The dose ladder: starting low and stepping up

Almost every GLP-1 prescription starts at the lowest dose and steps up over 2–4 months. Here's why — and what to expect at each rung.

Why we titrate

Starting at the maintenance dose causes severe nausea for nearly everyone. Slow escalation lets your gut adapt: gastric emptying gradually slows, appetite drops gradually, side effects stay manageable.

Semaglutide ladder

0.25 mg → 0.5 mg → 1.0 mg → 1.7 mg → 2.4 mg (Wegovy max). Each step lasts about 4 weeks before increasing. Most patients reach 1.7 mg or 2.4 mg by month 4.

Tirzepatide ladder

2.5 mg → 5 mg → 7.5 mg → 10 mg → 12.5 mg → 15 mg. Same logic, six steps because the dose range is wider. Some patients hold at 5 mg or 10 mg if that's working.

Slowing the ladder

If side effects are tough at any step, your doctor will hold you at that dose for another month before stepping up. That's normal and doesn't slow your overall outcome much.