Wegovy doses: pens from 0.25 to 7.2 mg, tablets from 1.5 to 25 mg, and how the dose is stepped up

In Spain, Wegovy comes as five weekly pens for escalation and maintenance (0.25, 0.5, 1, 1.7 and 2.4 mg), one weekly 7.2 mg pen and four daily tablets (1.5, 4, 9 and 25 mg). Its summary of product characteristics (SmPC) sets out a step-by-step increase: 16 weeks to reach 2.4 mg with the pen, and at least four weeks at each level up to 25 mg with the tablets. Which dose each person takes, when it goes up and where it stays is decided by their doctor, not by a calendar.

Which Wegovy doses are available in Spain?

CIMA, the medicines database of the Spanish Agency of Medicines and Medical Devices (AEMPS), lists three Wegovy product families as authorised and marketed in Spain. All contain semaglutide and all require a prescription:

• FlexTouch pens, one injection a week: 0.25, 0.5, 1, 1.7 and 2.4 mg. Authorised since 2022.
• 7.2 mg pen, one injection a week: a single-dose pen sold in boxes of four. Listed as authorised in CIMA on 22 July 2026.
• Tablets, one a day: 1.5, 4, 9 and 25 mg, in boxes of 30. Listed as authorised in CIMA on the same date and marketed in Spain in all four strengths.

The active substance is the same in all three, but pen milligrams and tablet milligrams can't be compared with each other, for a reason to do with absorption that's explained further down. That's why the maintenance dose is 2.4 mg a week with the pen and 25 mg a day with the tablet.

How does the SmPC describe dose escalation with the pen?

The pen's SmPC sets out a 16-week schedule with one injection a week: 0.25 mg in weeks 1 to 4, 0.5 mg in weeks 5 to 8, 1 mg in weeks 9 to 12 and 1.7 mg in weeks 13 to 16. After that comes the maintenance dose of 2.4 mg a week. The SmPC adds that if significant gastrointestinal symptoms appear, the increase can be delayed or the dose taken back to the previous level until they improve: the schedule is the fastest pace allowed, not a requirement.

The 7.2 mg dose is a separate step and comes with conditions. The SmPC restricts it to adults who had a BMI of 30 or more when they started treatment, after at least four weeks on 2.4 mg. If it brings no further improvement in weight, the SmPC says to go back to 2.4 mg. Adolescents are not recommended to go above 2.4 mg. Depending on the device, it is given as a single 7.2 mg injection or as three consecutive 2.4 mg injections at least 5 cm apart.

The case for that step comes from the 72-week STEP UP trial in adults with obesity but without diabetes: body weight fell by 18.7% with 7.2 mg, 15.6% with 2.4 mg and 3.9% with placebo. Some side effects also became more common with 7.2 mg: dysaesthesia, a change in how the skin feels, occurred in 21.6% on 7.2 mg compared with 0.3% on placebo, and hair loss in 5.3% compared with 1.0%.

How are Wegovy tablets stepped up to 25 mg?

For the tablets, the SmPC describes starting on 1.5 mg once a day for four weeks, then increasing to 4 mg, 9 mg and 25 mg, with at least four weeks at each level. Reaching 25 mg, which is both the maintenance dose and the maximum daily dose, therefore takes at least 12 weeks. The SmPC also leaves room for flexibility: if needed, the dose can be kept at the previous level, so getting to 25 mg isn't mandatory.

There's one rule the SmPC states without qualification: always one tablet a day. Two lower-strength tablets must not be combined to get the effect of a higher one. And because the tablet is taken on an empty stomach, after a recommended fast of at least 8 hours, with a sip of water of up to 120 ml, and then waiting at least 30 minutes before eating, drinking or taking other medicines, how much is actually absorbed also depends on how it's taken.

Why is the dose increased so slowly?

Because of digestive tolerance. The pen's SmPC says so explicitly: the 16-week escalation is there to reduce the likelihood of gastrointestinal symptoms. The tablets' SmPC notes that gastrointestinal reactions were seen mainly during dose escalation. In OASIS 4, the trial of the 25 mg tablet, digestive side effects overall occurred in 74.0% of participants compared with 42.2% on placebo. Most were mild or moderate and short-lived, and 3.4% stopped treatment because of them.

The pharmacokinetics help explain the pace: semaglutide has an elimination half-life of about a week and, with daily dosing, blood levels stabilise after 4 to 5 weeks. Moving up one step at a time gives the digestive system time to adjust to each level before moving on to the next.

How many tablets or pens come in each box?

• 1.5, 4, 9 and 25 mg tablets: 30 tablets per box, a month's supply at one a day. The European product information also authorises boxes of 10 and 90, but in Spain CIMA only lists the box of 30.
• 0.25, 0.5, 1, 1.7 and 2.4 mg FlexTouch pens: one pen containing 4 weekly doses plus 4 disposable needles, lasting 4 weeks.
• 7.2 mg pen: box of 4 single-dose pens, one per week.

If each step lasts four weeks, escalation uses one pen or one box of tablets per step. Storage differs too: the tablets don't need refrigerating, only keeping in their original packaging; the FlexTouch pen goes in the fridge before first use and, once started, keeps for 6 weeks below 30 °C or in the fridge.

Is a tablet dose equivalent to a pen dose?

Not milligram for milligram. Semaglutide is very poorly absorbed from the stomach: the absolute bioavailability of the tablet is around 1–2%, compared with 89% for the subcutaneous injection. Oral absorption also varies a great deal: after a single dose, variability was estimated at 166%, falling to 68% with continued daily dosing. That's why 25 mg a day by tablet and 2.4 mg a week by pen are not comparable amounts.

The SmPC describes only one switch between forms: from the 2.4 mg weekly pen to the 25 mg daily tablet, one week after the last injection, and the other way round, the day after the last tablet. It also warns that the effect of switching is not easy to predict. There is no official conversion table for other doses or for people coming from another medicine. Rybelsus, the oral semaglutide indicated for type 2 diabetes, has a different dose scale, explained in the new Rybelsus doses and their equivalents.

How much does each dose cost?

None of the presentations is funded by the Spanish National Health System: BIFIMED, the Spanish Ministry of Health's database, lists them as «Not funded by resolution». The price is set freely and the person with the prescription pays it in full. What has been verified:

• 0.25, 0.5 and 1 mg pens: €179.89 per pen, according to Vademecum.
• 1.7 mg pen: €200.19; 2.4 mg pen: €223.64.
• 25 mg tablets: €236.20 for a box of 30, according to press reports; this is not an official price.
• 1.5, 4 and 9 mg tablets and the 7.2 mg pen: no verified public price.

The figures for the prescription and the first month on tablets are in our guide to the price of and prescription for Wegovy tablets, and the month-by-month figures for the pens are in the monthly cost of each Wegovy pen.

The instructions for the daily dose are in how to take Wegovy tablets, and the full comparison between the two forms is in Wegovy tablets or injection.

Key points to remember

Wegovy has six pen doses and four tablet doses, and its SmPC describes a slow increase so the digestive system can adjust. Which step you're on, when to move up and where to stay is decided by your doctor based on your medical history.

What is available in Spain today for people who want to lose weight with medical support is medical weight-loss treatment with an assessment beforehand, a prescription from a registered doctor where appropriate, and ongoing follow-up. You can:

Check in a few minutes whether you're eligible