Starting Tirzepatide: What to Expect in Your First Week

Quick Answer: During your first week on tirzepatide (2.5 mg starting dose), expect mild to moderate side effects like nausea, reduced appetite, and possible digestive changes. Most people lose 1-3 pounds in the first week, though this is primarily water weight. Side effects typically peak 1-3 days after injection and gradually improve over 4-7 days. The first dose is intentionally low to allow your body to adjust to the medication.

Table of Contents

• What to Expect in Your First Week
• The First Dose: 2.5 mg
• Hour-by-Hour and Day-by-Day Timeline
• Common First Week Side Effects
• Appetite and Hunger Changes
• How Much Weight Will I Lose?
• How to Prepare Before Your First Dose
• 10 Tips for Your First Week
• What's Normal vs. When to Call Your Doctor
• Frequently Asked Questions

What to Expect in Your First Week

The first week of tirzepatide is designed to be a gentle introduction to the medication. You'll start with the lowest dose (2.5 mg) to allow your body to gradually adjust to the medication's effects on your GLP-1 receptors.

Key First Week Realities:

Side Effects:

• 60-70% of people experience at least one side effect in week one
• Most side effects are mild to moderate (not severe)
• Nausea is the most common (affects 20-30% of first-time users)
• Side effects typically peak 1-3 days after injection, then gradually improve
• Many people have no side effects at all during the first week

Appetite Changes:

• Some people notice reduced hunger immediately; others don't notice much change until higher doses
• Food may taste less appealing or portions may feel more filling
• Cravings for certain foods (especially sweets or fatty foods) may decrease
• Some people experience food aversions or strong preferences

Weight Loss:

• Expect 1-3 pounds of weight loss in the first week (primarily water weight)
• Some people lose more; others see no change (both are normal)
• The starting dose (2.5 mg) is not the therapeutic dose for weight loss—it's just an adjustment dose
• Significant weight loss typically begins at weeks 5-8 when you reach higher doses

For a complete understanding of the full weight loss timeline beyond just the first week, see our tirzepatide weight loss timeline guide.

The First Dose: 2.5 mg

Your first injection will be 2.5 mg of tirzepatide, administered subcutaneously (under the skin) once weekly. This is the standard starting dose for all patients, regardless of weight or medical history.

Why Such a Low Starting Dose?

The 2.5 mg dose is intentionally sub-therapeutic (below the dose needed for maximum weight loss). Its purposes are:

• Minimize side effects: Allowing your GI system to gradually adapt to slower gastric emptying
• Improve tolerability: Reducing the chance of severe nausea that could lead to discontinuation
• Assess response: Allowing you and your provider to gauge how you respond to the medication
• Build gradually: Following FDA-approved dose escalation for safety

Think of the first dose like a "test dose" to see how your body responds before moving to higher, more therapeutic doses.

When and Where to Inject

Timing:

• Choose a day of the week that works for your schedule (many people choose Saturday or Sunday)
• Can be taken any time of day (doesn't have to be the same time, just the same day each week)
• Can be taken with or without food
• Set a calendar reminder so you don't forget

Injection Sites:

• Abdomen (most common, at least 2 inches from belly button)
• Thigh (front or outer)
• Upper arm (back of arm, may need help)
• Rotate sites each week to prevent irritation

Hour-by-Hour and Day-by-Day Timeline

First 24 Hours After Injection

Time After Injection	What to Expect
0-2 hours	Minimal effects. Injection site may be slightly tender. Some people report feeling nothing at all.
2-8 hours	Medication begins circulating. You might notice subtle reduction in appetite at your next meal, or no change yet (both normal).
8-24 hours	Appetite suppression may become noticeable. Some people experience mild nausea, especially if eating large or fatty meals. Fatigue is possible but uncommon.

Days 1-7 After First Injection

Day	Common Experiences
Day 1-2	Minimal side effects for most people. Appetite may be reduced at meals. Some notice they get full faster. Slight nausea possible, especially after eating. Energy levels typically normal.
Day 3-4	Peak medication levels in blood. If side effects occur, they're often strongest during this period. Nausea may be more noticeable. Food may seem less appealing. Digestive changes possible (constipation or softer stools). Mild fatigue in some people.
Day 5-7	Side effects typically begin to diminish. Body adjusting to medication. Appetite suppression often becomes more consistent. Many people feel "back to normal" but with less hunger. Energy levels usually return to baseline or improve.

