Semaglutide 1.7 mg vs 2.4 mg vs 7.2 mg: what each dose showed

The Wegovy label now lists three maintenance doses for adults. Each has randomised evidence, but not the same evidence, and they were never all tested in one trial. This page lines up what exists.

The evidence for each dose

1.7 mg. Only STEP 6 randomised people to 1.7 mg as a maintenance dose. In 401 adults in Japan and South Korea, 68 weeks: 1.7 mg gave 9.6% weight loss, 2.4 mg gave 13.2%, placebo 2.1%. Against placebo the treatment differences were 7.5 points (95% CI 5.4 to 9.6) for 1.7 mg and 11.1 points (95% CI 9.2 to 12.9) for 2.4 mg. Reaching 5% loss: 72% on 1.7 mg, 83% on 2.4 mg, 21% placebo. Visceral fat area fell 22.2% on 1.7 mg and 40.0% on 2.4 mg. Gastrointestinal disorders: 64% on 1.7 mg, 59% on 2.4 mg, 30% placebo; discontinuation for adverse events 3%, 3% and 1% (PubMed 35131037). The population and BMI entry criteria differ from the global trials, so the absolute percentages are not directly comparable with STEP 1, but the gap between the two doses within the trial is the useful number: roughly 3.6 points.

2.4 mg. The programme dose. STEP 1: 14.9% versus 2.4% at 68 weeks in 1,961 adults without diabetes, difference 12.4 points (95% CI 11.5 to 13.4); 86.4% reached 5% loss, 69.1% reached 10%, 50.5% reached 15% (PubMed 33567185). STEP 5 held it to 104 weeks: 15.2% versus 2.6% (PubMed 36216945). Label Table 3 adverse reactions: nausea 44%, diarrhea 30%, vomiting 24%, constipation 24%, against 16%, 16%, 6% and 11% on placebo; 6.8% stopped for adverse reactions versus 3.2%.

7.2 mg. STEP UP, 1,407 adults with obesity, 72 weeks: 18.7% on 7.2 mg, 15.6% on 2.4 mg, 3.9% placebo. The difference between the two active doses was 3.1 points (95% CI 1.6 to 4.7). People on 7.2 mg were 1.8 times as likely to reach 20% loss and 2.4 times as likely to reach 25% loss as those on 2.4 mg. Gastrointestinal events: 70.8%, 61.2%, 42.8%. Dysesthesia (altered skin sensation): 22.9%, 6.0%, 0.5%. Serious adverse events: 6.8%, 10.9%, 5.5% (PubMed 40961952). The label's STEP UP table gives nausea 39% versus 35% versus 13%, vomiting 22% versus 16% versus 6%, constipation 20% versus 19% versus 8%, and 5% discontinuation for adverse reactions at 7.2 mg.

Reading the gradient

Each step up buys less than the one before. From 1.7 to 2.4 mg, STEP 6 found about 3.6 points of extra loss for a 41% increase in dose. From 2.4 to 7.2 mg, STEP UP found 3.1 points for a 200% increase. That is the usual shape of a dose-response curve, and it is why the label calls 2.4 mg "recommended" and frames 7.2 mg as conditional.

Tolerability moves the other way, more steeply at the top: the notable new signal at 7.2 mg is dysesthesia in nearly one person in four, something that was 6% at 2.4 mg.

What the label says about moving between doses

Escalation to maintenance is fixed: 0.25, 0.5, 1 and 1.7 mg for 4 weeks each, then 2.4 mg or 1.7 mg. For weight reduction and cardiovascular risk reduction, 1.7 mg is a full maintenance option "considering treatment response and tolerability"; for MASH, it is a step-down from 2.4 mg with re-escalation to be considered. The 7.2 mg step requires at least 4 weeks tolerating 2.4 mg and a clinical indication for additional weight reduction, in adults, for weight reduction only. The titration planner encodes exactly those paths and asks you to name the destination your prescriber chose.

Price does not follow dose

On Novo Nordisk's April 2026 self-pay sheet, 1.7 mg and 2.4 mg pens both cost $349 a month and 7.2 mg costs $399. Per milligram of semaglutide that is $51, $36 and $14. The cost view shows the arithmetic. None of it applies to compounded semaglutide, which is not FDA approved, was in none of these trials, and has no label dose at all. For the broader dose logic across GLP-1s, including tirzepatide's 5, 10 and 15 mg maintenance options, see the Tirzepatide Hub.