Titration

Also known as: dose escalation · dose ramping

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.

Titration (dose escalation) means you do not start at the target dose. You begin low, hold each step for a set period, and move up only if the current step is tolerated. The end point is the maintenance dose, the dose you stay on. For approved drugs, the step sizes and step lengths come from the label, which reflects how the drug was studied in its trials.

GLP-1 drugs are the clearest approved examples. The Wegovy (semaglutide) label, as first approved in 2021, starts at 0.25 mg once weekly for weeks 1–4, then 0.5 mg for weeks 5–8, 1 mg for weeks 9–12, 1.7 mg for weeks 13–16, and 2.4 mg from week 17 onward as the maintenance dose. The Zepbound (tirzepatide) label starts at 2.5 mg once weekly, a dose it describes as for starting treatment and not for chronic weight management, increases to 5 mg after 4 weeks, and then allows increases in 2.5 mg steps after at least 4 weeks on the current dose, up to a maintenance dose of 5, 10, or 15 mg.

Why it matters

The main reason is gastrointestinal tolerability. The Wegovy label says to follow the escalation schedule to minimize gastrointestinal adverse reactions, and if a step is not tolerated, to consider delaying the next increase by 4 weeks. In the 72-week tirzepatide obesity trial, the most common adverse events were gastrointestinal and occurred primarily during dose escalation.

Titration also matters after a gap. The Wegovy label notes that if more than 2 consecutive doses are missed, restarting with the escalation schedule may reduce the gastrointestinal symptoms that come with restarting. For research peptides without a label, there is usually no tested escalation schedule at all, so any schedule you see is a convention rather than a trial result.

How to read a titration schedule

Identify the starting dose, the step size, the time on each step, and the maintenance dose.
Note the rule for moving up, usually a minimum time on the current step plus acceptable tolerance.
Note the rule for not moving up: the label may say to delay an increase or to step back down temporarily.
Track symptoms at each step so you can tell which dose they started on.

Worked example

On the Wegovy schedule, weeks 1–16 are four 4-week steps (0.25, 0.5, 1, and 1.7 mg), so 4 × 4 = 16 weeks pass before the 2.4 mg maintenance dose starts in week 17. On the Zepbound schedule, getting from 2.5 mg to 15 mg takes five increases (5, 7.5, 10, 12.5, 15 mg), each after at least 4 weeks, so at least 5 × 4 = 20 weeks, which matches the 20-week dose-escalation period used in the tirzepatide obesity trial.

Common mistakes

Starting at the maintenance dose to "save time", which is exactly what the label schedules are designed to avoid.
Moving up a step before the minimum time on the current dose has passed.
Escalating through ongoing side effects instead of holding or delaying the step as the label allows.
Restarting at the old dose after a long gap instead of going back through the schedule.
Borrowing a GLP-1 titration schedule for an unrelated research peptide as if it applied.

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 trialTirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med, 2022. PMID 35658024.

Page updated October 3, 2026. 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.

Maintenance 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.

Receptor Desensitization

Receptor desensitization is the drop in a cell's response to a drug or hormone after repeated or continuous stimulation of its receptor.

Cmax

Cmax is the highest concentration a drug reaches in your blood after a dose; Tmax is how long after the dose that peak occurs.

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