Wegovy Prescribing Guide

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)

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

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.