The semaglutide dose schedule: each step, and what the US label says about missed doses

Five steps make up the US Wegovy schedule. Each of the first four lasts 4 weeks, and the fifth is the maintenance dose¹.

The weight-loss injection schedule in the US Wegovy label (DailyMed, 18 June 2026)¹. The date column is an example, not a plan: it assumes a first dose on Monday 2 November 2026 and no step held longer.

Each step the doctor holds for 4 more weeks moves every later date by 4 weeks¹.

In India, follow the leaflet in the pack and the doctor's plan. An expert committee of CDSCO, India's drug regulator, records Wegovy as approved here since 20 April 2022 for chronic weight management in adults⁷. The same record lists a prefilled pen in five strengths: 0.25, 0.5, 1.0, 1.7 and 2.4 mg⁷. Novo Nordisk launched Wegovy here on 24 June 2025⁸, and Emcure sells the same medicine as Poviztra⁹.

The step-up exists, says the US label, to lower the risk of digestive (gastrointestinal) side effects¹.

In a combined analysis of three STEP trials of semaglutide 2.4 mg, written partly by Novo Nordisk staff, almost all digestive side effects were mild to moderate¹⁰. They were most frequent during a dose increase or shortly after it, and 4.3 % of people on semaglutide stopped treatment for good because of them¹⁰. In the US label's weight-loss trials of Wegovy 2.4 mg, nausea affected 44 % of people¹. On a placebo, a dummy injection, the figure was 16 %¹.

When one step is hard to tolerate, the US label allows the doctor to put off the next increase by 4 weeks¹. An Indian expert panel agreed that slow eating, and no large meal in the evening, can help people tolerate the medicine and reduce nausea¹¹. If digestive side effects continue even after such changes, tell your doctor as soon as possible¹².

When to get help. Severe stomach pain that does not go away, and may reach through to the back, may be a sign of an inflamed pancreas¹³. For this, a diabetes leaflet from a Leeds trust of the UK's National Health Service (NHS) says to stop the medicine and contact a doctor immediately¹³. The US label says most kidney problems reported with semaglutide came in people who had become dehydrated from vomiting or diarrhoea¹. If vomiting continues and you cannot keep fluids down, or you have bloody diarrhoea, get medical help that day¹⁴. In an emergency in India, call 112; the other warning signs are in the guide to semaglutide side effects and the signs that need urgent care¹⁵. As well as telling the doctor, patients can report a suspected side effect to the Pharmacovigilance Programme of India (PvPI), on its helpline, 1800 180 3024, on working days^16,17.

The US label does not require it: for weight reduction in adults, it gives two maintenance doses, 1.7 mg or 2.4 mg, and recommends 2.4 mg¹. It tells the prescriber to weigh the treatment response, and how well the person tolerates the dose, when choosing between them¹.

Under the US weight-loss schedule, 0.5 mg is the second step, used in weeks 5 to 8, and not a maintenance dose¹. The US Ozempic label, for type 2 diabetes, is different: there, 0.5 mg can be a maintenance dose for blood sugar control¹⁸.

Above 2.4 mg, the US Wegovy label allows adults up to 7.2 mg a week¹. The prescriber may make this step after the person has tolerated 2.4 mg for at least 4 weeks, when more weight loss is clinically indicated¹. In the CDSCO record, the Indian Wegovy strengths stop at 2.4 mg⁷.

STEP 1, a trial funded by Novo Nordisk, gave adults without diabetes semaglutide 2.4 mg or placebo for 68 weeks, and both groups also had a lifestyle programme¹⁹. Body weight changed by −14.9 % on average with semaglutide, against −2.4 % on placebo¹⁹. A trial average does not predict one person's result.

Side effects were also more common than on placebo: in the US label's trials of 2.4 mg, vomiting affected 24 % of people against 6 %¹. In those trials, 6.8 % stopped treatment for good because of side effects, against 3.2 % on placebo¹.

Missed doses are a question for the prescribing doctor, and for the leaflet in an Indian Wegovy, Poviztra or Ozempic pack. Under the US Wegovy label, one missed dose is given as soon as possible if the next dose is more than 2 days away¹. It is skipped if the next dose is less than 2 days away¹.

The US Wegovy label's rules for missed doses of the weekly weight-loss injection¹.

An example: the injection day is Monday, and one Monday dose is missed.

• Remembered on Thursday. The next Monday dose is more than 2 days away, so the US label says the missed dose is given as soon as possible¹. Ask the doctor whether the next dose stays on Monday.
• Remembered on Sunday. Monday is less than 2 days away, so the US label says the missed dose is skipped and Monday's dose goes ahead as usual¹.
• Two Mondays missed in a row. The US Medication Guide says to contact the doctor about restarting; the US label has the doctor restart at a lower dose¹.

