Tirzepatide Dosage Chart: Full Titration Schedule

Tirzepatide is a once-weekly injection that is never started at its full strength. The dose climbs a fixed ladder, and that schedule is set by the FDA prescribing information rather than left to guesswork. This page is the chart: the exact dose at every step, how long you hold there, what the label says to do when a dose is missed or a step is not tolerated, and what the milligrams work out to in syringe units. Every number below was read off the current labels — both Zepbound and Mounjaro carry a revision date of 4/2026, checked against DailyMed on August 11, 2026¹² — not off a clinic protocol or a compounding-pharmacy chart.

One note up front: tirzepatide is a prescription-only medicine, and the chart below is the labeled schedule, not a self-dosing plan. Your clinician may move you up the ladder more slowly than the minimum spacing. Compounded tirzepatide, often sold by the milligram or in "units," does not come with this standardized titration and is a separate, riskier category — including the math (and the danger) behind how many units is 2.5 mg of tirzepatide.

The tirzepatide dosing chart, step by step

The starting schedule is identical for Zepbound and Mounjaro. Treatment begins at 2.5 mg once weekly, and the dose is raised in 2.5 mg increments no sooner than every four weeks¹².

The week numbers are the fastest legal climb, not a plan. The label sets a floor on speed — "at least 4 weeks on the current dose" — and no ceiling, so holding a rung for eight or twelve weeks is entirely within the schedule¹.

The 2.5 mg dose is an initiation dose only. The Zepbound label states it in those words: the 2.5 mg dosage is for treatment initiation and is not approved as a maintenance dosage¹. Mounjaro's wording is different and more specific — 2.5 mg is for treatment initiation and is not intended for glycemic control². Either way, nobody is meant to stay there.

Because each step needs a minimum of four weeks, climbing from the 2.5 mg start to the 15 mg ceiling takes about five months at the fastest — and many people stop at a lower dose that already works for them rather than pushing to the top.

What the label actually says at each rung

Most dosage charts online reproduce the six numbers and stop. The labeled instructions around those numbers are where the useful detail is, and they are short enough to state exactly:

• •Starting dosage. 2.5 mg subcutaneously once weekly for 4 weeks, for all Zepbound indications — weight and obstructive sleep apnea alike¹.
• •First increase. After 4 weeks, increase to 5 mg once weekly¹².
• •Every increase after that. The dosage may be increased in 2.5 mg increments after at least 4 weeks on the current dose¹. Mounjaro conditions the same step on need: increase in 2.5 mg increments if additional glycemic control is needed².
• •Choosing where to stop. Zepbound's label instructs prescribers to consider treatment response and tolerability when selecting the maintenance dosage, and — plainly — that if a patient does not tolerate a maintenance dosage, consider a lower one¹.
• •Maintenance dosages. 5 mg, 10 mg or 15 mg once weekly for weight reduction and long-term maintenance; 10 mg or 15 mg for obstructive sleep apnea¹.
• •Maximum. 15 mg once weekly for all Zepbound indications and for adults on Mounjaro¹².

Note what is not in that list: any instruction to reach 15 mg, any timetable for getting there, and any dose between the six labeled strengths. The approved product exists at 2.5, 5, 7.5, 10, 12.5 and 15 mg and nowhere in between¹.

Why each four-week step exists

The four-week spacing is not administrative caution, and the label says so outright: follow the escalation schedule to reduce the risk of gastrointestinal adverse reactions¹². The label then shows its work. In a pool of two Zepbound weight-reduction trials, severe gastrointestinal adverse reactions tracked the dose almost linearly — 1.7% at 5 mg, 2.5% at 10 mg, 3.1% at 15 mg, against 1% on placebo¹. That is the dose-response the ladder is built to manage.

The independent literature reaches the same place from the other direction. A systematic review across the tirzepatide trial program found GI effects were generally mild to moderate, dose-dependent, most frequent during dose increases, and the leading reason people discontinued³; an updated meta-analysis including SURMOUNT-2 confirmed the same dose-dependent pattern alongside dose-dependent weight loss⁴.

