Switching from liraglutide (Saxenda®) to semaglutide (Wegovy®)

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There is limited guidance available for switching between GLP-1 receptor agonists when used for weight loss. Much of the information comes from studies in patients with diabetes, or authors’ opinions based on clinical experience.

Semaglutide generally leads to greater weight loss than liraglutide, but may also cause more gastrointestinal (GI) adverse effects (primarily nausea, vomiting and diarrhoea). When switching from liraglutide to semaglutide, a conservative approach is generally recommended, starting with comparatively lower doses of semaglutide, to help reduce the risk of GI adverse effects during the transition. No wash-out period is required; semaglutide can be started the day after stopping liraglutide.

Current liraglutide (Saxenda®) dose Suggested starting semaglutide (Wegovy®) dose (1-5)
0.6 mg/day  0.25 mg/week 
1.2 mg/day  0.25 mg/week 
1.8 mg/day  0.25 or 0.5 mg/week 
2.4 mg/day  0.25 or 0.5 mg/week 
3 mg/day  0.5 mg/week 

Notes

  • Can start semaglutide the day after stopping liraglutide.
  • Titrate semaglutide dose every 4 weeks.
    • 0.25 mg → 0.5 mg → 1 mg → 1.7 mg → 2.4 mg as per the data sheet.
  • Monitor tolerability and efficacy during the transition.
    • Dose adjustments or slower titration may be necessary based on GI adverse effects, or glycaemic control in patients with diabetes.

References

  1. Rubino DM, Greenway FL, Khalid U, O’Neil PM, Rosenstock J, Sørrig R, et al. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes. JAMA. 2022 Jan 11;327(2):138–50.
  2. Whitley HP, Trujillo JM, Neumiller JJ. Special Report: Potential Strategies for Addressing GLP-1 and Dual GLP-1/GIP Receptor Agonist Shortages. Clin Diabetes Publ Am Diabetes Assoc. 2023;41(3):467–73.
  3. Almandoz JP, Lingvay I, Morales J, Campos C. Switching Between Glucagon-Like Peptide-1 Receptor Agonists: Rationale and Practical Guidance. Clin Diabetes Publ Am Diabetes Assoc. 2020 Oct;38(4):390–402.
  4. VA Pharmacy Benefits Management Services, Medical Advisory Panel, and VISN Pharmacist Executives. Semaglutide (WEGOVY) Subcutaneous Injection Conversion Guidance for Weight Management February 2023. 2023 Feb [cited 2025 Jul 9]; Available from: https://www.va.gov/formularyadvisor/DOC_PDF/CRE_Semaglutide_WEGOVY_Conversion_Guidance_Rev_Feb_2023.pdf
  5. Wisconsin Academy of Family Physicians. Updates to the GLP1-RA Dose Comparisons Chart [Internet]. [cited 2025 Jul 9]. Available from: https://www.wafp.org/assets/files/pdfs/GLP%20equivalent%20Doses%20UPDATED%20chart.pdf