Note: This is a general pattern. Your experience may be different—some people have no side effects at all, while others may have different timing of symptoms.

Common First Week Side Effects

Here's what the research and clinical experience show about first-week side effects at the 2.5 mg starting dose:

Gastrointestinal Side Effects

Side Effect	Frequency	Typical Severity	Management Tips
Nausea	20-30%	Mild to moderate	Eat smaller meals, avoid fatty/greasy foods, ginger tea, stay hydrated
Reduced appetite	40-50%	Mild (desired effect)	Eat protein-rich foods, don't force yourself to eat, track nutrition to ensure adequate intake
Constipation	15-20%	Mild	Increase water intake, add fiber gradually, stay active, consider stool softener
Diarrhea	10-15%	Mild	Avoid trigger foods, stay hydrated, consider probiotics
Bloating/gas	10-15%	Mild	Avoid carbonated drinks, eat slowly, limit gas-producing foods

Other Possible Effects

• Injection site reactions: 5-10% experience redness, itching, or mild pain at injection site (usually resolves within 24-48 hours)
• Headache: 5-10% report mild headaches (stay hydrated, usual pain relievers are safe)
• Fatigue: 5-10% feel more tired than usual (often improves by day 5-7)
• Dizziness: <5% experience mild dizziness (stay hydrated, avoid rapid position changes)

For comprehensive strategies to manage these side effects as you continue treatment, see our guide on managing tirzepatide side effects.

Appetite and Hunger Changes

One of the primary effects you'll notice in your first week is how tirzepatide affects your appetite and relationship with food:

What People Report:

"Food just doesn't sound as good":

• Favorite foods may seem less appealing
• Strong cravings for sweets or junk food often diminish
• You might not think about food as frequently
• Meal planning may become easier (less food preoccupation)

"I get full so quickly":

• Stomach feels full after smaller portions than before
• Eating beyond fullness may cause discomfort or nausea
• May need to adjust portion sizes downward
• Feeling of fullness lasts longer between meals

"I'm just not hungry":

• May forget to eat or skip meals unintentionally
• Hunger cues are significantly reduced
• Need to eat by the clock rather than hunger signals
• Important to ensure adequate nutrition even without hunger

Food Aversions and Preferences

Many people develop temporary or lasting food aversions on tirzepatide:

Common aversions:

• Fatty or greasy foods (may cause nausea)
• Very sweet foods (taste overly sweet)
• Heavy proteins (red meat, pork)
• Dairy products
• Foods with strong smells

Foods that often remain appealing:

• Bland starches (rice, bread, crackers)
• Fresh fruits and vegetables
• Chicken or fish
• Clear broths and soups
• Cold foods (less smell)

How Much Weight Will I Lose?

Setting realistic expectations for first-week weight loss is important:

Expected First Week Weight Loss

• Average: 1-3 pounds
• Range: 0-5 pounds
• Composition: Primarily water weight, not fat loss

Why First Week Loss Is Mostly Water Weight

Initial rapid weight loss on tirzepatide occurs primarily due to:

• Reduced glycogen stores: When you eat less, your body uses stored glycogen, which holds water (each gram of glycogen binds ~3 grams of water)
• Less food volume: Eating less means less food weight in your digestive system
• Sodium reduction: Lower food intake often means less sodium, leading to water loss
• Minimal fat loss: True fat loss takes time and occurs at ~1-2 pounds per week maximum

If You Don't Lose Weight in Week One

Some people see no weight change or even slight weight gain in the first week. This is completely normal because:

• 2.5 mg is below the therapeutic dose for weight loss
• Your body may retain water initially
• Constipation may temporarily increase scale weight
• Normal weight fluctuations can mask small losses
• Significant weight loss typically begins at weeks 5-8 when reaching higher doses

Important: Don't judge tirzepatide's effectiveness by your first week. The medication works cumulatively, and results improve as you progress through dose escalation.

