Guide
How semaglutide and tirzepatide doses escalate over the first 16 weeks.
Titration is the planned, gradual escalation of GLP-1 dosing from a starting dose to a maintenance dose. Standard titration takes 16-20 weeks. Slower titration is common when patients tolerate poorly. This guide covers each medication's schedule.
The GI side-effect burden of GLP-1s is dose-dependent. Starting at the maintenance dose would produce severe nausea and vomiting in most patients. Slow escalation lets the body adapt to each dose level before the next increase, dramatically reducing side-effect intensity.
Standard schedule: 0.25 mg weekly for 4 weeks, then 0.5 mg for 4 weeks, then 1.0 mg for 4 weeks, then 1.7 mg for 4 weeks, then 2.4 mg maintenance. Total titration: 16 weeks to maintenance.
Compounded semaglutide may use slightly different concentrations and step intervals depending on the compounding pharmacy. Some programs use a custom titration like 0.3 -> 0.6 -> 0.9 mg for the first three steps. Confirm your specific schedule with your prescribing clinician.
Standard schedule: 2.5 mg weekly for 4 weeks, then 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg in 4-week increments. Total titration: 20 weeks to maximum dose. Many patients maintain at 10 mg or 12.5 mg rather than escalating to the maximum.
Patients with significant GI side effects can extend each step from 4 weeks to 6-8 weeks without clinical disadvantage. The total weight-loss outcome at 72 weeks is comparable; only the path differs. If you cannot tolerate a step, slow down rather than push through.
The dose at which you reach your weight goal is your maintenance dose. Some patients find that a lower-than-maximum dose maintains their weight indefinitely. There is no clinical advantage to taking a higher dose than what maintains your goal weight.
16 weeks for semaglutide, 20 weeks for tirzepatide on the standard schedule. Slower paths are clinically reasonable.
No. Each step prepares the body for the next. Skipping a step is the most common cause of severe side effects.
Stay at the previous dose for an extra 2-4 weeks, then try again. If you still cannot tolerate, talk to your clinician about alternatives.
No. Maintain at the dose where you reach your goal weight.
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Editorial note. This guide is for educational purposes only and does not constitute medical advice. Always consult a licensed clinician about your specific situation.