Wegovy is not a single dose you take from the start. It climbs through five strengths over about four months, and understanding the shape of that climb explains most of what people find confusing about the first few months of treatment: why the early weeks feel like little is happening, why side effects arrive in waves rather than steadily, and why the schedule can be adjusted without the treatment failing. The escalation is deliberate, and it is the same for everyone regardless of starting weight.
The standard schedule
Treatment begins at 0.25 mg once a week for four weeks, then 0.5 mg for four weeks, 1 mg for four weeks, 1.7 mg for four weeks, and finally 2.4 mg once a week as the ongoing maintenance dose. Each injection is weekly, on the same day where possible, and the day can be changed if needed provided at least three days separate two injections. That adds up to sixteen weeks of escalation before the maintenance dose, and in practice rather more for many people, because holding a dose for longer than four weeks is common and entirely acceptable.
Why it starts too low to work
The 0.25 mg starting dose is not expected to produce meaningful weight loss, and people who judge the treatment on that first month usually conclude too early that it is not working for them. Its purpose is to let the digestive system meet semaglutide gradually. Starting at 2.4 mg would give most people severe nausea and vomiting, so the low opening dose buys tolerance at the cost of a slow start. Some appetite change often appears anyway during those first weeks, which is a useful early signal, but the dose doing the real work is still several steps away. Patience during the climb is part of the treatment. It is also worth knowing that the starting dose is identical whatever your weight, because the escalation is about digestive tolerance rather than body size, so there is no version of the schedule that begins higher for people with more to lose.
Side effects follow the steps, not the calendar
Because each increase presents the body with more drug than it has adapted to, nausea and digestive symptoms tend to cluster in the days after a step up and then settle over the following week or two. This is why the experience feels like waves rather than a steady state, and why the fifth week of treatment can be harder than the third. It also means a difficult patch usually has a specific cause and a specific answer. The most common mistake is treating the schedule as compulsory and pushing through an increase that is clearly not being tolerated. Practical measures help within a wave: smaller portions eaten slowly, less fat and less richness for a week or so after a step up, and steady fluids through the day. Those changes cost nothing and address the mechanism directly, since the medicine slows how quickly the stomach empties and large or fatty meals are the most dependable trigger for the resulting discomfort.
When the top dose is not the right dose
The 2.4 mg maintenance dose is where the trial evidence is strongest, and it is the intended destination for most people. It is not, however, a target to be reached at any cost. Some people find their appetite is well controlled at 1.7 mg, or even 1 mg, and are losing weight steadily without needing more; in that situation staying put is reasonable, and the maintenance dose can be set below the maximum. Equally, if 2.4 mg proves intolerable after genuine attempts, treatment at a lower dose is better than no treatment. This is a conversation with your prescriber rather than a decision to make alone, because it depends on how much progress you are making and what you are tolerating.
Missed doses and restarting
If a dose is missed and the next scheduled one is more than two days away, take it as soon as you remember and continue as normal. If it is closer than that, skip it and resume on the usual day, without doubling up. A longer gap changes the calculation: if more than two weeks pass without an injection, tolerance falls and your prescriber may want to restart at a lower dose and build up again rather than resuming where you left off. That is frustrating but sensible, since going straight back to a high dose after a break is the most reliable way to produce severe nausea.
Planning the climb around your life
One habit costs nothing and prevents a good deal of avoidable difficulty: look at the calendar before each increase rather than after it. The unsettled days arrive in the week following a step up, so moving to a new dose immediately before a holiday, a wedding or a demanding week at work is volunteering for trouble that a fortnight's delay would have avoided, and prescribers are entirely comfortable timing increases around real life. It also helps to keep brief notes through each transition, recording what you felt, how long it lasted and what helped, because your own pattern tends to repeat at the next step and turns later increases from unknowns into logistics. Those notes make reviews sharper too, since a prescriber shown a clear record can distinguish a normal adjustment from something needing attention far more quickly than one working from a vague sense that the last month was difficult.