How to Prepare Before Your First Dose

Preparing before starting tirzepatide can improve your first-week experience:

One Week Before Starting:

• Stock your kitchen: Buy easy-to-digest foods (crackers, ginger tea, bland proteins, broths)
• Clear trigger foods: Remove or hide highly tempting junk foods
• Prepare meals: Batch cook some simple, healthy meals you can easily reheat
• Set up tracking: Download a food tracking app or create a journal
• Take baseline photos: Front, side, and back photos for comparison
• Measure yourself: Waist, hips, chest, thighs, arms
• Weigh yourself: Establish starting weight

Day of First Injection:

• Choose timing wisely: Weekend injection gives you time to adjust without work stress
• Eat normally beforehand: Don't fast or overeat before your first dose
• Stay hydrated: Drink plenty of water throughout the day
• Have anti-nausea options ready: Ginger tea, crackers, anti-nausea medication if prescribed
• Clear your schedule: Don't plan intense activities for days 2-4 after injection
• Prepare light meals: Have easy-to-digest food options available

10 Tips for Your First Week

1. Eat Smaller, More Frequent Meals

Your stomach empties more slowly on tirzepatide. Instead of three large meals, try 4-5 smaller meals to prevent discomfort and nausea.

2. Prioritize Protein

Even with reduced appetite, aim for adequate protein (20-30g per meal). This helps preserve muscle mass and provides sustained energy despite eating less overall.

3. Stay Hydrated

Drink 64-96 ounces of water daily. Dehydration worsens nausea, constipation, and fatigue—three common first-week side effects.

4. Avoid Trigger Foods

Skip fatty, greasy, fried, or very sweet foods in your first week. These are most likely to cause nausea and discomfort.

5. Don't Force Yourself to Eat

If you're not hungry, don't force large meals. However, ensure you're meeting minimum nutrition needs (at least 1200 calories for women, 1500 for men as a general guideline).

6. Move Gently

Light walking can help with digestion and reduce nausea. Avoid intense exercise in the first 2-3 days after injection if you're experiencing side effects.

7. Track Everything

Log your food, water intake, side effects, and how you feel. This data helps you and your provider optimize your treatment.

8. Be Patient with Weight Loss

Remember that 2.5 mg is not the therapeutic dose. Significant weight loss begins at weeks 5-8 when you reach higher doses. Use week one to adjust to the medication, not to lose large amounts of weight.

9. Prepare for Appetite Changes

If reduced appetite makes eating challenging, focus on nutrient-dense foods rather than volume. A protein shake may be easier than a full meal.

10. Connect with Your Provider

Report any concerning symptoms, but know that mild side effects are normal. Your provider can advise whether what you're experiencing requires intervention.

What's Normal vs. When to Call Your Doctor

Normal First Week Experiences (No Need to Worry):

• ✓ Mild to moderate nausea that comes and goes
• ✓ Reduced appetite and eating less than usual
• ✓ Feeling full quickly during meals
• ✓ Constipation or diarrhea (mild)
• ✓ Mild headache or fatigue
• ✓ Injection site tenderness or redness (small area, resolves in 24-48 hours)
• ✓ Food aversions or taste changes
• ✓ Minimal or no weight loss in week one

Contact Your Doctor If You Experience:

• ❌ Severe, persistent nausea with inability to keep down fluids for 24+ hours
• ❌ Severe abdominal pain (could indicate pancreatitis, though rare)
• ❌ Vomiting for more than 24 hours
• ❌ Signs of dehydration (dark urine, dizziness, extreme thirst, no urination for 8+ hours)
• ❌ Severe diarrhea (more than 6 watery stools per day)
• ❌ Allergic reaction (rash, swelling, difficulty breathing)
• ❌ Vision changes or severe headache
• ❌ Racing heart or chest pain
• ❌ Severe injection site reaction (large area of redness, swelling, or pain that worsens)

When to Seek Emergency Care:

• 🚨 Difficulty breathing or swallowing
• 🚨 Severe, sudden abdominal pain
• 🚨 Severe, persistent vomiting
• 🚨 Signs of severe allergic reaction (facial swelling, hives, throat tightness)
• 🚨 Chest pain or rapid heartbeat

Note: Serious side effects are rare, especially at the low starting dose. The vast majority of people have an uneventful first week with only mild, manageable side effects or no side effects at all.

Getting Started with Tirzepatide

Ready to begin your weight loss journey with tirzepatide? Starting with the right support and high-quality medication makes all the difference in your first week and beyond.

