Tirzepatide Dosing Schedule: Complete Week-by-Week Guide

Quick Answer: Tirzepatide follows a gradual dose escalation schedule starting at 2.5 mg weekly and increasing every 4 weeks to a maximum of 15 mg weekly. The standard schedule is: 2.5 mg (weeks 1-4) → 5 mg (weeks 5-8) → 7.5 mg (weeks 9-12) → 10 mg (weeks 13-16) → 12.5 mg (weeks 17-20) → 15 mg (week 21+).

Understanding the proper tirzepatide dosing schedule is crucial for maximizing weight loss results while minimizing side effects. This medication requires a careful, gradual dose escalation over several months to allow your body to adjust. In this comprehensive guide, we'll walk you through each dose level, what to expect, and how to know when you're ready to increase your dose.

Why Tirzepatide Requires Gradual Dose Escalation

Tirzepatide is a powerful dual GIP/GLP-1 receptor agonist that affects your digestive system, appetite, and metabolism. Starting at a low dose and gradually increasing helps:

• Minimize side effects: Especially nausea, vomiting, and diarrhea
• Allow physiological adaptation: Your body adjusts to the medication's effects
• Optimize tolerability: Gradual increases reduce discontinuation rates
• Maximize effectiveness: Most patients achieve best results at higher doses
• Ensure safety: Following FDA-approved escalation protocols

For comprehensive information about how tirzepatide works, see our complete guide to tirzepatide.

Complete Tirzepatide Dose Escalation Schedule

Here's the standard FDA-approved tirzepatide dosing schedule used in clinical trials and recommended for most patients:

Important: Not everyone needs to reach the maximum 15 mg dose. Many patients achieve excellent results at 7.5 mg or 10 mg and stay at those maintenance doses long-term.

Dose Level 1: 2.5 mg (Weeks 1-4)

Purpose of Starting Dose

The 2.5 mg starting dose is intentionally low to allow your body to begin adapting to tirzepatide's effects on your GI system and appetite regulation.

What to Expect at 2.5 mg

• Weight loss: Modest initial loss of 3-5% body weight (mostly water weight and early fat loss)
• Appetite: Noticeable reduction in hunger, especially after first few injections
• Energy: May feel slightly fatigued during first 1-2 weeks as body adjusts
• Side effects: Mild to moderate nausea (30-40% of patients), usually peaks days 2-4 after injection

Common Experiences

• First injection: Often minimal side effects (body hasn't built up levels yet)
• Second injection: Side effects may peak (cumulative effect)
• Week 3-4: Most side effects improve as tolerance develops
• Food preferences: Many patients report decreased interest in heavy, greasy foods

When to Increase to 5 mg

You should increase after 4 weeks minimum if:

• ✓ Tolerable or minimal side effects
• ✓ Appetite reduction is waning by week 4
• ✓ Weight loss has begun but you have significant weight to lose
• ✓ Your healthcare provider approves

Consider staying at 2.5 mg longer if:

• ✗ Experiencing significant nausea or vomiting
• ✗ Unable to eat adequately or stay hydrated
• ✗ Other medical concerns
• ✗ Still achieving steady weight loss and satisfied with current dose

For more details on what to expect in your first weeks, read our starting tirzepatide guide.

Dose Level 2: 5 mg (Weeks 5-8)

What Changes at 5 mg

The 5 mg dose is the first truly therapeutic dose where most patients begin seeing more significant weight loss.

What to Expect at 5 mg

• Weight loss: Additional 5-7% body weight loss (cumulative 8-12% from start)
• Appetite suppression: More pronounced than at 2.5 mg
• Side effects: May temporarily worsen after first 5 mg injection, typically peak week 5-6 then improve
• Satiety: Feeling full from smaller portions becomes very noticeable

Managing the Transition

First 5 mg injection tips:

• Inject on an empty stomach or after light meal
• Keep easy-to-digest foods available (crackers, toast, bananas)
• Stay well-hydrated (8-10 glasses water daily)
• Avoid trigger foods (high-fat, spicy, very sweet foods)
• Plan lighter meals for days 2-4 after injection

For strategies to manage side effects, see our complete side effects guide.

