As of March 2026, there’s now a fifth step: Wegovy HD at 7.2 mg, available to people who’ve tolerated 2.4 mg for at least 4 weeks and need additional weight loss.
Key takeaways
- Semaglutide for weight loss (Wegovy) titrates from 0.25 mg to a 2.4 mg maintenance dose over 16 weeks, in 4-week steps.
- Wegovy HD (7.2 mg) was FDA-approved in March 2026 as an additional step for people who’ve tolerated 2.4 mg but want more weight loss. It’s not a starting dose.
- Semaglutide for diabetes (Ozempic) uses a different, lower ladder that tops out at 2.0 mg and skips the 1.7 mg step entirely.
- The 0.25 mg starting dose isn’t expected to produce significant weight loss on its own. Its job is to reduce nausea once the dose increases.
The full semaglutide weight-loss dosage chart
| Step | Weekly dose | Purpose |
|---|---|---|
| 1 | 0.25 mg | Starting dose, non-therapeutic. Lets your body adjust before the dose increases. |
| 2 | 0.5 mg | First step up. Some appetite reduction typically begins here. |
| 3 | 1.0 mg | Mid-range dose with more noticeable appetite and weight effects. |
| 4 | 1.7 mg | Transitional step, and also an FDA-approved maintenance dose for people who can’t tolerate 2.4 mg. |
| 5 | 2.4 mg | Standard maintenance dose, reached around week 17. |
| 6 | 7.2 mg (Wegovy HD) | New, FDA-approved March 2026. Only for patients who’ve tolerated 2.4 mg for at least 4 weeks and need additional weight loss. |
Each step requires a minimum of 4 weeks before advancing. Slower titration is fine if side effects need more time to settle; skipping ahead of schedule isn’t part of the approved dosing and tends to make nausea worse rather than speeding up results.
Semaglutide for weight loss vs. semaglutide for diabetes
“Semaglutide” is the active ingredient, but the dosing ladder depends on which brand and indication you’re being treated for. Wegovy (weight loss) climbs to a 2.4 mg (or now 7.2 mg) maintenance dose. Ozempic (type 2 diabetes) uses a lower ladder that stops at 2.0 mg and doesn’t include the 1.7 mg step at all, since diabetes management generally doesn’t require as high a dose as significant weight loss does. If you’re on Ozempic and curious about the weight-loss ladder, that’s a conversation to have with your provider rather than something to adjust on your own.
What Wegovy HD changes
Wegovy HD isn’t a new starting point. It’s specifically for people who are already at the 2.4 mg maintenance dose, have tolerated it for at least 4 weeks, and want additional weight loss beyond what 2.4 mg is producing. In the trial that supported its approval, people on the 7.2 mg dose lost an average of about 20.7% of their starting body weight, compared to roughly 17.5% on the standard 2.4 mg dose. A notable side effect seen more often at the higher dose was dysesthesia, an altered skin-sensation symptom, which showed up in about 22% of participants on 7.2 mg versus 6% on 2.4 mg.
Whether stepping up to the HD dose makes sense depends on how you’ve responded to 2.4 mg and what your provider sees in your overall health picture, not something to request just because a higher number sounds like faster progress.
Why the 4-week spacing matters
Semaglutide has a long half-life of about a week, which means it takes roughly 4 to 5 weeks for blood levels to fully stabilize after each dose increase. The spacing between titration steps isn’t arbitrary. It’s built around how long the drug actually takes to reach a steady level in your system, and jumping ahead of that schedule mainly increases the odds of nausea and other GI side effects becoming severe enough to derail treatment.
Common side effects
Nausea, diarrhea, constipation, and reduced appetite are the most frequently reported side effects, especially in the days right after a dose increase. These are usually mild to moderate and ease as your body adjusts to each new step. Less common but more serious risks include gallbladder problems and pancreatitis, which is why regular check-ins with your provider matter throughout treatment, not just at the start.
Missed dose guidance
If you miss a dose, take it as soon as possible if it’s within 5 days of your scheduled day. If more than 5 days have passed, skip that dose and resume your regular weekly schedule at your next scheduled day. Don’t take two doses close together to make up for a missed one.
A note on compounded semaglutide
Compounded semaglutide, made by compounding pharmacies rather than the brand manufacturer, is often dosed in units or milliliters rather than the milligram amounts used in this chart, which can make it harder to compare directly to the FDA-approved schedule above. The FDA has also issued warnings about non-standard salt forms of semaglutide showing up in some compounded products, which aren’t the same active ingredient as what’s used in Wegovy or Ozempic. If you’re considering a compounded option, ask your provider directly how its dosing maps to the standard ladder and what’s actually in the specific product you’d be prescribed.
What each step actually feels like
The early steps tend to be more about tolerability than dramatic results. Most people report losing a modest amount of weight during the 0.25 mg month, mostly from the appetite reduction that even a low dose produces, while side effects like nausea and fatigue are often most noticeable during this first month simply because the body is encountering the medication for the first time. As the dose climbs toward 1.0 mg and 1.7 mg, appetite suppression tends to become more pronounced, and by the time most people reach 2.4 mg, side effects have typically settled into a manageable baseline compared to earlier steps.
A plateau somewhere around week 12 is one of the most common concerns people raise, and in most cases it reflects being mid-titration rather than the treatment failing. Weight loss on semaglutide tends to continue accelerating as the dose climbs toward maintenance, so a slower month during titration isn’t necessarily a sign to change course.
Getting started
A licensed provider needs to evaluate your health history and weight loss goals before prescribing semaglutide, since the right starting point, target dose, and pace of titration depend on individual factors a chart alone can’t account for. At DermOnDemand, our board-certified providers review your information online and build a personalized treatment plan, typically within 24 hours, with prescriptions sent directly to your pharmacy when appropriate.
Frequently asked questions
Do I need to reach the 2.4 mg dose?
No. Some people do well and stay long-term on 1.7 mg if that’s what they tolerate, since 1.7 mg is itself an FDA-approved maintenance dose, not just a transitional step.
Is Wegovy HD available yet?
Wegovy HD was FDA-approved in March 2026 with a launch expected shortly after. Availability may vary by pharmacy and region as the rollout continues.
Can I switch from Ozempic’s dosing schedule to Wegovy’s if my goal shifts from diabetes management to weight loss?
That’s a decision for your provider to make based on your specific health picture. The two ladders aren’t interchangeable on your own.
Ready to find out if semaglutide is right for you? Start an online consultation with DermOnDemand and get a personalized treatment plan, often within 24 hours. Learn more on our Ozempic and Wegovy pages, or see pricing details here.
