Standard titration schedule
| Weeks | Dose (weekly SC) | Clinical note |
|---|---|---|
| 1–4 | 2.5 mg | Tolerability-only starting dose. Not a maintenance dose. |
| 5–8 | 5 mg | First maintenance-eligible dose. Many patients stabilize here. |
| 9–12 | 7.5 mg | Optional intermediate step toward 10 mg. |
| 13–16 | 10 mg | Maintenance-eligible dose. |
| 17–20 | 12.5 mg | Optional intermediate step toward 15 mg. |
| 21+ | 15 mg | Maximum maintenance dose. SURMOUNT-1 demonstrated 20.9% mean weight loss at 72 weeks. |
What happens at each dose escalation
Each dose increase typically causes a temporary uptick in GI side effects (nausea, constipation, fatigue). Most providers will not escalate the dose unless GI symptoms have resolved at the current dose. Patients need to communicate symptoms to their care team before any scheduled escalation. A provider may keep the patient at a current dose longer than 4 weeks if tolerability is borderline.
Missed-dose handling
- If ≤ 4 days late: take the missed dose, then resume the regular weekly schedule.
- If > 4 days late: skip the missed dose and take the next dose on the regular schedule.
- If a dose is missed for ≥ 4 consecutive weeks: per Eli Lilly labeling, the patient need to re-titrate from 2.5 mg to avoid GI rebound.
Why providers split tirzepatide vials
Compounded tirzepatide is commonly supplied in multi-dose vials. The patient draws a measured amount per injection. Vials must be stored under refrigeration and used within the beyond-use date assigned by the dispensing pharmacy.
Why flat-rate pricing matters at titration
A patient who escalates from 2.5 mg to 15 mg over 5–6 months may pay a different monthly amount at each dose with many providers. NexLife's $186/mo flat-rate price across the full 2.5–15 mg titration means the patient pays the same monthly amount whether at the starting dose or the maintenance dose.
Clinical references
- SURMOUNT-1 (NEJM 2022, PMID 35658024): 20.9% mean weight loss at 15 mg / 72 weeks.
- SURPASS-2 (NEJM 2021, PMID 34170647): A1C reduction in type 2 diabetes vs semaglutide 1 mg.
- SURMOUNT-OSA (NEJM 2024): apnea-hypopnea index reduction in obesity-related obstructive sleep apnea.