Dose schedules, drug by drug
Every GLP-1 medicine climbs a ladder of doses on a fixed timetable. Here is every schedule in one place, and the reasoning behind the pace.
The short version
- Nobody starts at a full dose. Every product begins low and steps up on a schedule — this is called titration.
- The standard step is four weeks, and it is not arbitrary: it is roughly how long the drug takes to reach a stable level in your blood.
- Stepping up faster is the single most reliable way to make yourself miserable. Trials that pushed the pace saw people quit.
- The lowest doses are not therapeutic doses. They exist to let your gut adapt.
Every product in this class shares the same design: a starting dose too low to do much, followed by scheduled increases until you reach a maintenance dose. It looks like caution. It is actually pharmacology.
Why four weeks
A drug reaches a steady level in the blood after roughly five half-lives. Semaglutide's half-life is about a week, so a new dose takes four to five weeks to fully express itself. Tirzepatide, at about five days, takes around 25 days.
Move up before that, and you are stacking a new dose on top of a level that has not finished rising. The nausea that follows is not a sign of a bad reaction — it is the sign of an impatient schedule.
This is why the first weeks feel deceptive. Many people feel very little on the starting dose and conclude the medicine is not working. It is working exactly as designed; blood levels are still climbing toward the plateau, and the appetite effect grows with them.
Semaglutide for weight management — Wegovy®
| Weeks | Dose | What this step is for |
|---|---|---|
| 1–4 | 0.25 mg weekly | Adaptation only. Not a treatment dose. |
| 5–8 | 0.5 mg weekly | First dose with a noticeable appetite effect for many. |
| 9–12 | 1.0 mg weekly | Midpoint. Some people stop here and do well. |
| 13–16 | 1.7 mg weekly | Final step before maintenance. |
| 17+ | 2.4 mg weekly | Maintenance dose. |
Full escalation takes about sixteen weeks. If 2.4 mg is not tolerable, a prescriber may hold at 1.7 mg as a maintenance dose instead — a lower dose you stay on beats a higher dose you abandon.
Semaglutide for type 2 diabetes — Ozempic®
| Weeks | Dose | Notes |
|---|---|---|
| 1–4 | 0.25 mg weekly | Starting dose. Adaptation only. |
| 5+ | 0.5 mg weekly | First maintenance dose. |
| after ≥4 weeks | 1.0 mg weekly | If further glucose control is needed. |
| after ≥4 weeks | 2.0 mg weekly | Maximum. |
Tirzepatide — Mounjaro® and Zepbound®
Both products use the same ladder: 2.5 mg increments, at least four weeks apart.
| Weeks | Dose | Notes |
|---|---|---|
| 1–4 | 2.5 mg weekly | Starting dose. Not a maintenance dose. |
| 5–8 | 5 mg weekly | Lowest maintenance dose for weight management. |
| 9–12 | 7.5 mg weekly | Intermediate step. |
| 13–16 | 10 mg weekly | Maintenance dose. |
| 17–20 | 12.5 mg weekly | Intermediate step. |
| 21+ | 15 mg weekly | Maximum dose. |
Note the asymmetry: 5 mg, 10 mg and 15 mg are recognised maintenance doses, while 7.5 mg and 12.5 mg exist mainly as stepping stones. You are not required to climb to the top. Many people settle at 5 or 10 mg and stay there.
Liraglutide — Saxenda®
A daily injection, so the ladder moves weekly rather than monthly. Liraglutide's half-life is about 13 hours, so a new dose stabilises in a couple of days.
| Week | Daily dose |
|---|---|
| 1 | 0.6 mg |
| 2 | 1.2 mg |
| 3 | 1.8 mg |
| 4 | 2.4 mg |
| 5+ | 3.0 mg — maintenance |
Oral semaglutide — Rybelsus®
| Days | Daily tablet | Notes |
|---|---|---|
| 1–30 | 3 mg | Adaptation only. |
| 31–60 | 7 mg | First treatment dose. |
| 61+ | 14 mg | Maximum. |
The tablet has rules the injections do not. Take it on an empty stomach with no more than about 120 ml of plain water, then wait at least 30 minutes before eating, drinking anything else, or taking other oral medicines. Absorption is poor and easily disrupted; ignoring the waiting period can mean absorbing very little of the dose.
When the ladder should slow down
The schedules above are defaults, not obligations. Prescribers routinely extend a step — six or eight weeks instead of four — when side effects are still settling. There is no penalty for a slower climb. The relevant question is not how fast you reach the top dose but whether you are still taking the medicine six months from now.
Trials make this concrete: gradual escalation cut discontinuation rates dramatically compared with starting at full dose. The slow ladder is not excessive caution. It is the reason the treatment stays usable.
Never adjust the ladder yourself. Dose changes belong to your prescriber. Increasing on your own to speed up results is the most common way people end up unable to keep food down; decreasing on your own can quietly undo months of progress. If a step is unbearable, that is a conversation, not a solo decision.
Keeping track of which week of which step you are on is exactly the kind of thing that gets lost between appointments. Side effects follow this schedule closely — knowing where you are on the ladder tells you a lot about what you are feeling.
Reading a schedule you were given
Prescriptions do not always match the tables above, and a mismatch is usually deliberate rather than an error. Prescribers extend steps, hold below a maximum, and occasionally start lower than the label default for someone with a history of severe nausea or a low starting weight.
If your schedule differs from what you read here, the useful response is to ask why rather than to assume one of the two is wrong. The answer is normally a specific reason relating to you, and hearing it is more valuable than the schedule itself.
Sources
- Zepbound® dosage, schedules and missed doses. Eli Lilly and Company.
- Zepbound® dosage guide. Drugs.com.
- GLP-1 dose adjustment for weight loss. Healthline.
- US Prescribing Information for Wegovy®, Ozempic®, Rybelsus®, Mounjaro®, Zepbound® and Saxenda®.
Related
- You missed a dose. Now what? — The rules differ by product, and they hinge on how many days have passed. Here is the decision for each medicine, in the order you actually need it.
Which medicine you are on
Everything above applies across the class, because it comes from a shared mechanism. The numbers that differ — dose ladders, missed-dose windows, in-use storage periods, half-lives — differ by product, sometimes substantially. Each medicine has its own reference here:
Ozempic · Wegovy · Mounjaro · Zepbound · Rybelsus · Saxenda · Victoza · Trulicity · all medicines
How this page is sourced. Figures come from manufacturers' approved labelling and from published clinical and pharmacokinetic literature. Regional labels differ, sometimes materially — where a number matters, the leaflet in your own box outranks anything written here. This site is not written or medically reviewed by clinicians, and we say so rather than implying otherwise; our editorial standards set out what that means and how corrections work.