Standard dosing for semaglutide and tirzepatide is designed to balance efficacy against tolerability. Most patients can follow standard titration; some need to slow it down. This guide covers the schedules, the rationale, and legitimate reasons to deviate.
| Week | Dose | Notes |
|---|---|---|
| 1–4 | 0.25 mg/week | Initiation; minimal weight effect expected |
| 5–8 | 0.5 mg/week | Modest weight effect begins |
| 9–12 | 1.0 mg/week | Most patients see meaningful appetite reduction |
| 13–16 | 1.7 mg/week | Approaching maintenance |
| 17+ | 2.4 mg/week | Maintenance; continued indefinitely if tolerated |
| Week | Dose | Notes |
|---|---|---|
| 1–4 | 2.5 mg/week | Initiation |
| 5–8 | 5 mg/week | First effective dose |
| 9–12 | 7.5 mg/week | Continue if escalation tolerated |
| 13–16 | 10 mg/week | Common maintenance level |
| 17–20 | 12.5 mg/week | Continued escalation if needed |
| 21+ | 15 mg/week | Maximum; not all patients need to reach this |
Dose-limiting side effects (nausea, GI symptoms) are mechanism-related. Slow titration allows tolerance to develop. Skipping steps significantly increases discontinuation risk.
Many patients stabilize at sub-maximum dose that produces target effect with acceptable side effects. The question is not "did you reach max" but "is current dose working for your goals."
Programs with dose-step pricing create a financial incentive to stay at lower doses than clinically optimal. Flat-rate programs (NexLife) remove this incentive — titration is a clinical decision, not a budget decision.