-20 weeks to maintenance) but gentler per step.

Mounjaro titration is shorter (12-20 weeks) with larger dose jumps per step.

Patients who are needle-anxious or have sensitive digestive systems often tolerate Wegovy's gentler escalation better.

Patients who want to reach maintenance dose faster often prefer Mounjaro's steeper titration.

Where most Wegovy patients stop

From UK clinical experience:

~20 percent settle at 1.0mg.

~35 percent at 1.7mg.

~35 percent at 2.4mg.

~10 percent at 7.2mg.

As with Mounjaro, the "right" dose is the lowest one that produces the response you want.

Practical injection notes

Once weekly, same day each week.

Injection site: abdomen, thigh, or upper arm. Rotate weekly.

Inject at room temperature (take pen out of fridge 20-30 minutes before).

The Wegovy pen has a single-use click mechanism. Each pen delivers one weekly dose and is discarded.

Missed doses: if it has been less than 5 days since your scheduled day, take it when you remember. If more than 5 days, skip that dose and resume on your normal day.

Monthly review questions

Each month we check:

Current weight and weight change.

Appetite and food noise.

Side effects in the last four weeks.

Protein intake (are you getting enough?).

Energy and sleep.

Based on answers we either hold the current dose or step up. We will not push you through the titration if you are uncomfortable; the side effects can be reduced by slowing the schedule.

The honest bottom line

Wegovy titration is gentler, slightly slower, and ends either at 2.4mg (classic maintenance) or 7.2mg (higher effect) depending on your goal. For the majority of patients 1.7mg to 2.4mg is the sweet spot. Our monthly reviews are where we make the dose call together.

Ready to start?

If this article has made you think medication might help, the next step is a short consultation with one of our weight-management doctors.

Begin your consultation at this link. Online in 30 minutes, or in person at Westfield London.