GLP-1 Dosage and Titration Schedules: Semaglutide and Tirzepatide

Neither semaglutide nor tirzepatide is dosed at its effective, weight-management-strength target from week one. Both climb there in steps, on a fixed schedule set by the FDA-approved label — not a provider's house preference. Here is that schedule for each drug, straight from the prescribing information.

Semaglutide (Wegovy): the five-step climb

Wegovy's approved titration runs through five dose levels, moving up roughly every 4 weeks: 0.25 mg, 0.5 mg, 1 mg, 1.7 mg, then the 2.4 mg maintenance dose — a minimum of about 16 weeks to reach target, longer if a step needs repeating¹. If a dose isn't tolerated, the label allows the prescriber to hold at the current step, or repeat it, before moving up¹. The 0.25 mg and 0.5 mg steps are not treatment doses in their own right — they exist only to get the GI system used to the drug before it does the real work.

Tirzepatide (Zepbound): the six-step climb

Zepbound's schedule has one more rung: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, then 15 mg, each step held a minimum of 4 weeks before the next². Reaching the maximum 15 mg dose takes at least 20 weeks. Unlike Wegovy, Zepbound's label sets three separate FDA-approved maintenance doses — 5 mg, 10 mg or 15 mg — rather than one fixed target, so a prescriber can stop the climb once the dose is working, rather than always pushing to the ceiling².

Why the schedule is slow by design

Gastrointestinal side effects — nausea, diarrhea, vomiting — are dose-related, and titrating slowly is the label's own strategy for holding them down; see the real incidence numbers in GLP-1 side effects. Skipping steps to reach a "target" dose faster skips the entire reason the schedule exists, and it is not how either drug was studied in its pivotal trial.

What happens if you miss a dose

The two drugs have different rules, and mixing them up matters:

• Wegovy: keep at least 48 hours between any two injections. If your next scheduled dose is more than 48 hours away, take the missed one as soon as you remember; if it's closer than 48 hours, skip it and resume your normal weekly day.
• Zepbound: you have a 4-day (96-hour) window to take a missed dose late. Past 4 days, skip it and resume schedule. Never take two doses within 3 days (72 hours) of each other.

Neither rule is a suggestion — both come directly from each drug's FDA-approved dosing and administration section¹².

What happens when treatment ends

Both schedules above describe getting onto the drug, not what happens after stopping it. The most direct trial-level answer to that — and it's a real regain pattern, not a null result — is in GLP-1 weight regain after stopping. And well before you reach either endpoint, most patients hit a plateau while still on a stable maintenance dose — that's expected physiology, not the drug failing; see does GLP-1 weight loss plateau for why it happens. If you're weighing how long either drug stays active once a dose is skipped or treatment pauses, how long GLP-1 drugs stay in your system has the half-life figures behind that question.

Reading a provider's dosing claims

A provider's own dosing schedule for a compounded formulation may not match the brand-name titration above exactly — compounded product isn't bound to the same FDA-reviewed schedule, which is one more reason to confirm what pharmacy and what dosing plan stands behind any figure a provider quotes; see is compounded GLP-1 legit and safe. For the injection mechanics themselves — sites, rotation, needle handling — see how to inject GLP-1 medications. And if you're deciding between the two molecules in the first place, the trial-level results behind each schedule are in semaglutide vs tirzepatide.