Getting Started
GLP-1 Dosing and Titration, Week by Week
Nearly every difficult first experience with a GLP-1 traces back to going up too fast. The titration schedule is not caution for its own sake — it is the single biggest lever on whether the first three months feel manageable or miserable.
7 min read · Updated · Published by CoreAge Rx
Why the dose starts low
The starting dose of semaglutide is 0.25 mg. The dose that produced 14.9% weight loss in the STEP 1 trial is 2.4 mg — nearly ten times higher. You begin at a dose that is not expected to do much, on purpose.
The reason is your stomach. GLP-1 slows gastric emptying, and the digestive system needs weeks to adapt to that. Introduce it gradually and most people barely notice. Introduce it all at once and you get the nausea horror stories. Every step in the ladder below exists to buy your body four weeks of adjustment.
The semaglutide ladder
| Weeks | Weekly dose | What it is for |
|---|---|---|
| 1–4 | 0.25 mg | Adaptation. Appetite changes often start; weight change is usually small. |
| 5–8 | 0.5 mg | Consistent appetite suppression begins. Steady loss typically starts here. |
| 9–12 | 1.0 mg | A commonly effective maintenance dose in its own right. |
| 13–16 | 1.7 mg | Stepped up if progress has slowed and tolerance is good. |
| 17+ | 2.4 mg | The full trial dose. Not everyone needs to reach it. |
The tirzepatide ladder
| Weeks | Weekly dose | What it is for |
|---|---|---|
| 1–4 | 2.5 mg | Adaptation dose. Not intended for weight loss. |
| 5–8 | 5 mg | The first therapeutic dose; many people do well here long-term. |
| 9–12 | 7.5 mg | Stepped up if results have plateaued. |
| 13–16 | 10 mg | A common effective maintenance point. |
| 17–20 | 12.5 mg | For those still progressing toward a larger goal. |
| 21+ | 15 mg | The maximum studied dose, and the SURMOUNT-1 headline figure. |
Note that tirzepatide has six steps to semaglutide's five, which is part of why it offers finer control. The trade-offs between them are in Semaglutide vs. Tirzepatide: Which Is Right for You?.
You may not need the top dose
This is worth saying loudly, because the ladders above invite the assumption that the goal is the last rung. It is not. Plenty of patients reach a good, sustainable rate of loss at semaglutide 1.0 mg or tirzepatide 5 mg and stay there for the rest of the programme.
The right dose is the lowest one that produces steady progress with side effects you barely think about. Going higher than that adds side-effect burden and cost for no additional benefit.
Get a schedule built around you
Your physician sets the starting dose and the pace, and adjusts both as you go.
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When to hold instead of stepping up
Talk to your physician about staying at your current dose another month if any of these apply:
- You are still getting meaningful nausea more than a week after your last increase.
- You are losing weight at a good rate already — roughly 1–2 pounds a week. There is nothing to fix.
- You are struggling to eat enough protein, which puts lean mass at risk. See Protecting Muscle While You Lose Fat.
- You are losing faster than about 2 pounds a week over a sustained stretch, which usually means the dose is ahead of you.
- Life is unusually demanding right now — travel, illness, a hard month at work. A dose increase is easier to absorb in a calm week.
Missed doses
It happens to everyone eventually. The half-life of these medications is around a week, which gives you a genuinely forgiving window.
- Remembered within 4 days of the scheduled day — take it as soon as you remember, then return to your usual weekly day.
- More than 4 days late — skip that dose entirely and take the next one on your normal day. Do not double up.
- Two or more weeks missed — contact your provider before resuming. You may need to restart at a lower dose, because tolerance fades faster than people expect.
Practical injection notes
- Pick a day and keep it. Sunday evening or Monday morning works well for many people — side effects, if any, land midweek rather than on a weekend.
- Rotate sites. Abdomen (at least two inches from the navel), outer thigh, or back of the upper arm. Move it each week.
- Time of day does not matter, as long as it is roughly consistent.
- Storage. Refrigerated, out of direct light. Let it come toward room temperature for a few minutes before injecting — cold medication stings more.
- Sharps go in a proper container, not the household bin.
If you are drawing from a vial rather than using a pen, How to Inject a GLP-1, Step by Step walks through it step by step, and Your First Month on a GLP-1: What to Expect covers the wider first four weeks. Travelling with it is its own small problem — see Travelling With GLP-1 Medication.
Common questions
Can I move faster if I am tolerating it well?
That is your physician's call, and sometimes the answer is yes. But tolerating a dose in week three does not predict tolerating a jump in week four — the schedule exists because the adaptation takes time regardless of how you feel today.
What if I plateau at the top dose?
Plateaus are normal and often resolve on their own — The GLP-1 Results Timeline, Month by Month shows the real shape of the curve. If a genuine stall persists, options include reviewing protein and resistance training, or switching medication class.
Can I change my injection day?
Yes. Shift it by up to a couple of days at a time and keep the new day consistent afterwards.
Does the dose go back down eventually?
Often, in maintenance. Many patients hold their weight on a lower dose than they lost it on — see Maintenance: Keeping the Weight Off.
Start at the right dose, at the right pace
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