So the mechanism of the chart is simple: each rung buys the gut four weeks to adapt at a concentration it has never seen before. Skipping a rung, or shortening the hold, spends that adaptation window. For the full picture of those side effects and how they are managed, see our tirzepatide dosing ladder and side effects guide; for when each wave peaks and fades, how long do Zepbound side effects last; and for the effect that drives most of the quitting, tirzepatide and nausea.

Where Zepbound and Mounjaro differ

The two brands are the same drug at the same milligram strengths, but the labels are written for different conditions, which changes several details — including one that most charts miss.

Obesity and long-term weight maintenance (Zepbound). The full 2.5-to-15 mg ladder applies, and 5, 10 and 15 mg are all approved maintenance dosages¹.

Obstructive sleep apnea (Zepbound). You still titrate up from 2.5 mg, but the approved maintenance band is 10 mg or 15 mg — the 5 mg rung is a step on the way, not a place to stop¹. More on that indication in Zepbound for sleep apnea.

Type 2 diabetes in adults (Mounjaro). Same 2.5 mg start, same 2.5 mg steps at four-week minimums, same 15 mg maximum. The difference is the trigger: you step up if additional glycemic control is needed, and 2.5 mg is explicitly not intended for glycemic control².

Type 2 diabetes in children aged 10 and older (Mounjaro). This is the detail almost no dosage chart carries. Mounjaro is indicated for pediatric patients 10 years of age and older with type 2 diabetes, and their maximum dosage is 10 mg once weekly, not 15 mg². The 12.5 mg and 15 mg rungs of the adult chart are not available to them. Zepbound has no pediatric indication at all¹.

A common point of confusion is worth stating plainly: Zepbound and Mounjaro are not different drugs and not different doses. They are the same tirzepatide molecule at 2.5, 5, 7.5, 10, 12.5 and 15 mg, branded separately for separate FDA indications — the comparison in full is at Mounjaro vs Zepbound.

Tirzepatide dosing in units

"How many units is my dose?" is the second-most-asked question about this chart, and it has a clean answer for the brand and a messy one for everything else.

On the brand product, the answer is: none. Zepbound and Mounjaro are not dosed in units. Single-dose pens and single-dose vials deliver 2.5, 5, 7.5, 10, 12.5 or 15 mg in a fixed 0.5 mL. The multi-dose vials and the single-patient-use KwikPen hold 2.4 mL — four doses — and deliver each dose in 0.6 mL¹². Lilly keeps that volume constant by changing the concentration at every rung:

That is the whole trick, and it is worth understanding before anyone converts anything: the approved product solves the volume problem by moving the concentration, so the patient's number never changes. The label reinforces it — patients using vials are told to use a syringe appropriate for the dose, giving as its example a 1 mL syringe capable of measuring a 0.5 mL or 0.6 mL dose, with a new syringe and needle every time¹². That is not an insulin syringe, and the instruction never mentions units.

Units belong to compounded vials, where the concentration is chosen by the pharmacy and is not standardized. On a U-100 insulin syringe, 100 units = 1 mL, so 1 unit = 0.01 mL — a measure of volume, not of drug. The conversion is volume (mL) = dose (mg) ÷ concentration (mg/mL), then units = mL × 100. Applied across this chart's ladder, at three concentrations compounders commonly list:

These are illustrations of the arithmetic, not a recommendation of any concentration or dose. Read the spread across a single row: the same 2.5 mg is 6 units or 25 units depending only on the vial. Draw 25 units from a 40 mg/mL vial believing it is 2.5 mg and you have injected 10 mg — the fourth rung of the chart, on your first week. Patients have self-administered ten-fold dosing errors making exactly this class of mistake with compounded GLP-1 products¹⁰. The full treatment of that question, and the only safe way to get your own number, is on how many units is 2.5 mg of tirzepatide; to run the arithmetic for any concentration, use the dose-to-unit converter.

