The dose is escalated slowly on purpose — to blunt the nausea that comes with starting too fast. Here are the published schedules and the wave of next-generation drugs behind them, all of which are still investigational.
Wegovy escalates over 16+ weeks, four weeks per step: 0.25 → 0.5 → 1.0 → 1.7 → 2.4 mg weekly, then holds at 2.4 mg (a higher 7.2 mg option now exists for tolerant patients). Ozempic is the same molecule for diabetes and tops out at 2 mg, so off-label weight use underdoses relative to Wegovy. An oral semaglutide for weight has also been approved.
Steps up in 2.5 mg increments no sooner than every four weeks: 2.5 (a starter dose, not therapeutic) → 5 → 7.5 → 10 → 12.5 → 15 mg weekly. Approved maintenance doses are 5, 10 or 15 mg. The slow climb exists to limit gastrointestinal side effects during escalation.
The next wave, none yet approved for obesity: retatrutide, a triple GLP-1/GIP/glucagon agonist, hit ~24% in phase 2 and ~28% in early phase 3; orforglipron, an oral once-daily pill, ~12%; CagriSema (cagrilintide + semaglutide) ~22.7%; plus survodutide and once-monthly MariTide. Cross-trial comparisons are indirect — different populations and endpoints — and press-release figures precede full peer review. Evidence ●●●○○ (early / not yet approved)
Slow is the point
Most GI side effects cluster during dose escalation and settle at a steady dose. Rushing the titration to lose faster mostly buys more nausea, not more weight loss.
The Weight Loss Guide