GLP-1 dose escalation schedule: how Wegovy, Ozempic, Mounjaro and Zepbound doses step up
All four US labels start low and step up no sooner than every 4 weeks. Wegovy goes 0.25, 0.5, 1 and 1.7 mg, then 2.4 mg (or 1.7 mg) from week 17; Zepbound starts at 2.5 mg and rises in 2.5 mg steps to 5, 10 or 15 mg. If a step isn't tolerated, the Wegovy label lets prescribers delay escalation by 4 weeks. Each step is your prescriber's call.
What is a GLP-1 dose escalation schedule?
GLP-1 medicines are not started at full strength. You begin on a low dose and step up every few weeks until you reach a maintenance dose, the dose you stay on long term. This step-by-step climb is called titration, or dose escalation.
Each medicine has its own ladder, and the steps are set out in its prescribing information. We checked the current US labels for Wegovy, Ozempic, Mounjaro and Zepbound on DailyMed on 14 October 2026. Labels change, so your prescriber and pharmacist always have the final word.
What are the dose steps for Wegovy, Ozempic, Mounjaro and Zepbound?
| Medicine | Starting dose | Steps up | Maintenance and maximum |
|---|---|---|---|
| Wegovy injection (semaglutide, weight and heart risk) | 0.25 mg weekly, weeks 1–4 | 0.5 mg (weeks 5–8), 1 mg (weeks 9–12), 1.7 mg (weeks 13–16) | From week 17: 2.4 mg (recommended) or 1.7 mg. For adult weight reduction, up to 7.2 mg after at least 4 weeks on 2.4 mg |
| Ozempic (semaglutide, type 2 diabetes) | 0.25 mg weekly for 4 weeks | 0.5 mg; then 1 mg and 2 mg only if more glucose lowering is needed, each after at least 4 weeks | 0.5, 1 or 2 mg; maximum 2 mg |
| Mounjaro (tirzepatide, type 2 diabetes) | 2.5 mg weekly | 2.5 mg steps (5, 7.5, 10, 12.5 mg) after at least 4 weeks, if more glucose control is needed | Maximum 15 mg in adults; 10 mg in children aged 10+ |
| Zepbound (tirzepatide, weight and sleep apnea) | 2.5 mg weekly for 4 weeks (starting dose only) | 5 mg, then 2.5 mg steps after at least 4 weeks | Weight: 5, 10 or 15 mg. Sleep apnea: 10 or 15 mg. Maximum 15 mg |
A few details the table can’t hold:
- Wegovy 7.2 mg. The label added a higher maximum for adults using Wegovy for weight reduction. It is only an option once 2.4 mg has been tolerated for at least 4 weeks and more weight loss is clinically indicated. Teens aged 12 and over follow the same ladder, but their maintenance options are 1.7 or 2.4 mg.
- Wegovy tablets follow a daily, monthly ladder instead: 1.5 mg for days 1–30, 4 mg for days 31–60, 9 mg for days 61–90, then 25 mg once daily.
- Ozempic and Mounjaro are diabetes medicines, so steps beyond the early doses happen only if more glucose lowering is needed. For Ozempic’s kidney-protection use, the label sets 1 mg as the maintenance dose.
To see what these steps look like on a calendar, try the GLP-1 titration planner.
Why do GLP-1 doses go up so slowly?
The labels give the reason directly: the escalation schedule is there to reduce the risk of gastrointestinal side effects. Nausea, vomiting, diarrhea and constipation are among the most common side effects of these medicines.
Trial data back this up. In STEP 1 (semaglutide 2.4 mg), nausea and diarrhea were the most common adverse events and were typically mild to moderate and transient. In SURMOUNT-1 (tirzepatide), most GI events were mild to moderate and happened mainly during dose escalation. A multidisciplinary expert consensus also notes that GI effects usually begin during escalation and often ease after the maintenance dose is reached.
Higher doses aren’t free of trade-offs either. In STEP UP, GI adverse events were reported by 70.8% of people on semaglutide 7.2 mg, compared with 61.2% on 2.4 mg and 42.8% on placebo. Altered skin sensation (dysaesthesia) was also more common at 7.2 mg (22.9% vs 6.0%).