The US Ozempic label for type 2 diabetes uses 5 days instead: a missed dose is taken as soon as possible within 5 days, and skipped after that¹⁸. In the example, both wordings say to take the dose on Thursday and to skip it on Sunday^1,18. If a missed dose falls near the edge of either window, ask your doctor.

Any time of day works under the US label, with or without meals, as long as the injection falls on the same day each week¹. The injection goes under the skin of the stomach, thigh or upper arm, and the site is rotated with each dose¹. The US label says a new time or site needs no dose change¹.

Pens, and the figures printed on them, differ between Indian brands. Wegovy in India comes as a multi-dose FlexTouch pen, and each strength is one step of the schedule, according to PharmEasy³. Zydus uses a reusable pen with a cartridge²⁰. Dr Reddy's disposable Obeda pen, Sun Pharma's Sematrinity pen and the vials Natco announced are reported as multi-dose packs^21,22,23. On these, a figure such as 2 mg is the amount in the whole pack, not one dose^21,22,23. In the US, the Wegovy FlexTouch pen is labelled 9.6 mg and holds 4 weekly doses of 2.4 mg¹. The doctor sets the weekly dose, and can show how your pen or vial gives it.

Storage rules also differ by pen, so follow the leaflet in your own pack. According to PharmEasy, Wegovy pens are stored in a fridge at 2–8 °C before first use, and are not frozen²⁴. It adds that some opened pens may stay at room temperature for a limited number of days, with a possible maximum temperature²⁴. PharmEasy also says never to use a pen that has been frozen, left in a hot car or in direct sun²⁴. For comparison only, the US FlexTouch pen goes in the fridge before first use¹. After first use, the US label allows 56 days at 15–30 °C, or in the fridge¹. Your Indian pen may carry a different rule.

Use a registered pharmacy. India's government advises that GLP-1 medicines be obtained only on prescription, through legitimate, regulated channels². Haryana's drug regulator was reported in April 2026 to have seized more than 260 suspected counterfeit pens of Mounjaro, which is tirzepatide, not semaglutide²⁵.

Semaglutide for type 2 diabetes has its own US schedule, and so does the daily semaglutide tablet sold in India for diabetes, which uses different milligram numbers^18,26,27.

Doses from the US labels; brands from Indian reports and CDSCO records. For each Indian brand, the pack leaflet and the doctor set the dose^{1,18,26,27,28}.

The Indian launch report named no 2 mg Ozempic strength, which is the top step of the US Ozempic schedule^18,28.

In the US, Wegovy also comes as a daily tablet that rises from 1.5 mg to 25 mg by day 91¹. No Indian approval or launch of it was found by 20 October 2026³³.

When to get help. With insulin or a sulfonylurea, the US label says semaglutide may raise the risk of low blood sugar¹. The NHS lists sweating, shaking, a pounding heart and dizziness as signs³⁴. For a person with diabetes, it advises quick treatment, such as a small glass of fruit juice; then tell the doctor³⁵. If someone may have very low blood sugar and is not responding normally, or is unconscious, call 112^15,35. Give an unconscious person nothing to eat or drink³⁵.

How is the semaglutide dose worked out? The US label sets the same fixed steps in milligrams for adults on the weight-loss schedule¹. The doctor decides when to move up, and which maintenance dose to keep¹.

How long does semaglutide take to work? STEP 1 reported its average result at 68 weeks; the section on 2.4 mg gives it with the side-effect rates¹⁹. The step-up alone fills the first 16 weeks of the US schedule¹. This page gives no week-by-week forecast.

Where can I read the patient information? The full US prescribing information for Wegovy is on DailyMed. It is the US text; in India, read the leaflet inside the pack.

Is there a mixing chart for semaglutide vials? Not here. India's government advises that a vial, like a pen, is obtained only on prescription, through legitimate, regulated channels². Ask the prescribing doctor how to measure each dose from a vial.

What does Wegovy cost in India? The guide to semaglutide brands and generics in India gives dated prices from named sources.

What happens if semaglutide is stopped? If you want to stop, talk to your doctor first, and read what happens if you stop, and who should not take semaglutide. The NHS advises against a sudden stop³⁴. It says stopping could affect blood sugar in people with type 2 diabetes³⁴. A year after stopping semaglutide 2.4 mg and the lifestyle programme, people in the STEP 1 extension had put back two-thirds of the weight lost, on average³⁶.

Talk to a Zelta specialist about the schedule in your own plan.