GLP-1 dosing is supposed to be the simple one. Inject once a week. Wait. Step up. Repeat. In practice, every titration I've seen run real-world has at least one stall: a week 4 that becomes week 6 because of nausea, a maintenance dose that gets bumped back down, a Sunday injection that slipped to Wednesday and broke the user's mental schedule.
Here's how the standard ladders actually work, what the manufacturer schedule says, and how to log it so your app doesn't lock you into a fiction.
Tirzepatide · the Mounjaro / Zepbound ladder
The FDA-approved label for tirzepatide is once weekly subcutaneous, with this titration:
- Week 1–4: 2.5 mg (initiation only · not therapeutic)
- Week 5–8: 5 mg
- Week 9–12: 7.5 mg
- Week 13–16: 10 mg
- Week 17–20: 12.5 mg
- Week 21+: 15 mg (maximum)
In reality, almost nobody runs this clean. The pattern is:
- 4 weeks on each step unless side effects say otherwise
- Hold longer at any step where weight loss is still active
- Skip the bump if you don't need the additional appetite suppression
The practical maintenance dose for most users is 5 mg or 7.5 mg for weight loss, 10 mg or 12.5 mg for users prioritizing metabolic effects (lipid panels, A1c) over appetite.
Semaglutide · the Wegovy / Ozempic ladder
Slower than tirz, with smaller steps:
- Week 1–4: 0.25 mg
- Week 5–8: 0.5 mg
- Week 9–12: 1.0 mg
- Week 13–16: 1.7 mg
- Week 17+: 2.4 mg (Wegovy max for weight loss)
Diabetics on Ozempic typically max at 1.0 or 2.0 mg. Cross-walking from Ozempic to Wegovy is the slow part · your ladder isn't 0.25 → 2.4 across the board; you start at your current dose and ladder up if you're going for the weight-loss indication.
Retatrutide · the experimental triple-agonist
Retatrutide isn't FDA-approved yet. Phase 3 data suggests it'll go to market at higher doses than tirzepatide. Trial protocols use:
- Week 1–4: 2 mg
- Week 5–8: 4 mg
- Week 9–12: 8 mg
- Week 13+: 12 mg
If you're running compounded reta from a research source, your ladder should look like a slowed-down trial protocol. Don't outrun the data. Side effects at the higher doses are real.
Maintenance · when to stop laddering
The question every GLP-1 user hits around week 12: do I keep going up?
The honest answer is: stop laddering when one of these is true.
- You've hit your target weight loss rate (0.5–1% body weight per week is the trial average, and faster than 1.5% is hard to sustain without muscle loss).
- Side effects are interfering with adherence. Constipation, sulfur burps, fatigue at higher doses. Better to maintain at 5 mg with 100% adherence than ladder to 10 mg and skip doses.
- You're at maintenance. Some users hold at 5 mg or 7.5 mg for months and slowly drop weight without ever maxing the ladder.
Coming off is its own thing. Tapering matters · abrupt cessation triggers fast appetite return and well-documented regain. Most clinical guidance now recommends a slow taper backward through the same ladder over 8–12 weeks if you discontinue.
How to log a ladder without your app lying to you
Most GLP-1 apps treat the ladder as a static schedule. Set it once, and the reminder fires every 7 days at the dose the schedule says.
The problem: real ladders stall. Week 4 becomes week 6 because of side effects. Week 8 becomes week 9 because Sunday became Wednesday for one shot.
Regimio handles this in three ways:
1. Protocol versioning. When you bump from 5 mg to 7.5 mg, the app inserts a new protocol row with the new dose and a superseded_by link from the old one. Your history shows: Week 1–4 at 2.5 mg → Week 5–8 at 5 mg → Week 9 to present at 7.5 mg. Your reminder schedule respects the current protocol; your history respects what actually happened.
2. Cadence anchoring. Inject your weekly dose late on Wednesday instead of Sunday? The next dose reminder shifts forward 7 days from Wednesday, not from the originally-scheduled Sunday. No more "you missed a dose" alerts when you simply pushed the schedule.
3. Side-effect logging independent of dose. The daily check-in chip strip lets you log nausea, GI, fatigue, libido, mood · at any time, not just at injection. So when you decide whether to step up, you have actual evidence, not a vague "last week was rough."
A real-world ladder
This is what a typical Regimio user's tirzepatide ladder looks like over 16 weeks:
| Week | Dose | Notes |
|---|---|---|
| 1 | 2.5 mg | Mild nausea day 2 |
| 2 | 2.5 mg | Nausea resolved |
| 3 | 2.5 mg | Steady |
| 4 | 2.5 mg | First weight drop noticed |
| 5 | 5.0 mg | Constipation +sulfur day 1–3 |
| 6 | 5.0 mg | Adapted |
| 7 | 5.0 mg | Strong appetite suppression |
| 8 | 5.0 mg | -8 lb total |
| 9 | 5.0 mg | Held · appetite still strong |
| 10 | 5.0 mg | Held |
| 11 | 7.5 mg | Step up · manageable |
| 12 | 7.5 mg | -12 lb total |
| 13 | 7.5 mg | Maintenance feels right |
| 14 | 7.5 mg | Steady |
| 15 | 7.5 mg | Steady |
| 16 | 7.5 mg | -15 lb · plateauing |
Real ladders look like this. Schedules that don't accommodate held weeks and shifted injection days break trust fast.
What we built into the GLP-1 logger
When you tap "Add GLP-1" in Regimio, you get three presets:
- Tirzepatide ladder (2.5 → 15)
- Semaglutide ladder (0.25 → 2.4)
- Maintenance (no titration · current dose, weekly)
You can edit any step. You can extend any week. You can pause the ladder and resume.
The next-dose countdown on your home screen always reads what the current protocol says, not what the original schedule said. Your weight pulls from Apple Health if you've enabled it, otherwise you log it manually on the same daily check-in.
That's it. Nothing fancy. The complexity is hidden behind a clean two-tap log.
Try it in the private beta. Or read more on reconstitution math · relevant for compounded GLP-1.