If you’re just starting, our guide to your first month on a GLP-1 covers what the early weeks often feel like, and GLP-1 nausea relief has practical tips.
What if side effects make it hard to step up?
This is where the labels differ, and it’s worth knowing what yours says:
- Wegovy injection: if a dose isn’t tolerated during escalation, prescribers can consider delaying escalation for 4 weeks.
- Wegovy tablets: the label also allows delaying escalation, and if 25 mg isn’t tolerated, it suggests considering a switch to Wegovy injection 1.7 mg weekly.
- Zepbound: if a maintenance dose isn’t tolerated, the label says to consider a lower maintenance dose.
- Ozempic and Mounjaro: the labels don’t spell out a delay option, but their later steps only happen if more glucose lowering is needed anyway.
The expert consensus describes options clinicians use when GI effects persist. These include staying 2–4 weeks longer on the current dose, not escalating while symptoms continue, or settling on a maintenance dose below the label maximum. These are prescriber decisions. Don’t skip doses, split pens or stay put on your own without telling your care team. If you’ve missed doses, see what to do after a missed GLP-1 dose, because longer gaps can change how treatment restarts.
Can I stay on a lower dose?
Every label lists more than one maintenance dose: 1.7 or 2.4 mg for Wegovy, 5, 10 or 15 mg for Zepbound, 0.5, 1 or 2 mg for Ozempic, and up to 15 mg for Mounjaro. Reaching the top step isn’t the goal in itself. The Wegovy and Zepbound labels both ask prescribers to weigh treatment response and tolerability when choosing the maintenance dose.
Trials show that lower maintenance doses still work, though on average less than higher ones. In SURMOUNT-1, mean weight change at 72 weeks was −15.0% on tirzepatide 5 mg, −19.5% on 10 mg and −20.9% on 15 mg, compared with −3.1% on placebo. In STEP UP, the figures were −18.7% on semaglutide 7.2 mg and −15.6% on 2.4 mg. These are averages, and individual results vary a lot.
So “can I stay on a lower dose?” is a fair question to ask. The answer depends on your weight trend, side effects, blood glucose if you have diabetes, and your health goals, which makes it a decision for you and your prescriber together.
What should you note before each dose step?
Your prescriber decides whether to step up, hold or adjust, and good notes make that conversation easier. In the week or two before each step, keep track of:
Side effects
Which symptoms you had, how severe they were, how many days after the injection they appeared, and whether they’re easing or getting worse.
Eating and drinking
Your appetite, whether you can manage regular meals and enough protein, and whether you’re keeping fluids down.
Weight trend
A weekly average rather than single weigh-ins. Daily water shifts can hide the real direction.
Glucose and other readings
If you have diabetes, your glucose readings, plus any lows if you also take insulin or a sulfonylurea.
Doses and questions
Missed or late doses, and any questions you want to ask. Our article on GLP-1 doctor visits and lab tests covers what else is useful to bring.
When should you call your doctor?
Contact your care team promptly, or get urgent help, if you notice:
- Severe stomach pain that won’t go away, sometimes spreading to your back, with or without vomiting (a possible sign of pancreatitis)
- Vomiting or diarrhea that stops you keeping fluids down, or signs of dehydration such as dizziness or passing very little urine
- Pain in your upper stomach, fever, yellowing of the skin or eyes, or clay-colored stools (possible gallbladder problems)
- Swelling of the face, lips, tongue or throat, trouble breathing or swallowing, or a severe rash (possible serious allergic reaction; get help right away)
- Symptoms of low blood sugar if you also take insulin or a sulfonylurea
Keeping your titration on track
Escalation goes more smoothly when you and your prescriber can see what each step did. GLPMate logs every dose with reminders, keeps a side-effect log with severity next to your weight trend, and turns it all into a doctor report (PDF) you can bring to your appointment.
This article is educational only and not medical advice. Talk to your prescriber before changing anything about your dose or schedule.
