Titration

Titration is the staged dose increase every GLP-1 medication requires. You do not start at the dose that produces the trial results; you climb to it. The labels say why in plain terms: the escalation exists to reduce the risk of gastrointestinal adverse reactions.

Each drug has its own ladder. Wegovy injection starts at 0.25 mg once weekly for four weeks and steps up roughly every four weeks to a usual maintenance dose of 2.4 mg. Zepbound and Mounjaro start at 2.5 mg weekly for four weeks — a starter dose the Zepbound label states is not approved as a maintenance dose — then rise in 2.5 mg increments no sooner than every four weeks, to a maximum of 15 mg. Saxenda climbs weekly from 0.6 mg to 3 mg daily. Foundayo moves in 30-day steps from 0.8 mg through 2.5, 5.5, 9, 14.5 and up to 17.2 mg once daily.

Do the arithmetic and the timeline surprises people. Reaching 15 mg of tirzepatide takes at least five dose steps, so around five months; Foundayo’s top dose is a similar distance away. Someone expecting trial-level results by week eight is comparing themselves against a dose they have not reached.

The most useful thing to know is that the schedule is a floor, not a mandate. The labels specify minimum intervals between increases, not maximums. Staying at your current dose for an extra month because nausea has not settled is a legitimate clinical decision, and the Zepbound label directs prescribers to consider treatment response and tolerability when selecting the maintenance dose. The Wegovy label goes further: if two or more consecutive injections are missed, restart escalation at a lower dose.

Ask your prescriber what maintenance dose they are aiming for, what symptoms should trigger a pause rather than a push, and who to contact between visits. Our titration planner and escalation evidence review lay out each ladder.