Titration schedules, explained

Why there is a ladder at all

Labeled schedules for these medications begin at a dose that is explicitly described as an initiation dose rather than a maintenance one, and step up from there. The stated reason across product labeling is tolerability — the escalation exists so the body encounters the medication gradually rather than at a maintenance level from day one.

That framing matters for how you read the ladder: the initiation step is not a low dose you are failing to progress past. It is a designed starting point.

The ladders differ, substantially

These are the manufacturers' labeled steps. They are included here because the tracker offers them as presets, not as a recommendation.

Semaglutide products

• One common ladder runs 0.25 mg → 0.5 mg → 1 mg, with a maximum labeled maintenance dose of 2 mg weekly.
• The weight-management ladder runs longer: 0.25 → 0.5 → 1 → 1.7 → 2.4 mg weekly — five steps, each with a minimum interval of about four weeks.

Tirzepatide products

• Starts at 2.5 mg weekly, then 5 mg, with further increases described in 2.5 mg increments.
• Steps available: 2.5, 5, 7.5, 10, 12.5 and 15 mg weekly, with 15 mg the highest labeled maintenance dose.

These are not interchangeable. Being at 1 mg of one is not comparable to 1 mg of another. See Switching between GLP-1 medications.

The counting problem

Labeled increases are described after a minimum time at the current step — commonly at least four weeks. Counting those four weeks accurately is harder than it sounds, for three reasons.

• A shifted dose moves the count. If an injection lands two days late, the week it belongs to is now ambiguous unless you wrote the date down.
• Refills interrupt the count. A gap waiting on a pharmacy is easy to forget once it is resolved.
• The count restarts at every step. Across a five-step ladder, an early error carries all the way through.

The reliable fix is to count from dated entries rather than memory. The GLP-1 Titration Planner maps steps onto real calendar dates, and the tracker pages count weeks at the current step from your logged injections.

Staying at a step longer is normal

The minimum interval is a minimum, not a schedule. Plenty of people stay at a step for considerably longer than four weeks, and some remain at an intermediate step as their maintenance dose rather than continuing to the top of the ladder.

Whether you move, when, and where you stop are all decisions for you and your prescriber based on your situation. A tracker's job is to tell you accurately where you are, not to advance you.

What changes at each step

Two practical consequences people underestimate:

• Supply arithmetic changes. A vial or pen yields a different number of doses at each step, so a supply plan made at your starting dose stops being true. The Vial Longevity Calculator recalculates from your current step.
• Cost per dose changes. Same supply, fewer doses, so the real cost of each dose rises as you escalate even though nothing about the price changed. The Cost Planner shows this.

Frequently asked