Last updated November 2, 2026 · Reviewed by the Gala Health team
Why doses start low
The Wegovy label says to follow its escalation schedule to reduce the risk of gastrointestinal adverse reactions, and the Zepbound label says the same. Nausea, vomiting, diarrhea and constipation are the most common side effects, and the Zepbound label notes that most nausea, vomiting and diarrhea occurred during dose escalation and decreased over time. The starting doses are for getting used to the medicine, not for the full effect. The Zepbound label states that its 2.5 mg dose is for treatment initiation and is not approved as a maintenance dose.
Both labels also say to consider treatment response and tolerability when choosing a maintenance dose, which is why two people on the same medicine can end up at different doses. See our guide to GLP-1 side effects for what to expect and when to call your provider.
Wegovy injection schedule (semaglutide)
| Weeks | Once-weekly dose |
|---|---|
| 1 to 4 | 0.25 mg |
| 5 to 8 | 0.5 mg |
| 9 to 12 | 1 mg |
| 13 to 16 | 1.7 mg |
| 17 onward | Maintenance: 1.7 mg or 2.4 mg (2.4 mg recommended) |
If a dose is not tolerated, the label says to consider delaying escalation for 4 weeks. For patients who tolerate 2.4 mg for at least 4 weeks and need additional weight reduction, the label allows a maximum of 7.2 mg weekly.
Wegovy tablets schedule (daily semaglutide)
| Days | Once-daily dose |
|---|---|
| 1 to 30 | 1.5 mg |
| 31 to 60 | 4 mg |
| 61 to 90 | 9 mg |
| 91 onward | Maintenance: 25 mg |
Tablets are taken on an empty stomach in the morning with up to 4 ounces of water, with a wait of at least 30 minutes before eating, drinking or taking other oral medicines. Read more in our guide to the Wegovy pill vs injection.
Zepbound schedule (tirzepatide)
| Step | Once-weekly dose |
|---|---|
| Weeks 1 to 4 | 2.5 mg (starting dose only) |
| After 4 weeks | 5 mg |
| Each later step | Increase by 2.5 mg after at least 4 weeks on the current dose |
| Maintenance | 5 mg, 10 mg or 15 mg (10 mg or 15 mg for sleep apnea) |
| Maximum | 15 mg |
If a maintenance dose is not tolerated, the label says to consider a lower maintenance dose.
Ozempic and Mounjaro schedules (type 2 diabetes)
Ozempic and Mounjaro are approved for type 2 diabetes, and their dose increases are based on blood sugar control rather than a fixed calendar.
| Ozempic® (semaglutide) | Mounjaro® (tirzepatide) | |
|---|---|---|
| Starting dose | 0.25 mg weekly for 4 weeks | 2.5 mg weekly |
| Next step | 0.5 mg weekly after 4 weeks | Increase in 2.5 mg steps after at least 4 weeks, if more blood sugar control is needed |
| Further steps | 1 mg, then 2 mg, each after at least 4 weeks on the previous dose, if more control is needed | Up to the maximum |
| Maximum | 2 mg weekly | 15 mg weekly in adults; 10 mg in children aged 10 and older |
For patients with type 2 diabetes and chronic kidney disease, the Ozempic label sets 1 mg weekly as the maintenance dose after at least 4 weeks on 0.5 mg.
Compare these with the weight-management schedules in our guides to Ozempic vs Wegovy and Zepbound vs Mounjaro.
What to do about a missed dose
Missed-dose rules differ by product, so check your own label and ask your provider if unsure.
| Product | Label instruction |
|---|---|
| Wegovy injection | Take it as soon as possible if the next dose is more than 2 days away. If the next dose is less than 2 days away, skip it and resume on the regular day. If 2 or more consecutive doses are missed, restart escalation at a lower dose. |
| Wegovy tablets | Skip the missed dose and take the next dose the following day. |
| Zepbound and Mounjaro | Take it as soon as possible within 4 days (96 hours) after the missed dose. After more than 4 days, skip it and take the next dose on the regular day. |
| Ozempic | Take it as soon as possible within 5 days after the missed dose. After more than 5 days, skip it and take the next dose on the regular day. |
You can change the day of the week if needed, as long as doses are far enough apart: at least 2 days (more than 48 hours) for Ozempic and at least 3 days (72 hours) for Zepbound and Mounjaro.
Compounded medications: mg, mL and units
Compounded medications are not FDA-approved. The label schedules above apply to the brand-name products only. Approved semaglutide is dosed in milligrams, comes in standard concentrations and is supplied in prefilled pens. Compounded vials come in various concentrations, and instructions are sometimes written in 'units' on an insulin syringe, a fixed volume whose medicine content depends on the concentration.
Ask your provider or pharmacy to give each dose in milligrams and milliliters for the syringe you will use, and confirm any change in concentration between shipments before injecting.
- Ask for each dose in mg and in mL, matched to the syringe you will use.
- Do not copy a dose from the internet or from another person's schedule.
- If your concentration, vial or syringe changes, confirm the new instructions before injecting.
Learn more in our guides to compounded vs brand-name GLP-1 medications and how to inject a GLP-1 medication.
Getting started with Gala
Gala offers compounded semaglutide, compounded tirzepatide and brand-name Ozempic®. A licensed provider reviews your online assessment and prescribes only if it is appropriate for you. If prescribed, your medication ships to your home, you can message your care team with dosing questions, and your provider can adjust your dose over time. The Gala GLP-1 app can log your doses; see the Gala GLP-1 app.
To see which options may fit, start your online GLP-1 assessment, read about compounded GLP-1 medications, or browse the weight loss hub.
This article is for information only and is not medical advice. Do not change your dose without talking to your prescriber.
Frequently asked questions
Why do GLP-1 doses start so low?
The prescribing information says gradual dose escalation reduces the risk of digestive side effects such as nausea, vomiting and diarrhea. The starting dose is for treatment initiation, not for maintenance. Your prescriber decides how fast to increase based on how you respond and tolerate the medicine.
How often does the dose go up?
For Wegovy injection the label increases the dose every 4 weeks until the maintenance dose. For Zepbound and Mounjaro, the dose can rise in 2.5 mg steps after at least 4 weeks on the current dose. Wegovy tablets increase every 30 days.
What if I miss a weekly GLP-1 dose?
It depends on the product. For Wegovy injection, take it if the next dose is more than 2 days away, otherwise skip it. For Zepbound and Mounjaro, take it within 4 days of the missed dose. For Ozempic, take it within 5 days. If you are unsure, ask your provider.
What if I miss several doses in a row?
The Wegovy label says that if 2 or more consecutive injection doses are missed, escalation should restart at a lower dose to reduce the risk of digestive side effects. Ask your provider before restarting at your old dose.
Why is compounded dosing in units a concern?
A unit on an insulin syringe is a fixed volume, and how much medicine it holds depends on the concentration of the vial, so the same number of units can mean different amounts of medicine. Compounded medications are not FDA-approved, so ask your provider to give each dose in mg and mL.
Ready to talk to a provider?
Your answers go to a licensed provider, who decides whether treatment is right for you. Learn more about Weight Loss.
Sources
- Novo Nordisk. WEGOVY (semaglutide) injection and tablets prescribing information. FDA-approved label.
- Novo Nordisk. OZEMPIC (semaglutide) prescribing information. FDA-approved label.
- Eli Lilly. ZEPBOUND (tirzepatide) prescribing information. FDA-approved label.
- Eli Lilly. MOUNJARO (tirzepatide) prescribing information. FDA-approved label.
This article is for general information and is not medical advice. Talk to a licensed provider about your own health.