GLP-1 Titration Schedule Guide: Semaglutide and Tirzepatide Dosing

Why Titration Matters

GLP-1 receptor agonists require gradual dose escalation to minimize gastrointestinal side effects. Starting at the full therapeutic dose significantly increases the likelihood of nausea, vomiting, and treatment discontinuation.

Semaglutide Titration Schedule

Based on the FDA-approved Wegovy prescribing information for the obesity indication.

Month 1: 0.25 mg weekly -- initiation dose for tolerability. Minimal weight loss expected.

Month 2: 0.5 mg weekly -- first escalation. Some appetite suppression begins.

Month 3: 1.0 mg weekly -- meaningful appetite reduction typically becomes consistent.

Month 4: 1.7 mg weekly -- many patients find this is their maintenance dose.

Month 5+: 2.4 mg weekly -- full therapeutic dose.

Tirzepatide Titration Schedule

Based on the FDA-approved Zepbound prescribing information.

Weeks 1-4: 2.5 mg weekly -- initiation dose.

Weeks 5-8: 5 mg weekly -- noticeable appetite suppression begins.

Weeks 9-12: 7.5 mg weekly (optional) -- intermediate dose.

Weeks 13-16: 10 mg weekly -- mid-range therapeutic dose.

Weeks 17+: 12.5 mg or 15 mg weekly -- highest studied doses.

Managing Side Effects During Titration

Nausea is the most commonly reported side effect during dose escalation. Strategies include eating smaller meals, avoiding high-fat foods immediately after injection, staying hydrated, and timing the injection before bed.

Some practitioners recommend BPC-157 for GLP-1 related nausea based on its gastric-protective properties studied in animal models.

When to Hold or Reduce Dose

If GI symptoms persist beyond 5-7 days at a new dose level, many prescribers recommend staying at the current dose for an additional 2-4 weeks before attempting escalation again.

Blood Work During Titration

Baseline labs before the first dose. Follow-up at 8-12 weeks after reaching a stable dose. Key markers include HbA1c, fasting glucose, fasting insulin, lipid panel with ApoB, and liver enzymes.

Use MyProtocolStack to log each dose and upload labs at each stage. StackAI can analyze your response pattern across your titration progress.

Frequently Asked Questions

Can I titrate faster than the recommended schedule? Accelerating titration increases the risk of GI side effects and treatment discontinuation.

What if I miss a dose during titration? If less than 5 days have passed, take the dose. If more than 5 days, skip it and resume at the next scheduled dose. Consult your prescriber.

Should I restart titration if I stop and restart? If the gap is more than 4-6 weeks, many prescribers recommend restarting from a lower dose.

*Written by the MyProtocolStack team. Last updated: March 2026.*