At Contour Health, we provide:

• Expert guidance: Licensed providers who walk you through what to expect in your first week
• Quality medication: Compounded tirzepatide from 503B FDA-registered facilities
• Ongoing support: Regular check-ins to help you navigate side effects and optimize your dose
• Affordable pricing: Making long-term treatment sustainable

Learn more about our compounded tirzepatide program and start your journey with confidence.

For comprehensive information about tirzepatide beyond just the first week, see our complete guide to tirzepatide.

Frequently Asked Questions

How soon will I feel the effects of tirzepatide?

Most people begin noticing appetite suppression within 2-24 hours of their first injection. However, the effects are subtle at the 2.5 mg starting dose. You might notice you get full faster during meals or think about food less frequently. Some people don't notice significant effects until they reach higher doses at weeks 5-8.

Is it normal to feel nauseous after my first tirzepatide injection?

Yes, mild to moderate nausea affects 20-30% of people after their first injection. It typically peaks 1-3 days after injection and improves by days 5-7. The nausea is usually manageable with small meals, avoiding fatty foods, staying hydrated, and eating slowly. Severe nausea that prevents you from drinking fluids should be reported to your doctor.

What should I eat in my first week on tirzepatide?

Focus on bland, easy-to-digest foods: chicken, fish, rice, crackers, bread, clear broths, fruits, vegetables, Greek yogurt. Avoid fatty, greasy, fried, or very sweet foods that may trigger nausea. Prioritize protein (20-30g per meal) to preserve muscle. Eat smaller, more frequent meals rather than three large meals. Listen to your body—don't force yourself to eat if you're not hungry, but ensure you meet minimum nutrition needs.

How much weight will I lose in the first week of tirzepatide?

Expect 1-3 pounds of weight loss in your first week, though the range is 0-5 pounds. This initial loss is primarily water weight, not fat loss. Some people see no weight change in week one, which is completely normal. The starting dose (2.5 mg) is below the therapeutic dose for weight loss—significant results typically begin at weeks 5-8 when you reach higher doses. Don't judge the medication's effectiveness by your first week.

Can I skip my first dose if I'm nervous about side effects?

No, starting at the prescribed dose is important for proper treatment. The 2.5 mg dose is specifically designed to minimize side effects while allowing your body to adjust. Skipping doses or delaying treatment won't reduce your overall side effect risk—it will just delay your progress. If you're very concerned about side effects, discuss your fears with your provider, but follow their prescribed schedule.

Should I exercise during my first week on tirzepatide?

Light to moderate exercise (walking, gentle yoga) is fine and may even help reduce nausea and constipation. However, avoid intense workouts in the first 2-3 days after your injection if you're experiencing side effects like fatigue or nausea. Listen to your body—if exercise makes you feel worse, take it easy and resume when you feel better, usually by day 5-7.

What if I don't feel any different after my first dose?

That's completely normal. Some people have no noticeable effects from the 2.5 mg starting dose. The medication is still working at a cellular level even if you don't feel different. As you progress to higher doses (0.5 mg at week 5, 1.0 mg at week 9, etc.), the effects will become more noticeable. Absence of side effects in week one is actually a good thing—it means you're tolerating the medication well.

Can I drink alcohol in my first week on tirzepatide?

While tirzepatide doesn't directly interact with alcohol, it's best to avoid or limit alcohol in your first week for several reasons: 1) Alcohol can worsen nausea and GI side effects, 2) Alcohol on an empty stomach (common with reduced appetite) can cause problems, 3) Alcohol adds empty calories that work against your weight loss goals, 4) Some people have reduced alcohol tolerance on tirzepatide. If you do drink, do so cautiously and with food.

Should I take my first dose at night or in the morning?

It doesn't matter—you can inject tirzepatide at any time of day. Some people prefer morning injections so they can monitor for side effects during the day. Others prefer evening injections so they can sleep through any potential nausea. Choose whatever time works best for your schedule and stick with that same day each week (though the time doesn't need to be exact). Many people find weekend injections convenient so side effects don't interfere with work.

What if I have a missed dose in my first week?

If you miss your scheduled injection day, take it as soon as you remember, as long as it's within 5 days of your missed dose. If more than 5 days have passed, skip that dose and take your next dose on your regular scheduled day. Don't double up on doses. For detailed guidance on handling missed doses, see our article on what to do if you miss a tirzepatide dose.