Titration

Deep dive

Titration: complete reference

Dose titration in GLP-1 therapy refers to the gradual stepwise increase of medication dose from a low starter level to the maintenance dose — designed to minimize gastrointestinal side effects (nausea, vomiting, diarrhea) that occur most intensely with rapid dose escalation. For Wegovy (semaglutide 2.4mg), the standard titration is 0.25 → 0.5 → 1.0 → 1.7 → 2.4 mg, with each step lasting at least 4 weeks (total titration: 16 weeks). For Zepbound (tirzepatide 15mg), the schedule is 2.5 → 5 → 7.5 → 10 → 12.5 → 15 mg over 20 weeks minimum. The 4-week minimum at each step is not arbitrary — it represents the threshold below which patient discontinuation rates spike substantially. Some prescribers extend titration intervals to 6-8 weeks for patients with greater GI sensitivity. Skipping steps or accelerating titration is associated with significantly worse tolerability and higher dropout rates. After reaching maintenance, dose-reduction strategies may be used to maintain weight while reducing side effects long-term.

In practice

If you start Wegovy at the 2.4mg maintenance dose immediately, severe nausea is nearly guaranteed. Starting at 0.25mg and stepping up over 16 weeks gives your body time to adapt — most patients tolerate the full titration with manageable symptoms.

Clinical context

Clinicians use titration to balance efficacy with tolerability. Slower titration improves adherence; faster titration accelerates outcomes but risks discontinuation.