The Titration is the stepwise increase of a medication dose over weeks, guided by a provider, until the patient reaches a maintenance dose. The FDA-approved labels for Wegovy and Zepbound each set a titration schedule, which they call dosage escalation. At BrightSide, a licensed provider from Arora Health in Seattle reviews every dose change.
How does titration apply to compounded GLP-1 treatment?
A provider titrates a compounded GLP-1 prescription in steps, and the published schedules a provider can look to are on the labels of the FDA-approved drugs. Compounded semaglutide and tirzepatide are not FDA approved, so they have no FDA-approved label or schedule. FDA has received adverse event reports that may be related to compounded semaglutide or tirzepatide prescribed in doses beyond the FDA-approved label, including amounts increased more quickly than the label's titration schedule. It asks health care providers to be vigilant when they set doses and titration schedules for these products. At BrightSide, where you start and when you move up is decided with your provider. People who are new to compounded tirzepatide usually start at the lowest dose. If you already take it, tell us your current dose. Our providers can match the dose you're on if it's right for you.
What do the Wegovy and Zepbound labels say about titration?
Both labels start low and step up no faster than every four weeks. Wegovy injection starts at 0.25 mg once a week for four weeks, then moves to 0.5 mg, 1 mg and 1.7 mg for four weeks each, with the maintenance dosage from week 17. Zepbound starts at 2.5 mg once a week for four weeks, moves to 5 mg, and can then go up in 2.5 mg increments after at least four weeks on the current dose. Each label gives one reason for the schedule, which is to reduce the risk of gastrointestinal adverse reactions. Each also allows a slower pace. The Wegovy label says to consider delaying escalation for four weeks if a patient does not tolerate a dose. After two or more missed doses in a row, it says to reinitiate dosage escalation at a lower dosage.
What does titration mean at the pharmacy?
At the pharmacy, each step in a titration is a change to what the prescription and the pharmacy label say. With a brand-name drug, a new step means a pen or vial of the next fixed strength. With a compounded vial, a new step can mean drawing a different volume, or receiving a vial with a different concentration. FDA notes that concentrations of compounded semaglutide vary between compounders and that one compounder can offer several. Read the label on every new vial, because the volume for your dose can change when the concentration does. Our pricing page shows what happens to your price when your dose changes, and our pharmacy network page covers how we choose pharmacies.
| Step | Wegovy (semaglutide) injection label | Zepbound (tirzepatide) label |
|---|---|---|
| Starting dosage | 0.25 mg once weekly, weeks 1 through 4 | 2.5 mg once weekly for 4 weeks |
| Escalation | 0.5 mg in weeks 5 through 8, 1 mg in weeks 9 through 12, 1.7 mg in weeks 13 through 16 | 5 mg after 4 weeks, then increases of 2.5 mg after at least 4 weeks on the current dose |
| Maintenance dosage | Week 17 and onward, set by indication | 5 mg, 10 mg or 15 mg once weekly for weight reduction |
| If a dose is not tolerated | Consider delaying escalation for 4 weeks | Consider a lower maintenance dosage |
Common questions
How long does titration take?
On the labels, 16 weeks for Wegovy injection and at least four weeks for Zepbound. Wegovy reaches its maintenance dosage at week 17. Zepbound's lowest maintenance dosage, 5 mg, comes after four weeks at 2.5 mg, and each further 2.5 mg step takes at least four more weeks. The labels allow a slower pace, and your provider sets yours.
Do you start over at the lowest dose when you switch to BrightSide?
Not necessarily. Tell us what you take now, your dose and when you took your last one. A licensed provider reviews it and can match the dose you're on if it's right for you. After a longer break, your provider may suggest restarting lower and building back up.
Related terms
- Maintenance dose: the dose titration leads to.
- Microdosing: staying below the label maintenance doses.
- Semaglutide: the medication in the Wegovy schedule above.
- Tirzepatide: the medication in the Zepbound schedule above.
Sources
- Wegovy (semaglutide) prescribing information, Novo Nordisk, revised 6/2026, on DailyMed: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee06186f-2aa3-4990-a760-757579d8f77b
- Zepbound (tirzepatide) prescribing information, Eli Lilly, revised 8/2026, on DailyMed: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b
- FDA, FDA's concerns with unapproved GLP-1 drugs used for weight loss, content current as of October 1, 2026: https://www.fda.gov/drugs/drug-alerts-and-statements/fdas-concerns-unapproved-glp-1-drugs-used-weight-loss
- FDA, FDA alerts health care providers, compounders and patients of dosing errors associated with compounded injectable semaglutide products, content current as of July 26, 2024: https://www.fda.gov/drugs/human-drug-compounding/fda-alerts-health-care-providers-compounders-and-patients-dosing-errors-associated-compounded
Compounded medications are not FDA approved. They are prescribed by a licensed clinician and filled by a licensed 503A pharmacy.