What the label says when a dose is missed

Both labels carry the same rule, word for word, and it is one of the few places the prescribing information speaks directly to the patient¹²:

• •Within 4 days (96 hours) of the missed dose — take it as soon as possible, then resume the regular weekly schedule.
• •More than 4 days — skip the missed dose entirely and take the next one on the regularly scheduled day.
• •Changing your weekly day — allowed if necessary, provided at least 3 days (72 hours) separate the two doses.

That 72-hour floor is what stops a late dose and the next scheduled one from stacking. There is no instruction anywhere in either label to double up, and none to add a missed dose onto the next one. The full walkthrough, including how to move your injection day without breaking the spacing, is in our guide to a missed tirzepatide dose.

And here is the rule the label does not contain. People who have been off tirzepatide for weeks — a lapsed prescription, a supply gap, a break between programs — ask what dose to restart at. We read Section 2 of both labels in full at revision 4/2026: neither publishes a re-initiation schedule, neither sets a gap length after which you drop back to 2.5 mg, and neither addresses restarting at all beyond the 96-hour missed-dose window¹². That silence is the honest answer. Restarting after a long gap is a prescriber's judgment call, made on how long you were off and how you tolerated the dose before — not a number you can read off any chart, including this one.

When side effects hit: what the label authorizes

The chart is a floor on speed, not a mandate to climb on schedule, and the label provides for that in two ways.

First, in how the maintenance dose is chosen: consider treatment response and tolerability, and if a patient does not tolerate a maintenance dosage, consider a lower maintenance dosage¹. Stepping down is a labeled option, not an admission of failure. Second, in what the four-week minimum permits: nothing obliges an increase at week four, so holding the current rung until the last increase has settled is inside the schedule, not a deviation from it.

Two related instructions matter during the climb specifically. Renal function should be monitored in patients reporting reactions that could lead to volume depletion — nausea, vomiting, diarrhea — especially during dosage initiation and escalation¹, which is the label's own acknowledgment that the escalation weeks carry the risk. And Zepbound is not recommended in patients with severe gastroparesis at any dose¹. More on the kidney question in tirzepatide and kidneys, and on the full label warnings in our Zepbound side effects breakdown.

Maintenance dosing after goal weight

Once the scale stops moving, the question becomes what to stay on — and the labeled answer is narrower than most people expect. There is no separate, reduced "you've arrived" dose anywhere in the prescribing information. "Maintenance dosage" on the label means the dose you settle on after the run-in: 5, 10 or 15 mg once weekly for weight, 10 or 15 mg for sleep apnea¹. The 2026 Zepbound indication is itself written for the long term — to reduce excess body weight and maintain weight reduction long term¹.

The trial evidence points the same way. In SURMOUNT-4, participants who had already titrated up and lost weight were randomized either to continue tirzepatide or to switch to placebo; those who continued held or extended their loss, while those switched to placebo regained a substantial portion of it⁸. The chart gets you to an effective dose; staying there is what holds the result. The full treatment of that question — including where the popular "drop to the lowest dose that maintains" idea is and is not supported — is at Zepbound maintenance dose after goal weight, and the picture on coming off entirely is at what happens if you stop tirzepatide.

What the ladder changes elsewhere

Three labeled instructions are keyed to the titration schedule rather than to the drug in general, and they are easy to miss because they live outside Section 2.

• •Oral hormonal contraceptives. Zepbound delays gastric emptying, and the label advises patients on oral contraceptives to switch to a non-oral method, or add a barrier method, for 4 weeks after initiation and for 4 weeks after each dose escalation¹. On the fastest climb that is five separate four-week windows. Non-oral hormonal contraceptives are not affected. The detail is covered at Zepbound and birth control.
• •Insulin and sulfonylureas. When initiating tirzepatide, consider reducing the dose of any concomitant insulin or insulin secretagogue to lower hypoglycemia risk¹. On Mounjaro, insulin is given as a separate injection, never mixed, and not adjacent to the tirzepatide site². See also tirzepatide and metformin.
• •Kidney and liver impairment. No dosage adjustment is recommended for renal impairment, including end-stage renal disease, or for hepatic impairment — the ladder is the same¹.

