Semaglutide and Tirzepatide Dose Schedules: Label Titration Charts
Every approved semaglutide and tirzepatide product starts low and climbs in fixed steps, at least four weeks apart. The labels also say what to do when a dose is missed or a step is too rough on the stomach. Here are all four schedules side by side, with the arithmetic for converting those doses to syringe units.
- Ozempic and Wegovy (semaglutide) both start at 0.25 mg once a week for 4 weeks. Ozempic tops out at 2 mg. Wegovy climbs through 0.5, 1 and 1.7 mg to a 2.4 mg maintenance dose, and adults can go up to 7.2 mg if they tolerate 2.4 mg for at least 4 weeks.
- Mounjaro and Zepbound (tirzepatide) both start at 2.5 mg once a week and rise in 2.5 mg steps, at least 4 weeks apart, to a maximum of 15 mg. Zepbound's maintenance dose is 5, 10 or 15 mg.
- Missed-dose windows differ: 5 days for Ozempic, 4 days (96 hours) for Mounjaro and Zepbound. For Wegovy, take the missed dose unless the next one is less than 2 days away. The Wegovy label also says to consider waiting 4 more weeks before the next step if a dose isn't tolerated.
- Branded pens are pre-dosed, so there are no units to count. Units only come into it with a vial, and then the number depends on the concentration. FDA has received reports of 5- to 20-fold overdoses from compounded semaglutide caused by mixing up units and milligrams.
Short answer: semaglutide starts at 0.25 mg once weekly for 4 weeks, then goes to 0.5 mg. Ozempic can then rise to 1 mg and 2 mg, each after at least 4 weeks1. Wegovy steps up every 4 weeks through 1 mg and 1.7 mg to a 2.4 mg maintenance dose from week 172. Tirzepatide (Mounjaro, Zepbound) starts at 2.5 mg once weekly and goes up by 2.5 mg after at least 4 weeks on each dose, with a 15 mg ceiling3,4. The tables below list every step, the missed-dose rule for each product, and what a given dose works out to in syringe units if it is drawn from a vial.
This page covers the four FDA-approved injectable brands, using the prescribing information current on DailyMed in September 2026. It explains what the labels say. It does not replace the dosing plan from whoever prescribes for you. Compounded and "research" semaglutide or tirzepatide are not covered by these labels. That point comes up again below, because it is where most dosing errors happen.
Semaglutide dosage chart: Ozempic vs Wegovy
Ozempic and Wegovy contain the same molecule. They are approved for different uses and follow different ladders. Ozempic is labelled for glycemic control in adults with type 2 diabetes, for reducing major cardiovascular events in type 2 diabetes with established cardiovascular disease, and for reducing kidney-disease progression in type 2 diabetes with chronic kidney disease1. Wegovy is labelled for cardiovascular risk reduction, weight reduction in adults and in children aged 12 and over, and MASH2.
| Week | Ozempic (weekly) | Wegovy injection (weekly) |
|---|---|---|
| 1–4 | 0.25 mg | 0.25 mg |
| 5–8 | 0.5 mg | 0.5 mg |
| 9–12 | 0.5 mg, or 1 mg if needed after ≥4 weeks at 0.5 mg | 1 mg |
| 13–16 | 1 mg, or 2 mg if needed after ≥4 weeks at 1 mg | 1.7 mg |
| 17 onward | Maximum 2 mg | Maintenance: 2.4 mg (1.7 mg if 2.4 mg isn't tolerated) |
| After ≥4 weeks at 2.4 mg | — | Adults with weight reduction still clinically indicated: up to 7.2 mg |
Two differences are easy to miss. First, the Ozempic ladder is conditional. After 0.5 mg, the label says the dose "can" go to 1 mg and then 2 mg, each after at least 4 weeks, when more glycemic control is needed. For the kidney-disease indication, the target is 1 mg1. Nothing in the label requires anyone to reach 2 mg. Second, the Wegovy ladder is fixed at 4-week steps up to week 16. The maintenance dose then depends on the indication: 2.4 mg or 1.7 mg for cardiovascular risk reduction, 2.4 mg (or 1.7 mg if intolerant) for MASH, and 2.4 mg recommended or 1.7 mg for adolescents2. The 7.2 mg dose, sold as Wegovy HD in a 7.2 mg/0.75 mL pen, is for adults who have tolerated 2.4 mg for at least 4 weeks and for whom further weight reduction is clinically indicated2.
Wegovy also comes as a tablet, which has its own ladder: 1.5 mg a day for days 1–30, 4 mg for days 31–60, 9 mg for days 61–90, then 25 mg from day 912. Oral and injected doses do not convert milligram for milligram. The 25 mg tablet is not "ten times" the 2.4 mg injection, so neither ladder can be read against the other.
