GLP-1 medication lingo and all the numbers that come with it can get confusing fast. And when learning about dosing feels like it requires cracking open a science textbook, that learning curve only gets steeper. If your head is spinning around the ins and outs of GLP-1 dosing—or you’re just looking to feel more confident about how it works—you’re in the right place. Ahead, we’re breaking down everything you need to know with expert insight.
Featured Experts
- Dr. Spencer Nadolsky is an obesity and lipid specialist in Portage, MI.
- Rocio Salas-Whalen, MD is a board-certified endocrinologist in New York.
Why GLP-1 Dosing Starts Low
GLP-1 dosing typically starts low to prevent tolerance issues and the often-talked-about side effects that affect “digestion, appetite signaling and gut motility,” says New York endocrinologist Rocio Salas-Whalen, MD. “Starting low allows the brain and gastrointestinal system to adapt, which helps minimize side effects like nausea, reflux or fatigue.” This early phase of the GLP-1 process is known as titration, a carefully managed adjustment period. Once tolerated, the dose can be gradually increased—or held—under the supervision of your provider.
Another reason, Portage, MI lipid and obesity specialist Dr. Spencer Nadolsky explains, is that some people “may respond to a low dose and not need a higher dose.” In those cases, you wouldn’t want to put someone on a “higher dose, lose weight a lot faster and basically not be able to eat.” In other words, faster isn’t better, especially if it comes at the expense of feeling miserable.
How Providers Decide When to Hold, Increase or Adjust
Providers look closely at both weight loss and side effects when making dosing decisions. In general, Dr. Nadolsky says clinicians aim for patients to lose “somewhere around a half of a percent to one percent of their total body weight per week.” If weight loss is slower than that, “we go up,” he says.
However, side effects take priority: “If they’re having side effects, that takes the cake over everything else,” he says. In those cases, providers may “keep them at the same dose.” Dr. Salas-Whalen echoes the same idea. “I look at appetite control, weight trends, side effects, energy levels, muscle preservation and overall well-being. If someone is losing weight appropriately, feeling well and eating adequately, there’s often no need to increase the dose,” she says.
The goal for many patients is reaching a maintenance dose, which Dr. Salas-Whalen defines as the “lowest dose that allows someone to maintain their weight and metabolic health without unwanted side effects. You know you’ve reached it when weight stabilizes, hunger is manageable, labs are stable and the patient feels physically and mentally well.”
What Starting Doses Look Like by Medication
As Drs. Nadolsky and Salas-Whalen explain, starting doses vary by medication. Below is a look at how dosing progresses across the most commonly used GLP-1 medications in weight-loss care. Some may be used off-label, depending on the medication and individual treatment plan.
Tirzepatide
Tirzepatide, the active ingredient in the brand-name injectable GLP-1 medications Mounjaro and Zepbound, starts at 2.5 mg weekly and can be increased to 5 mg, 7.5 mg, 10 mg, 12.5 mg and 15 mg.
Semaglutide Injection
Injectable semaglutide (Wegovy) starts at 0.25 mg weekly. The dose is then gradually increased to 0.5 mg, 1.0 mg, 1.7 mg and 2.4 mg. As Dr. Nadolsky notes, a higher 7.2 mg dose may be released in the future.
Oral Semaglutide
Oral semaglutide starts at 1.5 mg daily and is gradually increased to 4 mg, 9 mg and 25 mg. Unlike injectable semaglutide for weight management, the oral version does not yet have a brand name. The only branded oral semaglutide—Rybelsus—is approved for type 2 diabetes.
