What is a maintenance dose? Wegovy, Zepbound, Ozempic and Mounjaro labels explained

What is a maintenance dose?

A maintenance dose is the dose of a medicine you stay on for ongoing treatment, after a starting and step-up phase. GLP-1 medicines begin at a low starting dose and go up in steps, called dose escalation or titration, every 4 weeks or so. The labels say this slow climb is meant to reduce stomach side effects.^1,2 Once the climb ends, the dose you settle on is the maintenance dose. This article describes what each US label's section 2, "Dosage and Administration", says. It is the labels' instruction to prescribers, not advice on which dose is right for you.

Think of it like a car merging onto a highway: you speed up in stages, then hold a cruising speed. The analogy stops working because there is no single "right" speed for everyone. Most labels list more than one maintenance dose, and the prescriber picks based on how well it works and how well it is tolerated.

Starting dose vs maintenance dose

Starting doses are there to let the body adjust. Some labels say plainly that they are not meant to treat the condition:

• The Zepbound label says the 2.5 mg dose "is for treatment initiation and is not approved as a maintenance dosage."²
• The Rybelsus and Ozempic tablet label says the 3 mg and 1.5 mg starting doses are not effective for blood sugar control.⁵
• The Wegovy injection label's Table 1 labels weeks 1 to 4 (0.25 mg) as the starting dose, weeks 5 to 16 (0.5 mg, 1 mg, 1.7 mg) as dose escalation and week 17 onward as the maintenance dose.¹

For the week-by-week steps, see the Wegovy and Zepbound dose schedule.

Maintenance doses on each US label

A few details are worth knowing. The Wegovy label says to consider "treatment response and tolerability" when choosing between 1.7 mg and 2.4 mg, and the Zepbound label uses the same words.^1,2 If someone cannot tolerate the 25 mg Wegovy tablet, the label says to consider switching to the 1.7 mg Wegovy injection.¹ The higher 7.2 mg Wegovy dose has its own article: Wegovy 7.2 mg. For how semaglutide (Wegovy, Ozempic) and tirzepatide (Zepbound, Mounjaro) differ, see Ozempic vs Wegovy vs Mounjaro vs Zepbound.

Is a maintenance dose the same as weight maintenance?

No. This is the most common mix-up. "Maintenance dose" means the dose you stay on after the climb. It does not mean you have stopped losing weight or reached a goal. In the trials behind these labels, people kept losing weight for many months after reaching their maintenance dose. In STEP 4, for example, people reached 2.4 mg semaglutide after 16 weeks of dose escalation, and those who stayed on it lost another 7.9% of their weight between weeks 20 and 68.⁶

"Weight maintenance" is a different idea: keeping lost weight off over the long term. The Wegovy and Zepbound labels name it as part of the approved use, to "reduce excess body weight and maintain weight reduction long term."^1,2

What happens if you stay on the dose, lower it, or stop?

Three randomized trials tested this in adults with obesity or overweight and without diabetes. Everyone first lost weight on the medicine, then was randomly assigned to keep going or switch to placebo, a dummy shot.

• STEP 4 (semaglutide, 2021). After 20 weeks on semaglutide, with an average loss of 10.6%, 803 adults were split. Those who continued 2.4 mg lost another 7.9% by week 68; those switched to placebo regained 6.9%.⁶
• SURMOUNT-4 (tirzepatide, 2024). After 36 weeks on their maximum tolerated dose of 10 or 15 mg, with an average loss of 20.9%, 670 adults were split. Over the next 52 weeks, the tirzepatide group lost another 5.5% while the placebo group regained 14.0%.⁷
• SURMOUNT-MAINTAIN (tirzepatide, 2026). This trial also tested a lower dose. After 60 weeks on their maximum tolerated dose of 10 or 15 mg, 378 US adults were assigned to stay on it, drop to 5 mg, or switch to placebo for 52 weeks. Counting from the very start, weight change at week 112 was −21.9% on the full dose, −16.6% on 5 mg and −9.9% on placebo. From week 84, people who regained more than half their lost weight could get rescue tirzepatide; 8%, 25% and 67% of each group did.⁸

An earlier study looked at stopping without any switch. In the STEP 1 extension, 327 adults who stopped semaglutide 2.4 mg and the lifestyle program after 68 weeks regained about two-thirds of their lost weight within a year.⁹ More detail is in what happens when you stop a GLP-1.

The SURMOUNT-MAINTAIN authors wrote that dropping to 5 mg might be an alternative to stopping, but that individual responses may vary.⁸ Company employees were among the authors of all three trials, SURMOUNT-MAINTAIN was funded by Eli Lilly, and the trials lasted 68 to 112 weeks.

Key terms in this article

• Starting dose: the low first dose that lets the body adjust; some labels say it is not meant to treat the condition.
• Dose escalation (titration): raising the dose in steps, usually every 4 weeks, to reduce side effects.
• Maintenance dose: the dose a label lists for ongoing treatment after the step-up phase.
• Maximum tolerated dose: the highest dose a person can take without side effects that are too hard to live with.
• Weight maintenance: keeping lost weight off over time; not the same as a maintenance dose.
• Placebo: a dummy treatment with no active drug, used in trials for comparison.