A common experience: finishing week one on a GLP-1 starter dose, feeling absolutely nothing (no appetite change, no side effects, no weight loss) and panicking that the medication isn't working.
It's working. Your starting dose just isn't meant to do what you think it's meant to do.
The starter dose is a handshake.
Semaglutide 0.25 mg. Tirzepatide 2.5 mg. These aren't therapeutic doses. They're introduction doses. Their job is to let your body meet the medication without overwhelming it.
Think of it this way: the starting dose is about 1/10th of the maximum. It exists to minimize the nausea, vomiting, and GI distress that would hit much harder if you jumped straight to a full dose.
The titration schedules.
Semaglutide (Ozempic, Wegovy).
| Weeks | Dose | What to expect |
|---|---|---|
| 1-4 | 0.25 mg | Initiation only; not therapeutic |
| 5-8 | 0.5 mg | First therapeutic dose; appetite effects may begin |
| 9-12 | 1.0 mg | Most people feel significant changes here |
| 13-16 | 1.7 mg | Higher maintenance (if needed) |
| 17+ | 2.4 mg | Maximum dose for weight management |
Tirzepatide (Mounjaro, Zepbound).
| Weeks | Dose | What to expect |
|---|---|---|
| 1-4 | 2.5 mg | Initiation; building tolerance |
| 5-8 | 5 mg | First escalation; effects emerging |
| 9-12 | 7.5 mg | Many people find their sweet spot here |
| 13-16 | 10 mg | Stronger appetite suppression |
| 17-20 | 12.5 mg | Higher maintenance (if needed) |
| 21+ | 15 mg | Maximum dose |
Each dose is held for at least 4 weeks. That's not caution. It's clinical trial data showing side effects peak in weeks 1-2 after an increase and settle by weeks 3-4.
"What if I feel nothing?"
This is the most common first-month concern, and it's usually unfounded.
At 0.25 mg semaglutide: Almost nobody feels significant appetite suppression. The clinical trials didn't expect it. Some people feel nothing all the way through 0.5 mg; effects often kick in at 1.0 mg.
At 2.5 mg tirzepatide: Similar story. Some people notice subtle changes; many notice nothing until 5 mg or 7.5 mg.
Read next Managing GI side effects that actually disrupt your dayOne of the biggest regrets people share is rushing to increase their dose every month whether they needed to or not. The lowest effective dose, the one that gives you results you can sustain, is the right dose.
Why you can't skip steps.
Skipping doses or escalating too fast leads to:
- Severe nausea and vomiting (the #1 reason people quit)
- Dehydration from not being able to keep food or water down (see hydration on GLP-1)
- Medication discontinuation: stopping entirely because the side effects were unbearable
The slow path is the sustainable path.
Your sweet spot may not be the maximum.
Many people achieve their goals at mid-range doses (1.0 mg semaglutide, 7.5 mg tirzepatide). Higher isn't always better. If a dose is working for you, there's no medical reason to keep climbing.
If side effects are intolerable at a new dose, contact your doctor. They may recommend staying at your current dose longer or stepping back temporarily. Never adjust doses on your own.
Sources
- FDAWegovy FDA Prescribing Information (2025)
- FDAZepbound FDA Prescribing Information (2025)
- GUIDELINEOzempic Dosing Schedule (Novo Nordisk)
- COHORTReal-world titration and persistence (Wiley DOM)
- JOURNALDose titration retrospective study (MDPI)
- META-ANALYSISGI safety during dose escalation: systematic review (PMC)
This article is for educational purposes only and is not medical advice. Always consult your healthcare provider about dose adjustments.