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Dose escalation typically every 4 weeks. Each step usually triggers a wave of nausea that fades within 7-14 days. This is the most attrition-prone phase.
Wegovy: 0.25 → 0.5 → 1 → 1.7 → 2.4 mg over 16 weeks. Zepbound: 2.5 → 5 → 7.5 → 10 → 12.5 → 15 mg over 20+ weeks. Weight loss steadily accelerates as dose increases. Mean by month 4: ~7-10% body weight loss.
Tolerance at each dose step. Some users plateau at 1 mg or 1.7 mg semaglutide and need a dose hold. Severe diarrhea or constipation persisting >2 weeks requires evaluation. Pancreatitis red flags (severe abdominal pain radiating to back).
STEP-1: most discontinuations in the trial occurred during titration. Patients who reach maintenance dose typically tolerate the long-term phase.
Pace titration to your tolerance, not the protocol. A 2-week dose hold at the step you cannot tolerate is better than discontinuation. Talk to your prescriber early about dose holds — most are happy to extend.
Editorial summary, not medical advice. Cycling, dose changes, and discontinuation should be coordinated with your prescriber.