Full titration schedules
Wegovy (semaglutide for weight loss)
The FDA-approved Wegovy titration schedule increases the dose every 4 weeks over 16 weeks to reach the 2.4mg maintenance dose. This gradual ramp-up minimizes nausea and GI side effects, which are the most common reason people discontinue treatment.
| Weeks | Dose | Phase | Common side effects |
|---|---|---|---|
| 1–4 | 0.25 mg/week | Initiation | Mild nausea, fatigue |
| 5–8 | 0.5 mg/week | Escalation 1 | Nausea, decreased appetite |
| 9–12 | 1.0 mg/week | Escalation 2 | GI effects peak here for many |
| 13–16 | 1.7 mg/week | Escalation 3 | Usually improving |
| 17+ | 2.4 mg/week | Maintenance | Most patients well-tolerated |
Zepbound (tirzepatide for weight loss)
Zepbound has a longer titration schedule — 5 dose levels over 20 weeks — before reaching the 15mg maintenance dose. Some patients may find that 10mg or 12.5mg is their optimal maintenance dose, and providers can hold at those levels.
| Weeks | Dose | Phase |
|---|---|---|
| 1–4 | 2.5 mg/week | Initiation |
| 5–8 | 5 mg/week | Escalation 1 |
| 9–12 | 7.5 mg/week | Escalation 2 |
| 13–16 | 10 mg/week | Escalation 3 |
| 17–20 | 12.5 mg/week | Escalation 4 |
| 21+ | 15 mg/week | Maintenance |
When to use slow titration
Your provider may recommend a slow titration schedule — staying at each dose level for 8 weeks instead of 4 — if you experience significant nausea, vomiting, or other GI side effects. This is not a failure; it's a common and effective strategy.
Clinical guidance: Studies show that patients who use slow titration have similar long-term weight loss outcomes compared to standard titration, with significantly better tolerability and lower discontinuation rates. The extra weeks at lower doses give your body more time to adapt.
Signs you might benefit from slow titration include: nausea that interferes with daily activities, vomiting after injections, inability to eat normal meals, or significant fatigue in the days following your injection. Always discuss dose adjustments with your prescribing provider before making changes.
What to do if you miss a dose
Missing an occasional dose is not a reason to panic, but timing matters:
- Within 5 days of missed dose: Take the missed dose as soon as you remember. Resume your normal weekly schedule from that new injection date.
- More than 5 days late: Skip the missed dose entirely. Take your next scheduled dose on the originally planned day. Never double up.
- Missing multiple doses in a row: Contact your provider. Your body may have lost its tolerance to side effects and re-starting at a lower dose may be necessary.
Travel tip: GLP-1 injections must be kept refrigerated (36–46°F / 2–8°C) but can be kept at room temperature (below 77°F / 25°C) for up to 28 days once in use. Plan refrigeration arrangements before trips and keep a note of your injection schedule in case of time zone changes.