Why a titration step lasts as long as it does
When you start a dose, the level climbs for four to five half-lives before it plateaus. That is not an opinion about tolerance – it is how accumulation works with any repeated dose.
- ~4 weeks
- to steady state on tirzepatide (5-day half-life)
- ~5 weeks
- to steady state on semaglutide (7-day half-life)
- ~3 days
- to steady state on liraglutide (13-hour half-life)
- 2x
- how much semaglutide accumulates over a single dose
The step lengths follow directly. Four weeks per step on the weekly drugs, one week per step on liraglutide. Liraglutide climbs five times faster not because it is gentler but because it settles in days rather than weeks.
The practical consequence gets missed constantly: week two of a new dose is not that dose. It is a level still on its way up. Judging whether a step is working, or whether the side effects are tolerable, before it has plateaued is judging something that has not finished happening.
Tirzepatide: Mounjaro and Zepbound
| Step | Weekly dose | Usual duration |
|---|---|---|
| 1 | 2.5 mg | 4 weeks. A starting dose, not a treatment dose. |
| 2 | 5 mg | 4 weeks or longer. The first dose most people feel properly. |
| 3 | 7.5 mg | 4 weeks or longer |
| 4 | 10 mg | 4 weeks or longer |
| 5 | 12.5 mg | 4 weeks or longer |
| 6 | 15 mg | Maintenance, if you get there |
Six strengths, each dispensed as a separate product. See tracking Mounjaro and tracking Zepbound.
Because every strength is its own box rather than a dial position, moving up a step on tirzepatide means a new prescription line every time. It also means the pen click arithmetic changes at every step, since the KwikPen delivers the same fixed volume whatever it contains.
Semaglutide: Wegovy
| Weeks | Weekly dose | Note |
|---|---|---|
| 1 to 4 | 0.25 mg | Starting dose |
| 5 to 8 | 0.5 mg | |
| 9 to 12 | 1 mg | |
| 13 to 16 | 1.7 mg | A step some people find harder than the ones before |
| 17 onwards | 2.4 mg | Maintenance |
Sixteen weeks from start to maintenance. See tracking Wegovy.
Semaglutide: Ozempic
| Step | Weekly dose | Note |
|---|---|---|
| 1 | 0.25 mg | 4 weeks, starting dose |
| 2 | 0.5 mg | Many people stay here indefinitely |
| 3 | 1 mg | Requires the 1 mg pen |
| 4 | 1.5 mg | Requires the 2 mg pen |
| 5 | 2 mg | Maximum |
Which doses are available to you depends on which pen you were dispensed – see tracking Ozempic.
Ozempic differs from the tirzepatide ladder in one practical way: the pen decides your ceiling. The 0.25 / 0.5 pen cannot reach 1 mg, and the 1 mg pen cannot reach 1.5. A step up sometimes means a new pen and sometimes only a new dial position, which is why supply planning on semaglutide is less predictable than the numbers suggest.
Liraglutide: Saxenda and Victoza
| Week | Saxenda daily dose | Victoza daily dose |
|---|---|---|
| 1 | 0.6 mg | 0.6 mg |
| 2 | 1.2 mg | 1.2 mg |
| 3 | 1.8 mg | 1.8 mg (maintenance) |
| 4 | 2.4 mg | – |
| 5 onwards | 3.0 mg (maintenance) | – |
One week per step, because liraglutide reaches steady state in about three days. See tracking Saxenda and Victoza.
Oral semaglutide
Tablets climb on their own ladders, and the important thing is that the ladders are not interchangeable between products. A newer tablet formulation absorbs better, so its lower numbers correspond to the higher numbers on the older one. Which step replaces which is a prescriber decision, not arithmetic.
| Product | Dose steps | Cadence |
|---|---|---|
| Rybelsus (current) | 1.5, 4, 9, 25, 50 mg | Daily |
| Rybelsus 3 / 7 / 14 mg (older) | 3, 7, 14 mg | Daily |
| Wegovy tablets | 1.5, 4, 9, 25 mg | Daily |
| Ozempic tablets | 1.5, 4, 9 mg | Daily |
See tracking Rybelsus and oral semaglutide.
Climbing faster than the level settles
Moving up before a step has plateaued means the new increase lands on a level that was still rising. The two additions stack, and the fortnight afterwards is doing the work of two adjustment periods at once.
That is the mechanism behind most avoidable nausea on these drugs, and it is also why a fast climb feels like it is working – eating very little because you feel unwell produces exactly the short-term result people are looking for, and it is not the result the dose was supposed to produce.
The reverse mistake is just as common: concluding a dose has stopped working three weeks in, when the level has not reached its plateau yet. The side effect timeline and the plateau guide both come back to this.
Holding, pausing and coming back down
None of these ladders is a schedule you are obliged to complete. Holding a step for months because it is working and tolerable is a completely ordinary outcome. So is going up and coming back down, and so is pausing entirely for a while.
What matters for tracking is that the history stays honest. Penwise records the schedule you are actually on: skip, postpone or reschedule any individual dose, and the reason and the date stay in the record rather than being overwritten. A step you held for eleven weeks should read as eleven weeks, not as a gap in a plan.
What Penwise tracks against the ladder
- The dose you were on for every single day, so any symptom or weight reading can be read against it.
- When each step started and ended, dated.
- The doses you skipped, postponed or moved, with what you decided.
- Adherence drift – whether you are running late and by how much – reported only when there is enough history to be sure.
- With Penwise+, the estimated level, so the climb to each plateau is visible rather than assumed.
Track the ladder you are actually on
Every step dated, every skip recorded, every symptom laid against the right dose. Free core tracker.
Common questions
How long should I stay on each GLP-1 dose?
Why do I have to wait four weeks before increasing?
Do I have to reach the maximum dose?
Can I go back down a dose?
How do the tirzepatide and semaglutide ladders compare?
Does Penwise remind me when a step is due?
Sources
Every factual claim on this page traces to the product information a regulator publishes, or to a published trial. Links open on the site of whoever issued the document.
- Mounjaro: EPAR product information European Medicines Agency
- Ozempic: EPAR product information European Medicines Agency
- Wegovy: EPAR product information European Medicines Agency
- Saxenda: EPAR product information European Medicines Agency
- Rybelsus: EPAR product information European Medicines Agency
Penwise is a tracking and education tool, not a medical device. Nothing on this page is medical advice, a diagnosis or a recommendation to start, stop or change a dose. Dosing decisions belong to you and your clinician. Ozempic, Wegovy, Rybelsus, Saxenda and Victoza are trademarks of Novo Nordisk; Mounjaro, Zepbound and Trulicity are trademarks of Eli Lilly. Penwise is not affiliated with, endorsed by or connected to either company.