Wegovy and Zepbound dose schedule: what the US labels list, step by step

The Wegovy injection dose schedule

Semaglutide is sold as Wegovy for weight and heart risk, and as Ozempic for type 2 diabetes. The Wegovy label's Dosage and Administration section (section 2.2, Table 1) lists the same starting steps for every approved use, in adults and in children 12 and older:¹

From week 17, the label lists these maintenance doses:¹

• Weight reduction in adults: 1.7 mg or 2.4 mg (recommended) once weekly. For people who have tolerated 2.4 mg for at least 4 weeks and when more weight loss is clinically indicated, the label says the dose may be increased to a maximum of 7.2 mg once weekly.
• Heart risk reduction in adults: 2.4 mg (recommended) or 1.7 mg.
• Weight reduction in children 12 and older: 2.4 mg (recommended) or 1.7 mg. The label says 7.2 mg has not been studied enough to be established in children.
• MASH (a fatty liver disease with scarring): 2.4 mg.

The label does not list an in-between step from 2.4 mg to 7.2 mg. In the two trials behind the 7.2 mg dose, people reached 2.4 mg or 7.2 mg over 20 weeks.¹ For the results of those trials, see Wegovy 7.2 mg: what the STEP UP trials found.

The Wegovy pill dose schedule

Wegovy also comes as a daily tablet for adults, for weight reduction and heart risk reduction. The label (section 2.3, Table 2) lists 30-day steps:¹

The label says to take one tablet in the morning on an empty stomach with up to 4 ounces of water, and to wait at least 30 minutes before eating, drinking or taking other oral medicines.¹ For the trial results, see oral semaglutide for weight loss.

The Zepbound dose schedule

Tirzepatide is sold as Zepbound for weight and obstructive sleep apnea, and as Mounjaro for type 2 diabetes. The Zepbound label (section 2.1) lists 2.5 mg once weekly for 4 weeks, then 5 mg. After that, the dose may go up in 2.5 mg steps after at least 4 weeks on the current dose.² The label says the 2.5 mg dose is only for starting and is not a maintenance dose.

The label lists maintenance doses of 5 mg, 10 mg or 15 mg for weight reduction, and 10 mg or 15 mg for sleep apnea. It says to consider response and tolerability when choosing the maintenance dose.² Past the first 4 weeks, it sets a minimum time on each dose rather than a fixed calendar.

Ozempic and Mounjaro dose schedules

For how the four medicines differ, see Ozempic vs Wegovy vs Mounjaro vs Zepbound.

Why the labels step up so slowly

All four labels say the escalation schedule is there "to reduce the risk of gastrointestinal adverse reactions."^1–4 The trial data in the labels show why:

In the Wegovy label, nausea affected 44% of people on Wegovy injection vs 16% on placebo, vomiting 25% vs 6%, and diarrhea 30% vs 16%. The label says these reactions were most often reported during dose escalation. Stomach side effects led 4.3% of adults on Wegovy injection to stop treatment, vs 0.7% on placebo.¹ The Zepbound label says most nausea, vomiting and diarrhea happened during dose escalation and decreased over time. Stopping because of stomach side effects rose with dose: 1.9% on 5 mg, 3.3% on 10 mg and 4.3% on 15 mg, vs 0.5% on placebo.²

The main trials agree. In STEP 1 (semaglutide 2.4 mg, 68 weeks), nausea and diarrhea were typically short-lived and mild to moderate.⁵ In SURMOUNT-1 (tirzepatide, 72 weeks), most stomach side effects were mild to moderate and came mainly during dose escalation.⁶ Both trials enrolled adults with obesity or overweight. For ways people manage these effects, see GLP-1 nausea and stomach side effects.

What the labels say if a dose is hard to tolerate

• Wegovy injection: if a dose is not tolerated during escalation, the label says to consider delaying the next step for 4 weeks. If 2 or more doses in a row are missed, it says to restart escalation at a lower dose.¹
• Wegovy tablets: the label says to consider delaying escalation if a dose is not tolerated, and to consider switching to Wegovy injection 1.7 mg if 25 mg is not tolerated.¹
• Zepbound: the label says to consider a lower maintenance dose if a maintenance dose is not tolerated.²
• Ozempic and Mounjaro: section 2 of these labels gives minimum times on each dose but no specific instruction for slowing down.^3,4

The Zepbound and Mounjaro labels add one more schedule note: people using birth control pills are advised to switch to a non-oral method, or add a barrier method, for 4 weeks after starting and for 4 weeks after each dose increase.^2,4 See GLP-1s, birth control and pregnancy.

Doses in units or mL: what the labels list

Each pen delivers a fixed dose, so the dose is set by which pen strength you are prescribed. The labels give doses in milligrams (mg) and volumes in milliliters (mL). They do not list doses in units.^1,2

• Wegovy single-dose pens: 0.25 mg, 0.5 mg and 1 mg come in 0.5 mL; 1.7 mg, 2.4 mg and 7.2 mg (sold as Wegovy HD) come in 0.75 mL. The Wegovy FlexTouch pen holds four 2.4 mg doses.¹
• Zepbound single-dose pens and single-dose vials: every strength, from 2.5 mg to 15 mg, is one dose in 0.5 mL.²
• Zepbound multi-dose vials and KwikPens: each holds 4 doses of 0.6 mL at one strength.²

The Zepbound label says patients should be trained on the exact product they receive, and retrained if it changes.² If you use vials, ask your pharmacist or prescriber to show you how. This article does not explain how to measure a dose.