What the pens actually deliver
Ozempic pens are multi-dose and fixed to their doses. The 2 mg/3 mL pen (0.68 mg/mL) delivers four 0.25 mg doses or two 0.5 mg doses. The 4 mg/3 mL pen (1.34 mg/mL) delivers four 1 mg doses, and the 8 mg/3 mL pen (2.68 mg/mL) delivers four 2 mg doses. Single-dose prefilled syringes of 0.25, 0.5 and 1 mg in 0.5 mL are also available1. Wegovy comes as single-dose pens or syringes at each step from 0.25 to 2.4 mg, as a FlexTouch pen holding 9.6 mg/3 mL that delivers four 2.4 mg/0.75 mL doses, and as the 7.2 mg single-dose pen2. With any of these, the dose is set by the device. There are no syringe units involved.
Tirzepatide dosage chart: Mounjaro vs Zepbound
Mounjaro is labelled for glycemic control in type 2 diabetes in adults and children aged 10 and over, and for reducing major adverse cardiovascular events3. Zepbound is labelled for weight reduction and for obstructive sleep apnea4. Both use the same 2.5 mg steps.
| Step | Mounjaro (weekly) | Zepbound (weekly) |
|---|---|---|
| Start | 2.5 mg | 2.5 mg for 4 weeks |
| Increases | +2.5 mg after ≥4 weeks on the current dose, if more glycemic control is needed | +2.5 mg after ≥4 weeks, until the maintenance dose is reached |
| Doses along the way | 5 · 7.5 · 10 · 12.5 mg | 5 · 7.5 · 10 · 12.5 mg |
| Maintenance / ceiling | Maximum 15 mg (10 mg in children 10+) | Weight reduction: 5, 10 or 15 mg. Sleep apnea: 10 or 15 mg. Maximum 15 mg |
The phrase "at least 4 weeks" matters. Four weeks is the fastest the label allows, not a timetable you have to keep. Zepbound's label tells prescribers to "consider treatment response and tolerability when selecting the maintenance dosage"4. So 5 mg is an approved place to stop. Nobody is expected to climb to 15 mg by default.
Both brands come as single-dose pens or vials of 2.5, 5, 7.5, 10, 12.5 or 15 mg in 0.5 mL, and as multi-dose vials or KwikPens holding four doses in 2.4 mL (0.6 mL per dose)3,4. A single-dose vial holds one dose, and the whole 0.5 mL is that dose.
Missed doses: what each label says
Each brand uses a different missed-dose window, because each schedule is built around the drug's own half-life and weekly timing. Treat them separately. A 5-day rule learned on Ozempic is wrong for Mounjaro.
| Product | Missed-dose rule | Changing the injection day |
|---|---|---|
| Ozempic | Take it as soon as possible within 5 days. After more than 5 days, skip it and take the next dose on the usual day1 | Allowed if the two doses are at least 2 days (>48 h) apart1 |
| Wegovy injection | If the next dose is more than 2 days away, take it as soon as possible. If it is less than 2 days away, skip it. After 2 or more missed doses in a row, restart escalation at a lower dose2 | — |
| Mounjaro | Take it as soon as possible within 4 days (96 h). After more than 4 days, skip it and take the next dose on the usual day3 | Allowed if doses are at least 3 days (72 h) apart3 |
| Zepbound | Take it as soon as possible within 4 days (96 h). After more than 4 days, skip it4 | Allowed if doses are at least 3 days (72 h) apart4 |
The Wegovy rule about two or more missed doses is the one people overlook. Someone who stops for two weeks and restarts at 2.4 mg is going against the label, which says to restart escalation at a lower dose2. The label doesn't give one fixed restart dose, so the prescriber chooses it.
Slowing escalation for nausea and other GI side effects
Gastrointestinal effects are the main reason the ladders exist. In Ozempic's placebo-controlled trials, nausea was reported by 15.8% of patients on 0.5 mg and 20.3% on 1 mg1. In Mounjaro's, the rates were 12%, 15% and 18% at 5, 10 and 15 mg3. The Ozempic label warns that use "has been associated with gastrointestinal adverse reactions, sometimes severe" and that it is not recommended in severe gastroparesis1.
The Wegovy label says it most directly: "If patients do not tolerate a dose during dosage escalation, consider delaying dosage escalation for 4 weeks." If 2.4 mg is not tolerated as maintenance, the dose can come down to 1.7 mg2. The tirzepatide labels get the same flexibility from their wording. Each increase happens "after at least 4 weeks", and on Mounjaro only "if additional glycemic control is needed"3. Staying on a step longer is within the label, and so is not going up at all. Decisions about stepping down or pausing belong with your prescriber.
