Titration — the gradual step-up in dose over weeks and months — is the foundation of safe, effective GLP-1 treatment. Rush it and side effects become severe. Follow it properly and most people tolerate escalation well. The schedules below are based on the MHRA-approved Summary of Product Characteristics for each medication, updated to reflect the Wegovy 7.2mg addition approved in January 2026.
Mounjaro (tirzepatide) titration schedule
Mounjaro has six dose increments — more than any other GLP-1 medication currently licensed in the UK. Every patient starts at 2.5mg regardless of their weight or treatment goals. The minimum time at each dose before escalating is four weeks, though staying longer is always an option.
Each Mounjaro pen contains 4 doses — one pen per month at standard weekly dosing. The starting dose of 2.5mg is an initiation dose only; it's not intended to produce significant weight loss but to let your body adjust to the mechanism before increasing.
Wegovy (semaglutide) titration schedule
Wegovy has five steps to the standard 2.4mg maintenance dose, taking approximately 16 weeks. From January 2026, two additional doses — 3.6mg and 7.2mg — are licensed in the UK for patients who have completed standard titration and tolerated 2.4mg. The 7.2mg is not a starting dose and should only be considered after adequate time at 2.4mg.
On the 7.2mg Wegovy dose: It was MHRA-approved in January 2026 and is now available through private providers, though not universally. It is only appropriate for patients who have been on 2.4mg for at least 8 weeks, are tolerating it well, and haven't achieved their goal weight. It is not a replacement for 2.4mg as a standard maintenance dose — it's an extension for patients who have plateaued.
Side-by-side comparison
| Factor | Mounjaro (tirzepatide) | Wegovy (semaglutide) |
|---|---|---|
| Starting dose | 2.5mg | 0.25mg |
| Standard maintenance dose | 10–15mg (individual) | 2.4mg (7.2mg optional) |
| Number of dose steps | 6 (to 15mg) | 5 to 2.4mg; 7 to 7.2mg |
| Weeks to standard maintenance | ~20 weeks minimum | ~16 weeks minimum |
| Minimum time at each dose | 4 weeks | 4 weeks |
| Can you slow down? | Yes — stay longer at any step | Yes — stay longer at any step |
| Can you go back down? | Yes — dose reduction is supported | Yes — dose reduction is supported |
| Doses per pen | 4 | 4 |
| Pen mechanism | KwikPen (click system) | FlexTouch (dial and press) |
What to expect at each stage
The experience at each stage is broadly predictable — though how any individual responds varies considerably. Here's what most people find:
When to slow down — and how
The four-week minimum between dose increases is a floor, not a target. The SmPC for both medications explicitly supports remaining at any dose for longer than four weeks if tolerability requires it. There's no clinical penalty for a slower titration — and there's a meaningful benefit in terms of side effects and adherence.
Long-term adherence matters more than reaching the maximum dose quickly. A person who stays on 7.5mg Mounjaro comfortably for a year will typically achieve better outcomes than someone who pushes to 15mg, develops severe nausea, and stops after three months.
Signs you should pause before escalating:
- Nausea that persists beyond 4–5 days after injection day, rather than settling in 1–2 days
- Vomiting more than once or twice, or persistent inability to eat normally
- Significant disruption to daily life — work, social commitments, sleep
- Weight loss proceeding well at your current dose — no clinical reason to increase
Dose reduction is always an option. Both medications support stepping back to the previous dose if the current one isn't tolerable. This is not a failure — it's appropriate clinical management. Tell your prescriber; don't just reduce unilaterally without logging it.
Finding your maintenance dose
Your maintenance dose is the lowest dose that produces adequate appetite suppression and continued weight loss — or, once at goal weight, holds your results. It's individual, and it may be well below the maximum licensed dose.
A meaningful proportion of people on Mounjaro find their effective maintenance dose is 7.5mg or 10mg rather than 15mg. On Wegovy, some find 1.7mg or even 1mg is sufficient. The data from SURMOUNT and STEP trials focused on maximum doses because trials aim to demonstrate maximum efficacy — but real-world prescribing is more nuanced.
The right question to ask at every review is not "should I go up?" but "is my current dose working?" If the answer is yes, there's no compelling reason to escalate — and good reasons not to, including cost, side effects, and simplicity.
Managing side effects during escalation
GI side effects — nausea, constipation, diarrhoea, bloating — are most pronounced at two points: when you first start the medication, and after each dose increase. They typically settle within one to two weeks at a stable dose. If they don't, that's a signal the dose increase was too fast.
What actually helps during escalation:
- Eat smaller meals — the medication slows gastric emptying; a large meal on top of that is uncomfortable. Smaller, more frequent eating works better during titration
- Avoid fatty, rich, or greasy foods — particularly in the 24–48 hours after injection. They're significantly harder to tolerate during escalation
- Time your injection strategically — many people inject before bed so the peak side-effect window (6–12 hours post-injection) happens overnight
- Stay hydrated — constipation is common and dehydration compounds it significantly. Fibre intake also helps
- Don't push through severe nausea — staying at your current dose an extra four weeks costs nothing and may resolve the problem entirely
Contact your prescriber or 111 immediately for severe or persistent abdominal pain — this can indicate pancreatitis. Also seek help for signs of dehydration from persistent vomiting or diarrhoea (dizziness, dark urine, inability to keep fluids down). These are rare but serious; don't wait and see with either.
Provider support during titration varies enormously. Some include clinical check-ins at each dose step; others just dispatch medication. Use cleardose to compare what's included.
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