What is the standard semaglutide titration schedule?

Most clinical protocols start at 0.25 mg weekly for 4 weeks, then step up every 4 weeks: 0.5 mg, 1.0 mg, 1.7 mg, and 2.4 mg as tolerated. Hold or extend a step if GI symptoms are not tolerated.

What is the standard tirzepatide titration schedule?

Tirzepatide typically starts at 2.5 mg weekly for 4 weeks, then advances every 4 weeks through 5 mg, 7.5 mg, 10 mg, 12.5 mg, and 15 mg as tolerated, with dose holds for GI tolerability.

How should providers handle GI side effects?

Stay at the current dose for an additional 4 weeks, reinforce hydration, smaller meals, and protein-forward intake. Antiemetics like ondansetron can be used short-term. Down-titrate one step if symptoms persist.

When should a dose be held or reduced?

Hold or reduce for severe nausea or vomiting, suspected pancreatitis, gallbladder symptoms, dehydration, planned surgery with anesthesia, or pregnancy. Reassess before resuming.

Are these schedules different for 503A and 503B compounded GLP-1s?

The titration logic is the same. Concentration and vial sizing differ by pharmacy. Compounded 503A vials are typically patient-specific; 503B office-use vials follow the same mg-per-week curve.

How do you transition patients between semaglutide and tirzepatide?

Discontinue the first agent, wait one dosing interval, then start the new agent at its lowest titration dose. Do not dose-match across agents.

What is the standard semaglutide titration schedule?

Most clinical protocols start at 0.25 mg weekly for 4 weeks, then step up every 4 weeks: 0.5 mg, 1.0 mg, 1.7 mg, and 2.4 mg as tolerated. Hold or extend a step if GI symptoms are not tolerated.

What is the standard tirzepatide titration schedule?

Tirzepatide typically starts at 2.5 mg weekly for 4 weeks, then advances every 4 weeks through 5 mg, 7.5 mg, 10 mg, 12.5 mg, and 15 mg as tolerated, with dose holds for GI tolerability.

How should providers handle GI side effects?

Stay at the current dose for an additional 4 weeks, reinforce hydration, smaller meals, and protein-forward intake. Antiemetics like ondansetron can be used short-term. Down-titrate one step if symptoms persist.

When should a dose be held or reduced?

Hold or reduce for severe nausea or vomiting, suspected pancreatitis, gallbladder symptoms, dehydration, planned surgery with anesthesia, or pregnancy. Reassess before resuming.

Are these schedules different for 503A and 503B compounded GLP-1s?

The titration logic is the same. Concentration and vial sizing differ by pharmacy. Compounded 503A vials are typically patient-specific; 503B office-use vials follow the same mg-per-week curve.

How do you transition patients between semaglutide and tirzepatide?

Discontinue the first agent, wait one dosing interval, then start the new agent at its lowest titration dose. Do not dose-match across agents.

What exactly does Direct Peptide Sales do?

We are a referral and introduction service. We verify your business and the states it serves, then introduce you to licensed telehealth prescribers and 503A or 503B pharmacies. You contract directly with them. We do not sell, price, prescribe, compound, bill, or ship any product.

How fast can my practice be introduced to a source?

Most qualified practices receive an introduction within one business day of applying. How quickly you go live after that depends on the agreement you sign with the prescriber and pharmacy you choose.

Nothing to apply, and we do not charge practices a fee. Product pricing, account terms, and any minimums are set by the pharmacy or prescriber you contract with, not by us.

Where do the peptides come from and are they verified?

Product comes from the licensed US 503A and 503B pharmacies you contract with. We only introduce sources that issue independent per-lot Certificates of Analysis covering identity, purity, sterility, and endotoxin. You can review sample COAs on this site before you apply.

Who handles prescribing, billing, and shipping?

The licensed prescriber and the pharmacy do. Prescribing is the provider's independent clinical decision, and dispensing, billing, and shipping sit with the pharmacy. We are not part of that transaction.

What if I'm not a licensed clinic?

Non-licensed wellness businesses such as coaches, gyms, studios, and nutrition practices can be introduced to a licensed telehealth prescriber who owns the clinical relationship. You never prescribe, hold, or dispense product.

How do you vet the sources you introduce?

Every source must be a named 503A pharmacy or FDA-registered 503B outsourcing facility, hold non-resident licensure in the states it ships into, issue per-lot Certificates of Analysis, and use prescribers licensed in the patient's state. We decline sources using research-use-only language.

Which states do you serve?

We make introductions across the United States and match you to partners that hold the right licensure for the states you serve.

Clinical reference

GLP-1 titration schedules for semaglutide and tirzepatide

A provider-facing reference for clinic-managed GLP-1 weight loss programs. Standard escalation curves, dose holds, side-effect management, and notes specific to 503A and 503B compounded vials.

Direct Peptide Sales is a referral service for licensed practices and wellness businesses. We introduce you to licensed prescribers and 503A/503B pharmacies. We do not sell, prescribe, bill, or ship product.

Last reviewed September 2, 2026 · Editorial policy

Semaglutide weekly titration

Standard escalation begins at the lowest tolerated dose and steps up every 4 weeks. Hold the step if GI symptoms have not stabilized.

