GLP-1 Dosing & Titration Schedule: Semaglutide and Tirzepatide Step-Up Charts

Every effective GLP-1 plan starts low and climbs slowly. You don't begin semaglutide or tirzepatide at the dose that produces the big weight-loss numbers — you start at a small dose and step up on a fixed schedule over months. This guide lays out the standard titration for both molecules, explains why the slow ramp is the whole point, and covers the practical questions people actually have: what the maintenance dose is, what to do about a missed dose, and how a compounded provider's schedule maps to the brand.

Why titration matters

The reason for the step-up is tolerability. GLP-1 medications slow gastric emptying and curb appetite, and starting at a full dose would overwhelm most people's gut with nausea and vomiting. By beginning low and increasing gradually, the schedule lets your body adapt at each level so the common gastrointestinal side effects stay mild and mostly temporary¹². This isn't optional fine print — the trials that proved these drugs work used these exact escalation schedules³⁴, and a real-world analysis links GLP-1 therapy to a higher risk of serious GI events, which is precisely what a patient ramp is designed to minimize⁵. Rushing the climb is the fastest way to make yourself miserable and quit; respecting it is how most people get to the effective dose comfortably. Our guide to side effects and how to manage them covers the symptom side in detail.

Semaglutide (Wegovy) titration schedule

For weight management, FDA-approved semaglutide follows a five-step monthly escalation to the 2.4 mg maintenance dose¹:

Weeks 1–4: 0.25 mg once weekly (a starter, sub-therapeutic dose to build tolerance).

Weeks 5–8: 0.5 mg once weekly.

Weeks 9–12: 1.0 mg once weekly.

Weeks 13–16: 1.7 mg once weekly.

Week 17 onward: 2.4 mg once weekly — the maintenance dose.

That's roughly four months from your first injection to the full maintenance dose. The label notes that if you don't tolerate a scheduled increase, the escalation can be delayed, and if 2.4 mg isn't tolerated it can be temporarily reduced with the goal of returning to it¹. Semaglutide is a once-weekly injection on the same day each week.

Tirzepatide (Zepbound) titration schedule

FDA-approved tirzepatide for weight management starts at 2.5 mg and steps up in 2.5 mg increments, with a minimum of four weeks at each dose before increasing²:

Weeks 1–4: 2.5 mg once weekly (starter dose).

Weeks 5–8: 5 mg once weekly.

From there, increase by 2.5 mg every 4 weeks as needed and tolerated — to 7.5 mg, then 10 mg, then 12.5 mg, up to a maximum of 15 mg once weekly².

The maintenance dose is whichever tolerated dose gives you the response you need — 5, 10, or 15 mg are the common maintenance targets, and not everyone needs to climb to the top. Like semaglutide, tirzepatide is a once-weekly injection, and the label allows delaying a step-up if a dose isn't tolerated².

Step-up chart at a glance

Here is the standard escalation for both molecules side by side. Weeks are approximate and always defer to your clinician's plan:

Month 1 — Semaglutide 0.25 mg · Tirzepatide 2.5 mg (starter doses; build tolerance).

Month 2 — Semaglutide 0.5 mg · Tirzepatide 5 mg.

Month 3 — Semaglutide 1.0 mg · Tirzepatide 7.5 mg.

Month 4 — Semaglutide 1.7 mg · Tirzepatide 10 mg.

Month 5+ — Semaglutide 2.4 mg (maintenance) · Tirzepatide 12.5–15 mg as needed.

The single most important rule across both: at least four weeks at each dose before stepping up, and no shame in staying longer at a level that's working or that you're still adjusting to.

What if I miss a dose?

For semaglutide, the label guidance is that if you miss a weekly dose and the next scheduled dose is more than 48 hours away, take it as soon as you remember; if the next dose is less than 48 hours away, skip the missed one and resume your regular schedule¹. For tirzepatide, a missed dose can be taken within 4 days (96 hours); if more than 4 days have passed, skip it and take the next dose on your regular day². Never double up to "catch up." If you miss several weeks in a row, don't simply restart at your old high dose — check with your clinician, because you may need to re-titrate to avoid a rough return of side effects.

How compounded providers handle titration

Compounded semaglutide and tirzepatide are prepared by licensed pharmacies rather than sold as FDA-approved finished products, and their dosing is sometimes expressed in different units or vial concentrations rather than the neat brand milligram steps — which is exactly why a transparent provider and real clinician oversight matter. A good compounded program still follows the same principle: start low, hold at each level for about four weeks, and step up only as tolerated. The risk to avoid is a provider that hands you a vial with vague instructions and no one to call when a dose is rough. When you compare programs, weight the clinician support and titration flexibility, not just the price — the 2-minute quiz folds those in, and you can see real monthly costs in the cost calculator. For choosing between the molecules, see semaglutide vs. tirzepatide; to shop the tirzepatide field specifically, see our best tirzepatide providers.

The takeaway: both molecules climb on a roughly monthly schedule to a maintenance dose over four to five months, the slow ramp exists to keep side effects manageable, and the provider worth paying for is the one that titrates you sensibly and picks up the phone when a dose is hard.