Semaglutide Dosing Chart: Titration Week by Week

Why Semaglutide Uses a Titration Schedule

Semaglutide is not started at its target dose. Instead, treatment begins at a very low introductory dose and increases gradually over four months — a process called titration. The reason is straightforward: the gastrointestinal side effects most associated with semaglutide (nausea, stomach discomfort, and loose stools) are dose-dependent and most pronounced when the body is first exposed to a new dose level. Slow titration lets your body adapt progressively, significantly reducing the likelihood and severity of these effects at each step.

Skipping dose levels or escalating too quickly is one of the most common reasons patients experience avoidable side effects. Following the schedule your provider gives you — and not rushing it — sets you up for the best long-term outcome.

The Standard Semaglutide Dosing Schedule

The following titration schedule mirrors the protocol used for Wegovy® (brand-name semaglutide for weight management) and is the basis for compounded semaglutide programs at licensed telehealth providers. Compounded semaglutide is different from FDA-approved branded products such as Wegovy® and Ozempic® and has not been evaluated by the FDA for safety, efficacy, or quality; your provider may adjust timing based on your individual tolerance.

• Weeks 1–4: 0.25 mg weekly — The starting dose. This is exclusively an introductory, tolerability dose; it is not expected to produce meaningful weight loss or strong appetite suppression at this level. Your body is adapting to the medication.
• Weeks 5–8: 0.5 mg weekly — The first active dose level. Most patients begin noticing some appetite suppression and reduced portion sizes at this stage. Mild GI effects may appear but are typically transient.
• Weeks 9–12: 1 mg weekly — A meaningful therapeutic dose. Consistent appetite suppression becomes the norm for most patients. Some patients achieve and sustain their target results at this level without needing further escalation.
• Weeks 13–16: 1.7 mg weekly — Near the maximum dose. Weight loss is typically ongoing at this stage for most patients. GI adaptation at previous levels makes this step easier than the early escalations.
• Week 17+: 2.4 mg weekly (maintenance) — The full weight-management dose used in the STEP clinical trials, which showed average weight loss of 14.9% over 68 weeks. This is the target maintenance dose for most patients on semaglutide for weight loss.

Each dose level is held for approximately four weeks before advancing. Your provider will confirm whether you are ready to escalate based on your tolerance and response.

What to Expect at Each Stage

Weeks 1–4: Adaptation

The most common experience at the starting dose is mild GI adjustment — occasional nausea, looser stools, or stomach sensitivity, particularly in the first day or two after each injection. These effects are typically mild and resolve quickly at this dose level. Appetite suppression, if you feel it at all, will be subtle. This stage is about laying the foundation, not rapid results.

Weeks 5–8: First Therapeutic Effects

At 0.5 mg, most patients notice that food noise — the constant mental pull toward eating — begins to quiet. Portions that previously felt normal start to feel like too much. This is the medication working as intended. Some patients experience a brief return of nausea as the body adjusts to the higher dose; this typically resolves within one to two weeks. For tips on managing GI effects, see our GLP-1 side effects guide.

Weeks 9–12: Consistent Results

By week 9, most patients report the clearest shift in their relationship with food. Meals feel satisfying with noticeably smaller portions. Cravings for high-calorie foods diminish for many people. Measurable weight loss is visible for most patients at this point — typically 5-10% of starting body weight by the three-month mark, though individual results vary significantly based on adherence, diet quality, and exercise.

Weeks 13–16: Near Maximum Dose

Most patients tolerate the step to 1.7 mg well by this stage because the preceding dose levels have already established GI adaptation. Weight loss tends to continue at a steady pace. Some patients reach their clinical goal at this dose and, in consultation with their provider, remain at 1.7 mg as their long-term maintenance dose rather than advancing to 2.4 mg.

Week 17+: Full Maintenance

At 2.4 mg weekly, patients are at the dose studied in the STEP trials. Most patients on this dose long-term sustain progressive weight loss through months 6, 9, and 12 before reaching a plateau. The STEP 1 trial showed that the majority of weight loss occurs in the first year, with stabilization thereafter. Continuing medication maintains the achieved weight; stopping typically results in regain.

Can You Stay at a Lower Dose?

Yes. Titration is a maximum-of protocol, not a requirement to reach the highest dose. Some patients achieve meaningful, sustained weight loss at 1 mg or 1.7 mg and, in consultation with their provider, choose not to advance further if they are tolerating the current dose well and results are satisfactory. Your provider makes this call with you based on your individual response.

What If a Dose Is Too Much?

If a new dose level causes persistent or severe GI effects, contact your provider. The standard clinical response is to hold at the current dose level for an additional four weeks before attempting escalation again — not to discontinue. Dose pausing is a normal part of titration management and does not indicate treatment failure. For patients sensitive to escalation, a modified slower titration (extending each step to six or eight weeks) is a valid approach.

Semaglutide vs Tirzepatide Dosing

Tirzepatide follows a similar titration approach but with different dose levels (2.5 mg to 15 mg over approximately 20 weeks). It also starts with a tolerability dose and escalates gradually. For a detailed comparison of the two medications — including which clinical trials showed better outcomes — see our semaglutide vs tirzepatide guide. For tirzepatide's specific dosing schedule, see the tirzepatide titration guide.

Wondering what the cost looks like across the full treatment program? See AvataCore pricing for current plan details, including semaglutide options.