Everything else about administration is dose-independent: once weekly at any time of day, with or without meals, injected into the abdomen or thigh (or the back of the upper arm by another person), rotating sites each time¹². Our step-by-step guide to injecting Zepbound covers the technique, and tirzepatide storage out of the fridge the handling.

Compounded dosing versus the labeled schedule

Compounded tirzepatide is a different product category, and its dosing differs from this chart for structural reasons rather than clinical ones.

The approved product exists at exactly six strengths in fixed-dose presentations; a compounded vial is a multi-dose container at a concentration the pharmacy chooses, from which the patient draws a volume. Nothing about that arrangement produces the labeled ladder on its own. A dose that is not one of 2.5, 5, 7.5, 10, 12.5 or 15 mg is, by definition, not on any tirzepatide label — there is no FDA-reviewed titration schedule, tolerability data or maximum behind it¹². A pharmacovigilance analysis of compounded GLP-1 receptor agonists drawing on the FDA Adverse Event Reporting System found a signal of medication errors and adverse events tied to the compounded products that the standardized fixed-dose presentations are designed to prevent⁹.

That is the honest framing: this chart describes the brand product, and a compounded program may or may not follow it. Ask which schedule yours uses, and in what units it will hand you the answer. The legal position of the compounded route is at compounded tirzepatide legal status, and if the appeal of stopping partway up the ladder is what brought you here, read tirzepatide microdosing first — parking at 2.5 mg means parking on the on-ramp.

One commercial consequence is worth flagging while you are looking at the chart: if you are buying compounded tirzepatide, ask whether the price climbs with you. Some sellers promise one flat price at every rung of the ladder and some quietly index the monthly fee to the dose, which turns a cheap first month into an expensive fourth one at exactly the point the chart says most people are still climbing — CoreAge Rx is among the minority charging one flat rate at every rung.

What the dose-response data show

The titration ceiling exists because higher doses do more — within limits. In SURMOUNT-1, the pivotal obesity trial, mean weight reduction rose with the dose: roughly 15% at 5 mg, about 19.5% at 10 mg and around 21% at 15 mg over 72 weeks, versus about 3% on placebo⁵. The same dose-stepped pattern appeared in SURPASS-2 in type 2 diabetes, where tirzepatide 5, 10 and 15 mg each beat semaglutide 1 mg on blood-sugar control with larger effects at higher doses⁶. SURMOUNT-2, in people with both obesity and type 2 diabetes, again showed clinically meaningful, dose-related weight loss⁷.

That is the honest reason the chart goes to 15 mg. But it is also why not everyone needs the top of the ladder — a 5 or 10 mg maintenance dose already produces large, clinically meaningful results, and the lowest effective dose is usually the goal rather than the maximum. Which rung earns the most is examined at what dose of Zepbound is most effective.

The honest bottom line

The tirzepatide dosage chart is the same for both brands: start at 2.5 mg once weekly for four weeks, step up 2.5 mg at a time with at least four weeks between increases, and settle at a maintenance dose of 5, 10 or 15 mg, with 15 mg the maximum¹². Zepbound's sleep-apnea indication starts its maintenance band at 10 mg; Mounjaro steps up only if more glycemic control is needed and caps pediatric patients at 10 mg¹². The four-week spacing exists because severe GI reactions track the dose in the label's own trial pool — 1.7%, 2.5%, 3.1% across 5, 10 and 15 mg¹ — and the climb to 15 mg reflects a genuine dose-response⁵⁶, not a target everyone must reach. Miss a dose and the rule is 96 hours; move your day and the rule is 72; restart after a long gap and the label has no rule at all, so ask your prescriber. (Coming off semaglutide, you restart this ladder from 2.5 mg regardless of your prior dose — see switching from semaglutide to tirzepatide.) For what the first four weeks are actually like — and why the label calls 2.5 mg a starting dose rather than a maintenance one — see Zepbound 2.5 mg. For the complete evidence base, see the tirzepatide evidence guide; to compare it with the other leading option, tirzepatide vs semaglutide; and to weigh how to get it, start with our best tirzepatide overview.