Zepbound (tirzepatide, Eli Lilly) is titrated on a fixed six-step ladder under the FDA prescribing information: 2.5 mg → 5 mg → 7.5 mg → 10 mg → 12.5 mg → 15 mg weekly subcutaneous, with at least four weeks at each step. The 2.5 mg starting dose is a tolerability lead-in and is not a treatment dose. Maintenance options are 5, 10, or 15 mg.
Dose ladder (FDA label)
| Step | Weeks | Dose (weekly SC) | Notes |
|---|---|---|---|
| 1 (lead-in) | Weeks 1–4 | 2.5 mg | Tolerability dose. Not a treatment dose — advance after 4 weeks even if no side effects. |
| 2 | Weeks 5–8 | 5 mg | First treatment dose. A valid maintenance option for chronic weight management. |
| 3 | Weeks 9–12 | 7.5 mg | Intermediate step. Increase only after at least 4 weeks on 5 mg. |
| 4 | Weeks 13–16 | 10 mg | A valid maintenance option for weight management and a minimum maintenance dose for obstructive sleep apnea (SURMOUNT-OSA). |
| 5 | Weeks 17–20 | 12.5 mg | Intermediate step toward 15 mg. Not a labeled long-term maintenance dose. |
| 6 (ceiling) | Week 21+ | 15 mg | Maximum dose. A valid maintenance option. Do not exceed 15 mg/week. |
Source: DailyMed Zepbound SPL, SetID 487cd7e7-434c-4925-99fa-aa80b1cc776b.
Quick facts
- Schedule: once weekly, same day each week, any time of day, with or without food.
- Site: subcutaneous injection into abdomen, thigh, or upper arm. Rotate sites weekly.
- Minimum time per step: at least 4 weeks before escalating. There is no maximum — a patient can stay at any tolerated dose indefinitely.
- Maintenance choices: 5 mg, 10 mg, or 15 mg for weight management. Either 10 mg or 15 mg for obstructive sleep apnea.
- Maximum: 15 mg once weekly. The label does not authorize doses above 15 mg.
- What counts as a stable maintenance dose: a dose the patient tolerates and that produces or sustains adequate weight reduction. The label does not require reaching 15 mg.
- Day-of-week change: permitted as long as the prior dose was given at least 3 days (72 hours) earlier.
Missed-dose protocol (verbatim from the FDA label)
“If a dose is missed, instruct patients to administer ZEPBOUND as soon as possible within 4 days (96 hours) after the missed dose. If more than 4 days have passed, skip the missed dose and administer the next dose on the regularly scheduled day.”
- Within 96 hours: take the missed dose, then resume the regular weekly schedule.
- After 96 hours: skip it. Do not double up the next week.
- For step-by-step decision logic, see the GLP-1 missed-dose guide.
Red-flag side effects (pause escalation or call the prescriber)
- Severe, persistent abdominal pain radiating to the back — possible acute pancreatitis. Stop dosing and seek evaluation.
- Right-upper-quadrant pain, fever, or jaundice — possible cholelithiasis or cholecystitis (the label notes acute gallbladder disease as a known adverse reaction).
- Symptomatic hypoglycemia — especially in patients on concomitant insulin or a sulfonylurea. Those agents may need dose reduction.
- Signs of severe dehydration from prolonged nausea, vomiting, or diarrhea — acute kidney injury has been reported. Hold the next dose until rehydrated.
- Allergic reaction — rash, urticaria, swelling, or anaphylaxis. Discontinue and seek emergency care.
- Visual changes in patients with diabetic retinopathy — rapid glycemic improvement can transiently worsen retinopathy; ophthalmology follow-up is advised.
Boxed warning: a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) is a contraindication.
What this cheat sheet does not cover
- Switching from Wegovy to Zepbound — there is no FDA-blessed milligram-for-milligram conversion; restart on the 2.5 mg lead-in. See the Wegovy ↔ Zepbound switch guide.
- Compounded tirzepatide dosing — compounded vials are not FDA-approved and may not follow the same titration. See the Zepbound drug page for the brand-vs-compound distinction.
- Pricing — cash-pay tiers via LillyDirect change frequently; check the live Zepbound drug page for current pricing.
- Drug interactions with oral contraceptives, warfarin, or insulin — see the full DailyMed label.
Related on Weight Loss Rankings
- Zepbound drug page — full label, indications, side effects, current pricing.
- GLP-1 titration planner — interactive week-by-week ladder for Zepbound, Wegovy, and Mounjaro.
- GLP-1 missed-dose guide — 96-hour decision tree across all weekly GLP-1s.
- Top tirzepatide weight-loss studies — PubMed-curated list of the SURMOUNT and SURPASS pivotal trials.
- Wegovy vs Zepbound — head-to-head verdict on the two FDA-approved weight-loss GLP-1s.