When to Increase to 7.5 mg

Increase after 4 weeks if:

• ✓ Side effects have improved or are manageable
• ✓ Still have significant weight to lose
• ✓ Appetite is returning by end of week
• ✓ Weight loss has slowed or plateaued

Dose Level 3: 7.5 mg (Weeks 9-12)

The "Sweet Spot" for Many Patients

For many patients, 7.5 mg becomes their long-term maintenance dose, balancing excellent efficacy with manageable side effects.

What to Expect at 7.5 mg

• Weight loss: Additional 4-6% body weight (cumulative 12-18% from start)
• Side effects: Usually significantly improved compared to earlier doses
• Appetite control: Strong, consistent appetite suppression
• Meal patterns: Naturally eating 2-3 smaller meals per day

Deciding: Stay at 7.5 mg or Continue Escalating?

Consider staying at 7.5 mg if:

• ✓ Losing 1-2 pounds per week consistently
• ✓ Appetite well-controlled throughout the week
• ✓ Close to your goal weight (within 20-30 pounds)
• ✓ Minimal side effects at current dose
• ✓ Cost considerations (some providers charge more for higher doses)

Consider increasing to 10 mg if:

• ✓ Weight loss has slowed significantly
• ✓ Still have 30+ pounds to lose
• ✓ Appetite is returning toward end of week
• ✓ Tolerating current dose very well
• ✓ Want to maximize weight loss results

Dose Level 4: 10 mg (Weeks 13-16)

Standard High-Dose Maintenance

The 10 mg dose is where many patients find their long-term maintenance sweet spot, achieving 15-23% total body weight loss.

What to Expect at 10 mg

• Weight loss: Additional 3-5% body weight (cumulative 15-23% from start)
• Clinical trial results: Most SURMOUNT trial participants achieved significant results at 10 mg
• Side effects: Generally well-tolerated by this point in treatment
• Appetite: Very strong, week-long appetite control

Is 10 mg Enough?

For most patients, 10 mg provides excellent results without needing to escalate further. Consider staying at 10 mg if you're:

• Achieving 1-2+ pounds weight loss per week
• Experiencing minimal side effects
• Happy with rate of progress
• Within 10-20 pounds of goal weight

Learn more about expected results at each dose level in our tirzepatide weight loss timeline.

Dose Level 5: 12.5 mg (Weeks 17-20) - Optional

For Those Needing Additional Efficacy

The 12.5 mg dose is optional and typically reserved for patients who:

• Need additional weight loss beyond what 10 mg provides
• Are tolerating 10 mg exceptionally well
• Still have significant weight to lose (20+ pounds)
• Have plateaued at 10 mg for 4+ weeks

What to Expect at 12.5 mg

• Weight loss: Additional 2-4% body weight (cumulative 17-27%)
• Side effects: Usually minimal at this stage of treatment
• Appetite: Maximum appetite suppression
• Duration: Stay for minimum 4 weeks before considering 15 mg

Dose Level 6: 15 mg (Week 21+) - Maximum Dose

The Maximum Approved Dose

15 mg is the highest FDA-approved tirzepatide dose and was used in clinical trials showing up to 20-27% body weight loss.

What to Expect at 15 mg

• Weight loss: Maximum efficacy, averaging 20-27% total body weight loss in clinical trials¹
• Clinical evidence: SURMOUNT-1 trial showed 15 mg produced greatest weight loss
• Side effects: Nausea rate similar to lower doses by this point (tolerance developed)
• Maintenance: Can stay at 15 mg long-term for weight maintenance

Who Should Consider 15 mg?

• Patients with BMI ≥40 or significant weight to lose
• Those who plateaued at 12.5 mg with more weight to lose
• Excellent tolerability at all previous doses
• Want to maximize weight loss results
• Healthcare provider recommendation

Who Might Not Need 15 mg?

