Wegovy Prescribing Guide

---
name: wegovy-prescribing-guide
description: Bedside prescribing reference for Wegovy (semaglutide 2.4 mg) — adult and pediatric indications, 16-week dose-escalation schedule, missed-dose rule, 12-week continuation rule, contraindications, warnings, and monitoring. Use when a clinician asks how to start Wegovy, how to titrate semaglutide 2.4 mg, Wegovy pediatric indication, missed Wegovy dose, Wegovy contraindications, or when a patient on Wegovy needs a monograph-level clinical decision. Grounded in the Canadian Product Monograph (Novo Nordisk, March 2024).
---

# Wegovy (Semaglutide 2.4 mg) — Prescribing Guide

## Indication

Adjunct to reduced-calorie diet + increased physical activity for chronic weight management in:

**Adults**
- BMI ≥ 30 kg/m² (obesity), **OR**
- BMI ≥ 27 kg/m² (overweight) **with** ≥ 1 weight-related comorbidity (hypertension, T2D, dyslipidemia, OSA)

**Pediatrics (12 to < 18 y)**
- BMI at **≥ 95th percentile** for age and sex (see `wegovy-pediatric-eligibility`)
- Body weight **> 60 kg (132 lb)**
- Inadequate response to diet + activity alone
- Not studied in secondary obesity (hypothalamic, monogenic, endocrine)

## Contraindications

- Personal/family history of **MTC** or **MEN-2**
- Hypersensitivity to semaglutide or excipients
- **Pregnancy** (contraindicated)
- **Breastfeeding** (contraindicated)
- Any other semaglutide product (Ozempic, Rybelsus) or other GLP-1 RA

## Dose Escalation (16-week schedule)

| Weeks | Weekly dose |
|---|---|
| 1–4 | 0.25 mg |
| 5–8 | 0.5 mg |
| 9–12 | 1 mg |
| 13–16 | 1.7 mg |
| 17+ | **2.4 mg (maintenance)** |

**If a dose is not tolerated:** delay escalation by 4 weeks.

**If maintenance 2.4 mg not tolerated:**
- Adults: drop to 1.7 mg for up to 4 weeks, then re-escalate to 2.4 mg.
- Pediatrics: may remain at 1.7 mg weekly as maintenance; **discontinue** if 1.7 mg also not tolerated.

## 12-Week Continuation Rule

Reassess at **12 weeks on maintenance (2.4 mg or maximum tolerated)**. Patients not showing clinically meaningful BMI improvement by then are unlikely to benefit with continued treatment.

## Missed Dose

- Next scheduled dose ≥ **48 h** away → administer ASAP.
- Next scheduled dose < 48 h away → **skip**; resume as scheduled.
- Missed **> 2 consecutive doses** → reinitiate per dose-escalation schedule to reduce GI symptoms.

## Administration

- s.c. injection, abdomen / thigh / upper arm — rotate sites.
- Same day each week; any time of day, with or without food.
- ≥ 72 h between doses if changing weekly day.
- Not IV or IM.
- Inspect: clear and colourless, no particles.

## Dose Adjustments in Special Populations

| Population | Adjustment |
|---|---|
| Age ≥ 65 | None; limited experience ≥ 75 y |
| Renal impairment | None; **not recommended in ESRD** |
| Hepatic impairment | Use with caution; not studied |
| T2D + SU/insulin | Reduce SU or insulin to lower hypoglycemia risk |

## Key Warnings

- **Thyroid C-cell tumours** (black-box): counsel on neck mass, dysphagia, dyspnea, hoarseness.
- **Acute pancreatitis** — 0.2/100 patient-years in trials (vs < 0.1 placebo). Discontinue if suspected; do **not restart** if confirmed. Caution if prior AP or pancreatitis in past 6 months.
- **Acute gallbladder disease** — cholelithiasis 1.6% (vs 0.7% placebo); cholecystitis 0.6% (vs 0.2%). Adolescents: cholelithiasis 3.8% (vs 0%).
- **Hypoglycemia** in T2D on SU/insulin — reduce those agents first.
- **Retinopathy** — monitor T2D patients with prior retinopathy for progression.
- **Heart rate increase** + **PR interval prolongation** — caution in conduction system disease, tachyarrhythmias. Discontinue if sustained resting HR increase.
- **Heart failure NYHA IV** — not recommended.
- **Intestinal obstruction / ileus** — reported post-market (unknown frequency).
- **Acute kidney injury** via GI volume depletion; monitor renal function when escalating in renal impairment.
- **Suicidal ideation** — monitor; do not use in history of suicidal attempts or active ideation.
- **Hypersensitivity / anaphylaxis** — discontinue.
- **Hair loss** (~3% vs 1.4% placebo) — counsel patient.

## Discontinue if:

- Pregnancy (stop ≥ 2 months before planned conception — long half-life ~1 week)
- Acute pancreatitis
- Hypersensitivity reaction
- Sustained resting HR increase
- Suicidal thoughts / behaviour

## Monitoring

- Blood glucose in T2D patients before and during treatment (Wegovy discontinuation may raise glucose).
- Resting heart rate at routine intervals.
- Renal function in patients with renal impairment reporting severe GI AEs.
- BMI trajectory — reassess at 12 weeks on maintenance.

## Most Frequent GI AEs (Adults, STEP 1–3)

Nausea 44% | Diarrhoea 30% | Vomiting 24% | Constipation 24% | Abdominal pain 20%. Placebo rates 10–16%.

Adolescents: nausea 42% | vomiting 36% | diarrhoea 22%.

For management → `glp1-gi-ae-symptom-advisor`, `glp1-dose-escalation-troubleshooter`, `glp1-gi-ae-pharmacological-rescue`.

## Pediatric Eligibility

See `wegovy-pediatric-eligibility` for BMI age/sex cutoffs (12.0–17.5 y) and weight threshold.

## Reference

WEGOVY Product Monograph, Novo Nordisk Canada, Submission 280250, revised 2024-03-22.