Your first GLP-1 prescription will start at a low dose. This is not optional — the slow titration schedule is designed to minimize side effects and let your body adjust. Here is exactly what to expect.
Semaglutide Starter Doses
| Week | Dose | Purpose |
|---|---|---|
| Weeks 1–4 | 0.25 mg/week | Initiation — minimal side effects expected |
| Weeks 5–8 | 0.5 mg/week | First therapeutic increase |
| Weeks 9–12 | 1.0 mg/week | Therapeutic range — most patients notice appetite changes here |
| Weeks 13–16 | 1.7 mg/week | Higher therapeutic dose |
| Week 17+ | 2.4 mg/week | Full maintenance dose (Wegovy) |
Tirzepatide Starter Doses
| Week | Dose | Purpose |
|---|---|---|
| Weeks 1–4 | 2.5 mg/week | Initiation |
| Weeks 5–8 | 5.0 mg/week | First therapeutic increase |
| Weeks 9–12 | 7.5 mg/week | Mid-range therapeutic dose |
| Weeks 13–16 | 10 mg/week | Higher therapeutic dose |
| Week 17+ | 12.5 or 15 mg/week | Full maintenance dose (Zepbound) |
Why Starting Low Matters
The low starter dose is not about efficacy — it is about tolerability. Nausea, the most common GLP-1 side effect, is dose-dependent. Starting low and increasing gradually gives your GI system time to adapt. Patients who skip or rush through titration report significantly higher rates of nausea and vomiting.
What to Expect at Each Stage
Weeks 1–4 (Starter Dose)
Most patients experience minimal effects at the starting dose. Some notice mild appetite reduction, but significant weight loss is not typical in the first month. This phase is about acclimation, not results.
Weeks 5–8 (First Increase)
The first dose increase is where most patients start noticing appetite suppression and food noise reduction. Mild nausea is common in the first 3 to 5 days after a dose increase but usually subsides. Eating smaller, more frequent meals helps manage GI symptoms.
Weeks 9–12 (Therapeutic Range)
By the third month, most patients are experiencing consistent appetite reduction and measurable weight loss. This is the dose range where clinical trials show the steepest weight-loss trajectory.
Can You Stay on a Lower Dose?
Yes. The titration schedule is a maximum escalation plan, not a requirement. If you are achieving your weight-loss goals at a lower dose with minimal side effects, your prescriber may recommend staying at that dose rather than continuing to increase.
This is particularly common with tirzepatide, where many patients find therapeutic benefit at the 7.5mg or 10mg level without needing to escalate to 15mg.
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Dose Adjustments and Your Prescriber
Your prescriber should check in with you at each dose increase. Key questions they will evaluate: Is your appetite meaningfully reduced? Are you experiencing persistent nausea or other GI symptoms? Is your weight-loss rate on track? Based on your answers, they may accelerate, slow down, or pause the titration.