• Already at or near goal weight at lower dose
• Experiencing side effects at 10-12.5 mg
• Budget constraints (some providers charge more for higher doses)
• Satisfied with results at 10-12.5 mg

Tirzepatide vs Semaglutide Dosing Comparison

How does tirzepatide dosing compare to semaglutide? Here's a side-by-side look:

For a complete comparison of these medications, see tirzepatide vs semaglutide.

What If You Miss a Dose?

Life happens, and you may occasionally miss your scheduled injection. Here's what to do:

Missed by Less Than 4 Days

• Action: Take the missed dose as soon as you remember
• Next dose: Resume your regular weekly schedule
• Example: If you inject Mondays and forget until Wednesday, inject Wednesday and resume the following Monday

Missed by More Than 4 Days

• Action: Skip the missed dose entirely
• Next dose: Resume your regular schedule with your next planned dose
• Important: Do NOT double dose to make up for a missed injection
• Example: If you inject Mondays and remember on Saturday, skip that dose and inject the following Monday

Multiple Missed Doses

If you've missed multiple weeks of tirzepatide:

• 2 weeks missed: Contact your provider; may resume at current dose
• 2-4 weeks missed: Provider may have you resume at your current dose or step back one level
• More than 4 weeks: May need to restart at 2.5 mg and re-escalate (tolerance may have decreased)

For more information, see our guide on missing tirzepatide doses.

When to Adjust Your Dose (Up or Down)

Signs You Should Increase Your Dose

Consider discussing a dose increase with your provider if:

• ✓ Completed minimum 4 weeks at current dose
• ✓ Weight loss has plateaued for 2+ weeks
• ✓ Appetite is returning by end of week (hunger increasing)
• ✓ Side effects minimal or resolved
• ✓ Still have significant weight to lose
• ✓ Tolerating current dose well

Signs You Should Decrease Your Dose

Consider discussing a dose reduction if:

• ✗ Persistent nausea, vomiting, or diarrhea
• ✗ Unable to eat adequate nutrition or stay hydrated
• ✗ Losing weight too rapidly (>3-4 pounds/week consistently)
• ✗ Significant fatigue or weakness
• ✗ Other concerning symptoms
• ✗ At or below goal weight but want to continue medication

Dose Reduction Protocol

If reducing dose:

• Typically step back one dose level (e.g., 10 mg → 7.5 mg)
• Stay at lower dose for 4+ weeks
• Can attempt re-escalation later if side effects resolve
• Always done under provider supervision

Does Dose Affect Cost?

Tirzepatide costs can vary by dose depending on your provider:

Brand-Name (Mounjaro/Zepbound)

• All doses: $1,000-$1,300/month regardless of dose level
• Same price for 2.5 mg as 15 mg
• Insurance copays typically the same across doses

Compounded Tirzepatide

Pricing varies by provider:

• Flat-rate providers (like Contour Health): $299/month for all dose levels
• Dose-based providers: $299-$595/month, with higher doses costing more
• Important: Confirm pricing across full dosing schedule before starting

For complete cost details, see our tirzepatide cost guide.

Long-Term Maintenance Dosing

Finding Your Maintenance Dose

Your optimal maintenance dose is the lowest dose that:

• Controls your appetite effectively
• Maintains your weight loss
• Has minimal or manageable side effects
• Fits your budget

This might be anywhere from 7.5 mg to 15 mg depending on individual response.

Staying on Tirzepatide Long-Term

Many patients continue tirzepatide for:

• Active weight loss phase: 6-12 months to reach goal weight
• Maintenance phase: 6-12+ months (or longer) to maintain weight loss
• Indefinite use: Some patients continue long-term as chronic weight management

Transitioning Off Tirzepatide

If stopping tirzepatide after reaching your goal:

• Gradual reduction: May taper down doses over 2-3 months
• Abrupt stop: Also safe, but appetite may return more suddenly
• Weight maintenance plan: Essential to prevent regain
• Lifestyle focus: Diet, exercise, sleep, stress management

Learn more in our guide to stopping tirzepatide.

