Zepbound is tirzepatide, made by Eli Lilly, injected under the skin once a week. It goes up in 2.5 mg increments, and you hold each dose for a minimum of four weeks before considering the next one. The ceiling is 15 mg.
The thing worth understanding before the table: the label does not tell you to reach 15 mg. It tells you to increase until you arrive at a maintenance dose that suits you — and three separate doses count as maintenance. Fifteen is where the ladder stops, not where you are expected to stand.
The steps
| Dose | Earliest week | What it is |
|---|---|---|
| 2.5 mg | 1 | A run-up, not a treatment dose. Its only job is letting your gut adjust, and you move on after four weeks whether or not it troubled you. |
| 5 mg | 5 | The first dose doing real work — and already a maintenance dose you may keep indefinitely. |
| 7.5 mg | 9 | A staging post between the two lower maintenance doses. |
| 10 mg | 13 | Maintenance again. Also the floor if you were prescribed it for obstructive sleep apnea. |
| 12.5 mg | 17 | Another staging post. Not one of the labeled maintenance doses. |
| 15 mg | 21 | The ceiling for every indication. Nothing above this is authorized. |
Those week numbers assume you never pause. Pausing is allowed, and staying four more weeks on a dose that is treating you badly is a normal thing to do rather than a setback.
Which doses count as maintenance
- Weight reduction and holding it: whichever of 5, 10 or 15 mg weekly suits you.
- Obstructive sleep apnea: only the top two rungs, 10 or 15 mg weekly, qualify.
- The maximum, whatever you are treating: 15 mg weekly.
Choosing between them is meant to weigh how well you tolerate the drug against how well it is working. A dose you can live with that is doing the job is the right dose, and there is no clinical prize for finishing the ladder.
If you miss one
Zepbound gives you a wider window than some of its rivals: four days.
- Inside 96 hours of the dose you missed? Get it in when you are able, then carry on with your usual weekly rhythm.
- Past 96 hours? Leave it. Your next dose happens on its normal day.
- Either way, one dose. Nothing is made up the following week.
Changing your injection day
Permitted, with one constraint: leave at least three days — 72 hours — between the old dose and the new one. Beyond that the day is yours, as is the time of day, and food makes no difference.
Inject the belly, the thigh, or the upper arm from behind, and move around rather than using one patch of skin repeatedly.
When to stop climbing and speak to someone
- Abdominal pain that is severe, will not shift, and bores through to your back. Pancreatitis behaves like this. Stop and get assessed.
- Pain beneath the right ribs, fever, or yellowing of the eyes or skin. Gallbladder trouble is a recognized adverse reaction.
- Low blood sugar you can feel — most likely if insulin or a sulfonylurea is also in the picture. Those doses often need reducing when tirzepatide goes in.
- Dehydration after a long run of vomiting or diarrhea. Kidney injury has followed exactly this. Hold the next dose until you are rehydrated.
- Rash, hives, swelling, or difficulty breathing. Stop and get emergency help.
- Changes in your vision if you have diabetic retinopathy. Blood sugar improving quickly can make retinopathy temporarily worse; get an ophthalmology review.
Ruled out entirely: anyone with medullary thyroid carcinoma in their own history or their family's, and anyone with MEN 2. That is the boxed warning, and it is a contraindication rather than a caution.
Four things this page is not
- A conversion chart from Wegovy. No milligram-for-milligram equivalence is authorized. Switching means starting again at 2.5 mg.
- A guide to compounded tirzepatide. Compounded vials are not the approved product and are under no obligation to follow this ladder at all.
- A price list. Cash tiers move around; the drug page carries what we have currently verified.
- An interactions reference. Oral contraceptives, warfarin and insulin all deserve more room than a cheat sheet gives them.
Where to go next
- The Zepbound page — indications, trial results, side effects and what it costs today.
- Titration planner — your own ladder mapped week by week.
- Missed-dose guide — the decision tree across every weekly GLP-1, since the windows differ.
- Wegovy against Zepbound — what the trials actually support.
- Alcohol and GLP-1s — what the labels say about drinking, which is less than you would expect.