GLP-1 dosage schedule generator

Why titration exists and why skipping it backfires

GLP-1 receptor agonists and the dual GIP/GLP-1 agonist tirzepatide slow gastric emptying, suppress glucagon, and increase satiety by acting on brainstem receptors and hypothalamic circuits that regulate food intake. They are effective because of these mechanisms — and the same mechanisms produce the adverse events most patients find intolerable at higher starting doses: nausea, vomiting, constipation, diarrhea, and abdominal pain. Titration exists because the receptors downregulate and the gut adapts over weeks, not hours. Jumping from 0.25 mg semaglutide directly to 2.4 mg produces severe GI events and is not tolerated by most patients.

The FDA labels codify this. Wegovy’s prescribing information mandates the 0.25 → 0.5 → 1.0 → 1.7 → 2.4 mg ramp over 17 weeks (each step lasts 4 weeks). Zepbound requires 2.5 → 5 → 7.5 → 10 → 12.5 → 15 mg, with at least 4 weeks at each step. Saxenda escalates weekly over the first four weeks from 0.6 to 3.0 mg daily. Ozempic and Mounjaro (the type 2 diabetes labels for the same molecules) use effectively the same ramp with slightly different maintenance ceilings (2 mg semaglutide; 15 mg tirzepatide).

The standard semaglutide (Wegovy/Ozempic) schedule

Seventeen weeks from starter dose to 2.4 mg maintenance, assuming no holds:

• Weeks 1–4: 0.25 mg subcutaneous weekly. This is a starter dose — it is not therapeutic. Expect minimal appetite effect. Nausea in the 24–48 hours after injection is the most common issue.
• Weeks 5–8: 0.5 mg weekly. First noticeable appetite suppression for most patients.
• Weeks 9–12: 1.0 mg weekly. Therapeutic threshold for type 2 diabetes; weight loss begins in earnest.
• Weeks 13–16: 1.7 mg weekly. A step unique to Wegovy (Ozempic goes 1 → 2 mg). Ozempic maxes here or at 2 mg.
• Week 17+: 2.4 mg weekly maintenance. This is the STEP 1 and STEP 3 dose at which 14.9% mean TBWL was reported at week 68.

The standard tirzepatide (Zepbound/Mounjaro) schedule

Twenty to twenty-four weeks from starter to top dose, with three labeled maintenance doses (5, 10, 15 mg) and two titration-only intermediate steps (7.5, 12.5 mg):

• Weeks 1–4: 2.5 mg subcutaneous weekly (starter, non-therapeutic).
• Weeks 5–8: 5 mg weekly. First labeled maintenance dose for Zepbound; SURMOUNT-1 reported 15.0% TBWL at 72 weeks on 5 mg.
• Weeks 9–12: 7.5 mg weekly (titration-only per label).
• Weeks 13–16: 10 mg weekly. Second labeled maintenance dose; SURMOUNT-1 showed 19.5% TBWL at 72 weeks on 10 mg.
• Weeks 17–20: 12.5 mg weekly (titration-only per label).
• Week 21+: 15 mg weekly maintenance. 22.5% mean TBWL at 72 weeks in SURMOUNT-1.

The standard liraglutide (Saxenda) schedule

Saxenda is the older daily GLP-1 with the fastest titration — one step per week over the first four weeks, reaching 3.0 mg daily by week 5:

• Week 1: 0.6 mg daily.
• Week 2: 1.2 mg daily.
• Week 3: 1.8 mg daily.
• Week 4: 2.4 mg daily.
• Week 5+: 3.0 mg daily maintenance. SCALE trial showed 8% mean TBWL at 56 weeks.

Cross-agent equivalence (rough)

Patients commonly transition between Wegovy, Zepbound, Ozempic, and Mounjaro due to insurance formulary changes, side-effect profiles, or efficacy. There are no head-to-head titration protocols mandated; common practice, anchored to SURMOUNT-5 head-to-head data:

• Ozempic 1 mg → Wegovy: can often continue at 1 mg Wegovy, re-titrate to 1.7 or 2.4 mg over 8 weeks.
• Ozempic 2 mg → Wegovy 2.4 mg: direct transition usually tolerated.
• Mounjaro 10 mg → Zepbound 10 mg: identical molecule, direct transition. No re-titration needed.
• Wegovy 2.4 mg → Zepbound: start Zepbound at 5 mg (not 2.5 mg) in most protocols because patient has established GLP-1 tolerability. Re-titrate to 10–15 mg over 12–16 weeks.
• Zepbound 15 mg → Wegovy: start Wegovy at 1.0 or 1.7 mg; patients typically lose weight slower after this switch, consistent with SURMOUNT-5 showing tirzepatide superiority.

When to hold instead of escalate

The FDA labels build in flexibility for exactly the scenario most patients encounter: a step feels tolerable in week 1 but becomes intolerable by week 3 as the medication accumulates at steady state. Semaglutide has a half-life of ~1 week — meaning steady state is not reached until weeks 4–5 at any new dose. Tirzepatide has a ~5-day half-life with similar dynamics. The practical implication: your worst side-effect days at a new dose are often weeks 2–4, not day 1.