FAQ
How long should I stay on each GLP-1 dose before increasing?
The current US labels for Wegovy, Ozempic, Mounjaro and Zepbound all use at least 4 weeks on a dose before the next step. That is a minimum, not a deadline: your prescriber may keep you on a step longer if side effects are hard to manage, and the Wegovy label specifically allows delaying escalation by 4 weeks.
What is the Mounjaro dose increase schedule?
Mounjaro starts at 2.5 mg once weekly. If more glucose control is needed, the dose goes up in 2.5 mg steps after at least 4 weeks on the current dose, to a maximum of 15 mg in adults (10 mg in children aged 10 and older). Zepbound uses the same 2.5 mg steps, but 2.5 mg is only a starting dose and maintenance is 5, 10 or 15 mg.
Can I stay on a lower GLP-1 dose if it's working?
The labels list more than one maintenance dose: 1.7 or 2.4 mg for Wegovy, 5, 10 or 15 mg for Zepbound, and 0.5, 1 or 2 mg for Ozempic. In SURMOUNT-1, people on tirzepatide 5 mg lost about 15% of body weight on average at 72 weeks. Whether a lower dose suits you is a decision to make with your prescriber, based on your response, side effects and health goals.
What happens if I can't tolerate the next dose increase?
Tell your prescriber rather than skipping, splitting or changing doses yourself. The Wegovy label says prescribers can consider delaying escalation for 4 weeks, and the Zepbound label says to consider a lower maintenance dose if one isn't tolerated. Severe or persistent stomach pain, or vomiting that stops you keeping fluids down, needs prompt medical attention.
Sources
- FDA Prescribing Information — Wegovy (semaglutide) injection and tablets, DailyMed (version effective June 2026, checked 14 Oct 2026) — 0.25/0.5/1/1.7 mg escalation table, 1.7 or 2.4 mg maintenance, 7.2 mg maximum for adult weight reduction, 4-week delay option, tablet schedule, warnings and patient symptoms
- FDA Prescribing Information — Ozempic (semaglutide) injection, DailyMed (version effective June 2026, checked 14 Oct 2026) — 0.25 mg start for 4 weeks, then 0.5 mg; 1 mg and 2 mg only if more glucose lowering is needed, after at least 4 weeks on the current dose
- FDA Prescribing Information — Mounjaro (tirzepatide), DailyMed (version effective August 2026, checked 14 Oct 2026) — 2.5 mg start, 2.5 mg increments after at least 4 weeks if more glucose control is needed, maximum 15 mg in adults and 10 mg in children aged 10+
- FDA Prescribing Information — Zepbound (tirzepatide), DailyMed (version effective August 2026, checked 14 Oct 2026) — 2.5 mg is for initiation only; 5, 10 or 15 mg maintenance; consider a lower maintenance dose if one isn't tolerated
- Wilding et al., NEJM 2021 (STEP 1) — semaglutide 2.4 mg, 68 weeks — nausea and diarrhea were the most common adverse events, typically transient and mild to moderate
- Jastreboff et al., NEJM 2022 (SURMOUNT-1) — tirzepatide 5, 10 and 15 mg, 72 weeks — mean weight change −15.0%, −19.5% and −20.9% vs −3.1% with placebo; GI events mostly mild to moderate and mainly during dose escalation
- Wharton et al., Lancet Diabetes Endocrinol 2025 (STEP UP) — semaglutide 7.2 mg vs 2.4 mg, 72 weeks — −18.7% vs −15.6% body weight; GI adverse events 70.8% vs 61.2%, dysaesthesia 22.9% vs 6.0%
- Gorgojo-Martínez et al., J Clin Med 2022;12(1):145 — multidisciplinary expert consensus on GI adverse events with GLP-1 RAs — GI effects usually start during escalation; clinician options include extending a step, not escalating while symptoms persist, or a lower maintenance dose
Sources checked:
This article is educational and is not medical advice, diagnosis or treatment. Medication decisions — including dose changes and what to do after a missed dose — belong with your prescriber. If you experience severe symptoms, seek medical care.