Injection Tips for Each Dose

Proper Injection Technique

Regardless of dose level:

• Injection sites: Abdomen, thigh, or upper arm (rotate sites weekly)
• Timing: Same day each week, any time of day
• With food: Can inject with or without food
• Technique: Subcutaneous injection at 90-degree angle

For complete injection instructions with images, see our tirzepatide injection guide.

Frequently Asked Questions

Can I start at a higher dose than 2.5 mg?

No, starting at 2.5 mg is required for safety and tolerability. Beginning at higher doses significantly increases the risk of severe nausea, vomiting, and dehydration. Always follow the recommended escalation schedule.

What if 2.5 mg causes severe side effects?

If you experience severe or intolerable side effects at the starting 2.5 mg dose, contact your healthcare provider. They may recommend:

• Staying at 2.5 mg longer (6-8 weeks instead of 4)
• Aggressive side effect management strategies
• Potentially trying semaglutide instead (different side effect profile)

Do I have to go all the way to 15 mg?

No. Many patients achieve excellent results at 7.5 mg or 10 mg and never escalate further. Only increase if you're tolerating your current dose well and need additional weight loss.

How long should I stay at each dose?

Minimum 4 weeks at each dose level. Some patients stay longer (6-8 weeks) if still losing weight consistently or experiencing side effects. Always discuss timing with your provider.

Can I increase my dose faster than every 4 weeks?

This is not recommended and goes against FDA-approved dosing. Faster escalation significantly increases side effect risk and may lead to treatment discontinuation.

What if I plateau at a lower dose?

If weight loss plateaus for 3-4 weeks at your current dose and you're tolerating it well, discuss increasing to the next dose level with your provider. Often, increasing the dose will break through the plateau.

Is 10 mg as effective as 15 mg?

15 mg produces slightly more weight loss than 10 mg in clinical trials (approximately 2-3% additional body weight loss). However, many patients achieve their goals at 10 mg, making the higher dose unnecessary.

Will I need to stay on tirzepatide forever?

Not necessarily. Many patients use tirzepatide to reach their goal weight (6-12 months), then transition to maintenance with lifestyle modifications, a lower dose, or a different medication. Discuss your long-term plan with your provider.

Can I reduce my dose after reaching my goal weight?

Yes, some patients successfully maintain their weight loss on a lower dose (stepping down from 15 mg to 10 mg, for example). Work with your provider to find the lowest effective maintenance dose.

How do I know which dose is right for me?

Your optimal dose depends on:

• Weight loss goals (how much you need to lose)
• Response to current dose (appetite control, weight loss rate)
• Side effect tolerability
• Provider recommendation based on your medical history

What if I feel great at 5 mg and don't want to increase?

If you're losing 1-2 pounds per week, tolerating 5 mg well, and happy with your progress, discuss staying at 5 mg with your provider. There's no requirement to escalate if you're achieving your goals.

Can I skip a dose level (like go from 5 mg to 10 mg)?

This is not recommended. Skipping doses increases side effect risk. Always follow the gradual escalation schedule: each dose level serves as preparation for the next.

Ready to Start Your Tirzepatide Journey?

Understanding the proper dosing schedule is the first step toward successful weight loss with tirzepatide. With gradual escalation, most patients tolerate the medication well and achieve significant, sustainable results.

At Contour Health, you get:

• Compounded tirzepatide: $299/month at all dose levels
• Expert guidance through your entire dose escalation
• Unlimited consultations with board-certified physicians
• Personalized dosing adjustments based on your response
• All supplies included (needles, alcohol swabs, sharps container)
• Medication delivered to your door

Start Your Evaluation - $299/Month All Doses

Not sure if tirzepatide is right for you? Learn about tirzepatide vs semaglutide or explore our complete tirzepatide guide.

Medical Disclaimer: This article is for educational purposes only and does not constitute medical advice. Tirzepatide is a prescription medication that must be used under the supervision of a licensed healthcare provider. Always follow your provider's dosing instructions. Individual responses vary.

References:

1. Jastreboff AM, et al. "Tirzepatide Once Weekly for the Treatment of Obesity." N Engl J Med. 2022;387:205-216. PMID: 35441470