If nausea or vomiting is interfering with hydration or daily functioning at a step, hold rather than escalate. The labels for both Wegovy and Zepbound permit indefinite holds at any sub-maintenance dose. Common holding patterns:

• Double a step: spend 8 weeks instead of 4 at 0.5 mg semaglutide or 5 mg tirzepatide.
• Triple a step: spend 12 weeks at a problematic dose, especially the 1.0 → 1.7 mg transition on semaglutide, which tends to be the hardest step in STEP 1 real-world data.
• Step down and retry: if 2.4 mg is intolerable, return to 1.7 mg for 4 weeks and re-attempt. This is explicitly permitted in the Wegovy label.

Your trajectory-to-goal will slow when you hold — that is the tradeoff. The calculator lets you add “hold weeks” to see where you land in the schedule.

What submaximal maintenance looks like

Not every patient needs the top dose. About 30–40% of patients in real-world cohorts plateau at a submaximal dose (1.0 or 1.7 mg semaglutide, or 5 or 10 mg tirzepatide) with clinically meaningful TBWL and better tolerability. Your obesity-medicine specialist may deliberately hold you at a lower dose if (a) your weight loss is on pace at a lower dose, (b) side effects are controlled there, or (c) long-term cost is a concern and the insurance copay scales with dose. For semaglutide, 1.0 mg produced approximately 9% TBWL at 68 weeks in STEP 2 (type 2 diabetes cohort) versus 15% on 2.4 mg — a substantial but not overwhelming difference for some patients.

Dose-response: what each step actually buys you

Trial data lets you estimate what the next titration step gets you in expected-value TBWL. Rough decomposition from SURMOUNT-1 and STEP dose-ranging:

• Semaglutide 0.5 mg → 1.0 mg: +3–4 percentage points TBWL at 68 weeks (STEP 2 dose comparison vs earlier trials).
• Semaglutide 1.0 mg → 1.7 mg: +2–3 percentage points; this is often the hardest tolerability step in real-world titration.
• Semaglutide 1.7 mg → 2.4 mg: +1–2 percentage points; marginal gain if tolerability is a question.
• Tirzepatide 5 mg (15.0% TBWL in SURMOUNT-1): the first maintenance dose, meaningful loss for many patients.
• Tirzepatide 5 mg → 10 mg: +4.5 percentage points TBWL (15.0% → 19.5% in SURMOUNT-1).
• Tirzepatide 10 mg → 15 mg: +3 percentage points (19.5% → 22.5%).

For a patient who reaches goal at 10 mg tirzepatide, the 15 mg step represents $2,000–$4,000/year of added cost for 10–20 lb of incremental loss — often not worth it. Discuss with your prescriber whether pushing to the top dose is your best move, especially for maintenance.

Missed dose rules

Per the FDA labels:

• Semaglutide (Wegovy/Ozempic): if the missed dose was within 5 days of the scheduled day, take it as soon as possible. If more than 5 days, skip and resume the next scheduled dose — do not double up.
• Tirzepatide (Zepbound/Mounjaro): if within 4 days, take as soon as possible. If more than 4 days, skip. Missed doses beyond 14 days often require re-titration — discuss with your prescriber.
• Liraglutide (Saxenda): if you miss 3 or more consecutive days, restart at 0.6 mg daily and re-titrate.

FAQ

How fast can I escalate if I tolerate each dose perfectly?

No faster than the label. The 4-weeks-per-step cadence is anchored to GLP-1 receptor pharmacology and steady-state kinetics, not individual tolerance. Accelerating has no demonstrated benefit on weight outcomes and predictably worsens GI side effects.

My pharmacy keeps giving me the wrong dose pen. What should I do?

Wegovy ships as five separate strength pens (0.25, 0.5, 1.0, 1.7, 2.4 mg). Zepbound and Mounjaro are available as single-dose pens at each strength, and Zepbound is also available as LillyDirect vials at 2.5, 5, 7.5, and 10 mg. Verify the mg on the pen or vial box matches your prescribed dose before injecting. Pharmacy fulfillment errors are the single most common cause of unintended dose jumps.

Does the compounded schedule differ?

Compounded semaglutide and tirzepatide from 503A pharmacies generally follow the same titration schedule as the branded products when prescribed by licensed clinicians. Some telehealth services (see our compounded cost tool) use weekly-fractional dosing (e.g., 0.25 mg compounded sema weekly × 4, then 0.5 mg) or daily microdosing. There is no trial data supporting microdosing at this time.

Can I skip to the top dose if I’ve been on Ozempic and I’m switching to Wegovy?

If you are at a therapeutic Ozempic dose (1.0 or 2.0 mg) and switch to Wegovy, the label permits continuing at the equivalent dose. You do not need to re-titrate from 0.25 mg. Confirm with your prescriber — cross-brand transitions require explicit documentation.

My insurer only approved 2.4 mg Wegovy. Can I still start at 0.25 mg?

The PA approval usually covers the titration pack or all strengths. If yours specifies only 2.4 mg, ask your prescriber to send a revised script with titration-pack language. Starting at 2.4 mg is contraindicated for almost everyone.

Related tools

• Weight-loss timeline projector — see expected loss by week on your dose
• Side effect tracker — log severity and frequency to share with your prescriber
• BMI trajectory projector — 52-week BMI plot by therapy
• Compounded GLP-1 cost calculator — if you are on a compounded alternative