From label dose to syringe units (vials only)
None of the branded products above needs a unit conversion. Units only matter when a dose is drawn from a vial with an insulin syringe. On a U-100 syringe, 100 units equals 1 mL. How many milligrams that holds depends on the vial's concentration. The formula is the same for every product: units = dose (mg) ÷ concentration (mg/mL) × 100. For how syringe markings work, see insulin syringe units explained.
The tables below apply that formula to the label dose steps at two example concentrations. This is arithmetic, not a dosing recommendation. Use the semaglutide calculator or tirzepatide calculator for your own vial and volume.
| Semaglutide dose | At 2.5 mg/mL (e.g. 5 mg in 2 mL) | At 5 mg/mL (e.g. 10 mg in 2 mL) |
|---|---|---|
| 0.25 mg | 10 units | 5 units |
| 0.5 mg | 20 units | 10 units |
| 1 mg | 40 units | 20 units |
| 1.7 mg | 68 units | 34 units |
| 2.4 mg | 96 units | 48 units |
| Tirzepatide dose | At 10 mg/mL (e.g. 20 mg in 2 mL) | At 15 mg/mL (e.g. 30 mg in 2 mL) |
|---|---|---|
| 2.5 mg | 25 units | 16.7 units |
| 5 mg | 50 units | 33.3 units |
| 7.5 mg | 75 units | 50 units |
| 10 mg | 100 units | 66.7 units |
| 12.5 mg | 125 units (more than one 1 mL syringe) | 83.3 units |
| 15 mg | 150 units (more than one 1 mL syringe) | 100 units |
The same number of units means different doses at different concentrations. At 2.5 mg/mL, 10 units is 0.25 mg. At 5 mg/mL, 10 units is 0.5 mg. That is how the errors FDA has documented happen. The agency received reports of patients drawing 5 to 20 times the intended dose of compounded semaglutide, and of prescribers miscalculating doses by 5 to 10 times. One patient told to inject 5 units on a U-100 syringe injected 50 units instead. A prescriber wrote 25 units where 0.25 mg (5 units at that concentration) was intended5. Outcomes included severe nausea and vomiting, fainting, dehydration, pancreatitis and gallstones, and some patients were hospitalized5. FDA's advice to prescribers and compounders is to provide a syringe sized for the intended dose and to counsel patients on how to measure it5.
Always write the dose in milligrams first. Convert to units only once you know the concentration of the vial in your hand, and recalculate whenever the vial or the volume of diluent changes.
Compounded and "research" products are outside these labels
Everything above comes from FDA-approved prescribing information. FDA states that compounded drugs "should only be used in patients whose medical needs cannot be met by an FDA-approved drug". It has received adverse-event reports from patients given compounded semaglutide or tirzepatide in doses beyond the label: more product per dose, more frequent doses, or faster escalation6. FDA has also warned companies selling semaglutide or tirzepatide "falsely labeled 'for research purposes' or 'not for human consumption'", and it notes it has no information on whether the salt forms some compounders use behave like the approved active ingredient6.
If you are on a compounded product, the label ladder is still the best-documented reference for step sizes and intervals. The label's safety data, though, apply only to the approved product. For how the three GLP-1-class compounds compare on trial results, see retatrutide vs tirzepatide vs semaglutide. For pharmacology and evidence, see the semaglutide and tirzepatide compound pages. For why a weekly drug builds up over several doses, see half-life, explained.
FAQ
References
Primary sources — PubMed / NEJM / The Lancet.
- Novo Nordisk. OZEMPIC (semaglutide) injection, for subcutaneous use — Prescribing Information (revised May 2026). DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=adec4fd2-6858-4c99-91d4-531f5f2a2d79
- Novo Nordisk. WEGOVY (semaglutide) injection and tablets — Prescribing Information (revised June 2026). DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee06186f-2aa3-4990-a760-757579d8f77b
- Eli Lilly and Company. MOUNJARO (tirzepatide) injection — Prescribing Information (revised August 2026). DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d2d7da5d-ad07-4228-955f-cf7e355c8cc0
- Eli Lilly and Company. ZEPBOUND (tirzepatide) injection — Prescribing Information (revised August 2026). DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b
- U.S. Food and Drug Administration. FDA alerts health care providers, compounders and patients of dosing errors associated with compounded injectable semaglutide products. July 26, 2024. https://www.fda.gov/drugs/human-drug-compounding/fda-alerts-health-care-providers-compounders-and-patients-dosing-errors-associated-compounded
- U.S. Food and Drug Administration. FDA's Concerns with Unapproved GLP-1 Drugs Used for Weight Loss. Content current as of September 1, 2026. https://www.fda.gov/drugs/drug-alerts-and-statements/fdas-concerns-unapproved-glp-1-drugs-used-weight-loss