Encyclopedia entry
GLP-1 starting dose
Every licensed UK GLP-1 medication starts at a low introductory dose and titrates upward at monthly intervals to maintenance. The introductory phase is to allow the gastrointestinal system to adapt and reduce the incidence of nausea and vomiting. The titration ladder is set in the SPC for each medication and is not optional or skippable.
Standard titration ladders
- Mounjaro (tirzepatide): 2.5 mg weekly for 4 weeks, then 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg. Maintenance dose is whatever step delivers tolerable side effects and adequate clinical effect.
- Wegovy (semaglutide): 0.25 mg weekly for 4 weeks, then 0.5 mg, 1 mg, 1.7 mg, 2.4 mg. Maintenance is typically 1.7 mg or 2.4 mg.
- Saxenda (liraglutide): 0.6 mg daily for 7 days, then 1.2 mg, 1.8 mg, 2.4 mg, 3 mg over 4 weeks. Maintenance is 3 mg daily.
Why titration is non-negotiable
The gastrointestinal effects of GLP-1 (delayed gastric emptying, reduced appetite signalling) are dose-dependent. Starting at maintenance dose typically causes severe nausea, vomiting, and intolerance. Skipping titration steps is a common reason for treatment dropout. Every UK SPC instructs the prescriber and pharmacist not to dispense a step above the patient\'s current titration position.
What happens if the patient does not tolerate the next step
The prescriber pauses titration. Options: hold at the current dose for an extra month before re-trying the next step, hold at the current dose as the maintenance, or step back if symptoms emerged after dose-up. The SPC explicitly allows extended titration where needed and does not require reaching the maximum dose.
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