Weeks 1–4: 0.25 mg weekly
Weeks 5–8: 0.5 mg weekly
Weeks 9–12: 1.0 mg weekly
Weeks 13–16: 1.7 mg weekly
Week 17+: 2.4 mg weekly maintenance

Tirzepatide weekly titration

Tirzepatide titration mirrors the 4-week-step pattern but uses a wider dose range. Maintenance is selected by tolerability and weight response.

Weeks 1–4: 2.5 mg weekly
Weeks 5–8: 5 mg weekly
Weeks 9–12: 7.5 mg weekly
Weeks 13–16: 10 mg weekly
Weeks 17–20: 12.5 mg weekly
Week 21+: 15 mg weekly maintenance

Dose holds and reductions

Patient safety is the priority over a fixed calendar. Use these triggers to hold the current step or step down one level.

Persistent nausea, vomiting, or dehydration
Suspected pancreatitis or gallbladder pathology
Planned surgery requiring anesthesia (hold per ASA guidance)
Pregnancy or active pregnancy planning
New or worsening visual changes (rule out diabetic retinopathy progression)

Side-effect management protocol

Most discontinuations happen in the first 12 weeks. A simple supportive playbook keeps patients adherent through the steepest part of the curve.

Hydration target of 80+ oz daily
Smaller, protein-forward meals (target 0.6–0.8 g/lb)
PRN ondansetron 4 mg for nausea, short-term
Extend the current step by 4 weeks before stepping down
Reinforce that GI symptoms typically resolve within 2 weeks of dose stability

Notes for compounded GLP-1 programs

Compounded semaglutide and tirzepatide from licensed 503A and 503B pharmacies use the same mg-per-week schedule. Vial concentration drives the volume per injection, not the clinical curve.

Verify mg/mL on every COA before publishing patient instructions
Document the prescribed weekly mg, not the volume, in the chart
Use B12 or other approved excipients only when clinically indicated and disclosed
Refrigerate per pharmacy labeling and confirm beyond-use date

Frequently asked questions

What is the standard semaglutide titration schedule?: Most clinical protocols start at 0.25 mg weekly for 4 weeks, then step up every 4 weeks: 0.5 mg, 1.0 mg, 1.7 mg, and 2.4 mg as tolerated. Hold or extend a step if GI symptoms are not tolerated.
What is the standard tirzepatide titration schedule?: Tirzepatide typically starts at 2.5 mg weekly for 4 weeks, then advances every 4 weeks through 5 mg, 7.5 mg, 10 mg, 12.5 mg, and 15 mg as tolerated, with dose holds for GI tolerability.
How should providers handle GI side effects?: Stay at the current dose for an additional 4 weeks, reinforce hydration, smaller meals, and protein-forward intake. Antiemetics like ondansetron can be used short-term. Down-titrate one step if symptoms persist.
When should a dose be held or reduced?: Hold or reduce for severe nausea or vomiting, suspected pancreatitis, gallbladder symptoms, dehydration, planned surgery with anesthesia, or pregnancy. Reassess before resuming.
Are these schedules different for 503A and 503B compounded GLP-1s?: The titration logic is the same. Concentration and vial sizing differ by pharmacy. Compounded 503A vials are typically patient-specific; 503B office-use vials follow the same mg-per-week curve.
How do you transition patients between semaglutide and tirzepatide?: Discontinue the first agent, wait one dosing interval, then start the new agent at its lowest titration dose. Do not dose-match across agents.
What exactly does Direct Peptide Sales do?: We are a referral and introduction service. We verify your business and the states it serves, then introduce you to licensed telehealth prescribers and 503A or 503B pharmacies. You contract directly with them. We do not sell, price, prescribe, compound, bill, or ship any product.
How fast can my practice be introduced to a source?: Most qualified practices receive an introduction within one business day of applying. How quickly you go live after that depends on the agreement you sign with the prescriber and pharmacy you choose.
What does it cost?: Nothing to apply, and we do not charge practices a fee. Product pricing, account terms, and any minimums are set by the pharmacy or prescriber you contract with, not by us.
Where do the peptides come from and are they verified?: Product comes from the licensed US 503A and 503B pharmacies you contract with. We only introduce sources that issue independent per-lot Certificates of Analysis covering identity, purity, sterility, and endotoxin. You can review sample COAs on this site before you apply.
Who handles prescribing, billing, and shipping?: The licensed prescriber and the pharmacy do. Prescribing is the provider's independent clinical decision, and dispensing, billing, and shipping sit with the pharmacy. We are not part of that transaction.
What if I'm not a licensed clinic?: Non-licensed wellness businesses such as coaches, gyms, studios, and nutrition practices can be introduced to a licensed telehealth prescriber who owns the clinical relationship. You never prescribe, hold, or dispense product.
How do you vet the sources you introduce?: Every source must be a named 503A pharmacy or FDA-registered 503B outsourcing facility, hold non-resident licensure in the states it ships into, issue per-lot Certificates of Analysis, and use prescribers licensed in the patient's state. We decline sources using research-use-only language.
Which states do you serve?: We make introductions across the United States and match you to partners that hold the right licensure for the states you serve.

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