Maintenance Dose
Also known as: maintenance · steady-state dose
A maintenance dose is the regular ongoing dose that keeps a drug's level and effect steady once any titration or loading is complete.
The maintenance dose is the dose you stay on. In pharmacology, it is the dose that replaces what your body eliminates between doses, so that the average level holds steady once steady state is reached. That ties it directly to clearance: at steady state, the rate drug goes in equals the rate it is cleared.
Approved labels name maintenance doses explicitly. In the 2021 Wegovy (semaglutide) label, the maintenance dose is 2.4 mg once weekly, reached in week 17 after titration. If it is not tolerated, the label allows a temporary drop to 1.7 mg for up to 4 weeks before going back to 2.4 mg, and says to stop the drug if 2.4 mg still cannot be tolerated. For Zepbound (tirzepatide), the recommended maintenance doses are 5, 10, or 15 mg once weekly, chosen based on treatment response and tolerability.
Why it matters
The maintenance phase is where long-term results are decided. In the STEP 4 randomized trial, adults who reached semaglutide 2.4 mg during a 20-week run-in were either kept on it or switched to placebo for 48 more weeks. Body weight changed by −7.9% with continued semaglutide and by +6.9% after the switch to placebo. Stopping the maintenance dose reversed much of what had been gained.
Because the maintenance dose is what you take for most of a protocol, it is the dose to compare across protocols and the one your steady-state labs reflect. Labs drawn during titration reflect lower, still-rising drug levels and are not a fair picture of the protocol you will actually be running. If you change the maintenance dose, give the new dose several half-lives before judging it, because the drug level takes that long to settle.
How to calculate it
- Decide the average steady-state concentration you are aiming for.
- Find the drug's clearance. Labels often report apparent clearance (CL/F), which already accounts for bioavailability.
- Multiply the clearance by the target concentration to get a dosing rate, then multiply by the dosing interval to get the dose.
Maintenance dose rate = clearance × target average steady-state concentration ÷ F (or apparent clearance CL/F × target concentration)
Run it backward with label numbers. Semaglutide 2.4 mg once weekly is 2.4 ÷ 168 h = 0.0143 mg/h. Dividing by the label's apparent clearance of about 0.05 L/h gives about 0.29 mg/L. With a molecular weight of 4113.58 g/mol, that is about 70 nmol/L, close to the label's reported average steady-state concentration of about 75 nmol/L.
Common mistakes
- Comparing protocols by their starting doses instead of their maintenance doses.
- Drawing "steady-state" labs during titration, before the maintenance dose has been taken for several half-lives.
- Assuming a lower dose works as well as the maintenance dose without evidence.
- Treating the maintenance dose as permanent instead of reviewing response and tolerability over time.
Sources
- Prescribing informationWEGOVY (semaglutide) injection, for subcutaneous use: Prescribing Information. U.S. Food and Drug Administration, 2021.
- Prescribing informationZEPBOUND (tirzepatide) injection, for subcutaneous use: Prescribing Information. U.S. Food and Drug Administration, 2023.
- Clinical trialEffect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial. JAMA, 2021. PMID 33755728.
Page updated . How we grade evidence: methodology.
Related Terms
Loading Phase
A loading phase is a period of larger initial dosing meant to reach a target drug level quickly, before switching to a smaller maintenance dose.
Titration
Titration is starting a drug at a low dose and raising it in planned steps, so your body can adjust and side effects stay manageable.
Steady State
Steady state is the point in repeated dosing where the drug eliminated each interval equals the drug taken in, so levels stop climbing.
On-Cycle
On-cycle is the phase of a cycle when you are actively taking a compound, as opposed to the planned break (off-cycle).
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