What Is a Titration Schedule? The GLP-1 dose escalation calendar

What a titration schedule actually is

"Titration" means adjusting a dose gradually to find the amount that works while limiting side effects. A titration schedule turns that into a calendar: a list of weeks paired with the dose taken in each block. For GLP-1 receptor agonists, the schedule is printed in the drug label and is the same for almost everyone — it is not personalised maths, it is a fixed ramp the manufacturer validated in trials.

The reason for the ramp is tolerability. Starting a GLP-1 at its full maintenance dose drives high rates of nausea, vomiting, and diarrhoea. The Wegovy and Zepbound labels both open at a sub-therapeutic "introductory" dose purely to let the gut adapt, then climb in equal steps. The starting dose is usually not meant to produce much weight loss at all — it is a warm-up.

This is also why people search for a "dose escalation calendar": it is the same object viewed from the planning side. Whether you call it a titration schedule or an escalation calendar, you are describing the week → dose table below.

The standard GLP-1 titration schedules

Below are the dose-escalation calendars exactly as written in the FDA labels for the two most common injectable GLP-1 weight-management drugs. Both hold each step for four weeks before increasing.

Semaglutide reaches its 2.4 mg maintenance dose at week 17; tirzepatide can keep climbing to a 15 mg maximum if each step is tolerated for at least four weeks. Maintenance doses are not forced — a prescriber may keep someone at 5 mg or 10 mg tirzepatide, or 1.7 mg semaglutide, if that dose controls appetite and is comfortable.

How this is calculated

The schedule gives you a dose in mg per week. To inject it, you need the volume in mL and then the mark on a U-100 syringe. The arithmetic is two steps:

1. Volume (mL) = dose (mg) ÷ concentration (mg/mL). Concentration comes from your pen or your reconstituted vial.
2. U-100 units = volume (mL) × 100. A U-100 syringe prints 100 units per 1 mL, so 0.20 mL is 20 units.

The dose changes every four weeks, so the syringe draw changes every four weeks too. That is the single most error-prone moment in a titration: people keep drawing last month's units after the dose has gone up. Re-run the maths at every step with the GLP-1 titration calculator rather than copying the previous week's mark.

Reading the escalation calendar as a staircase

The clearest way to picture a titration schedule is a staircase: each tread is a four-week block, each riser is a dose increase. You stand on a step long enough to settle, then climb.

Why doses start low and climb slowly

The escalation is driven by the gut, not by weight loss. In the STEP 1 trial, once-weekly semaglutide titrated to 2.4 mg produced large, sustained weight reduction, but gastrointestinal side effects were the most common reason people struggled — which is exactly why the dose is introduced gradually rather than all at once. Tirzepatide showed the same pattern in SURMOUNT-1: strong results at higher doses, reached through a stepped ramp.

If a step is poorly tolerated, the schedule bends. A prescriber may extend a block beyond four weeks, drop back one step, or settle you at a lower maintenance dose. The calendar is a maximum pace, not a contract. None of that changes the arithmetic — whatever mg you are actually on this week is what you divide by your concentration.

Common titration mistakes

The first mistake is drawing last month's units. When the dose steps up, the syringe mark changes; copying the previous draw under-doses you. Always recompute at each step.

The second is mixing up dose and concentration. "5 mg" is a tirzepatide dose; "10 mg/mL" is a vial concentration. They are different numbers with different units, and only the dose-divided-by-concentration result tells you what to draw.

The third is chasing the schedule too fast. The four-week hold exists for tolerability; rushing it does not speed up results and usually worsens side effects.

So, what is a titration schedule?

A titration schedule is a fixed, week-by-week dose ramp built into the GLP-1 drug label, starting at a sub-therapeutic introductory dose and increasing in equal steps every four weeks until a maintenance dose is reached. The key number to know is that semaglutide reaches its 2.4 mg maintenance at week 17, and tirzepatide can reach 15 mg by week 21 — each step holding for four weeks before the next rise. Because every dose change also changes the syringe draw, use the GLP-1 titration calculator to convert your current week's mg into the exact mL and U-100 units for your vial concentration.

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