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Tirzepatide vs Semaglutide: Dosage Comparison for Weight Loss
- Dr Titilayo Akinsola
- Oct 2, 2025
- 5 min read
If you’re considering medication-assisted weight loss, two of the most discussed options are semaglutide (GLP-1 agonist) and tirzepatide (GIP + GLP-1 dual agonist). Each has its own dose-titration schedule, efficacy data, side effect profile, and patient suitability. Understanding how the dosage differs between them is key to making informed choices.
What They Are & Why Dose Matters
Semaglutide works by mimicking GLP-1, which slows gastric emptying, increases satiety, and improves glucose metabolism.
Tirzepatide adds activation of the GIP receptor as well, which in trials has shown greater effects on weight loss and metabolic improvements, but also demands careful dosing to manage side effects.
Dose matters because higher doses tend to give larger weight‐loss effect — but also carry more risk of gastrointestinal adverse effects (nausea, etc.), and possibly higher cost or burden. The titration schedule (how fast you increase) also affects tolerability.
Typical Dosing for Weight Loss: Semaglutide
Here is the commonly used titration schedule (drawn from clinical trials and labels) for semaglutide when used for obesity/weight loss (non-diabetic or diabetic patients as appropriate):
Phase | Weekly Dose | Duration | Notes |
Starting / Tolerability | 0.25 mg once weekly | ~4 weeks | Used to help the body adjust; side effects (especially GI) more common if you start high. |
Next step | 0.5 mg weekly | ~4 weeks more | Still in acclimation phase. |
Mid-phase | 1.0 mg weekly | Next ~4 weeks | Weight loss starts to become more evident. |
Escalation | 1.7 mg weekly | Weeks roughly 13-16 | For more effect in patients tolerating earlier doses. |
Maintenance / Full therapeutic dose | 2.4 mg weekly | From ~week 17 onward | This is often considered full dose for many who want maximum benefit with acceptable tolerability. |
Typical Dosing for Weight Loss: Tirzepatide
Here’s the standard titration schedule in studies and under approved guidance for tirzepatide (brand names include Mounjaro, Zepbound) for weight loss or obesity (with or without diabetes):
Phase | Weekly Dose | Duration | Notes |
Starting dose | 2.5 mg once weekly | ~4 weeks | Tolerance induction; not fully therapeutic yet. |
First escalation | 5 mg once weekly | Next ~4 weeks | More effect begins, appetite suppression better. (Drugs.com) |
Intermediate doses | 7.5 mg → 10 mg weekly | Further ~4 week steps each (i.e. 4 weeks at 7.5 mg then up) | Used in many trials; good efficacy increases. |
Higher doses / maximum | Up to 15 mg weekly | As tolerated; usually after several titration steps | Maximum approved dose in most trials; best efficacy but more side effect risk. (Drugs.com) |
Comparative Dosing & Efficacy: What Studies Show
A network meta-analysis in non-diabetic adults with obesity found that tirzepatide shows greater dose-dependent efficacy:
Tirzepatide 15 mg or its maximum tolerated dose (MTD) led to weight losses around -18% to -20.9% vs placebo, while semaglutide at 2.4 mg or its MTD showed somewhat less, though still significant effect (~ -11-14%). (PubMed)
In individuals with type 2 diabetes, in the SURPASS-2 trial, tirzepatide at several doses (5, 10, 15 mg) produced more weight loss than semaglutide 1 mg weekly, on average. For example, tirzepatide 15 mg gave ~ -11.4 kg vs semaglutide ~ -5.9 kg over 40 weeks. (Drugs.com)
Real-world data (large matched cohorts) show that patients on tirzepatide are more likely than those on semaglutide to achieve ≥ 5%, ≥ 10%, or ≥ 15% weight loss at 3, 6, and 12 months. (PubMed)
Side Effects, Rate of Increase, and Tolerability
Both drugs have similar types of adverse events (nausea, vomiting, diarrhea, occasional hypoglycemia especially in diabetic patients on other medications).
The higher the dose, the greater the risk (especially GI symptoms).
Slower titration allows better tolerability. If patients cannot tolerate the usual schedule (e.g. nausea too intense), providers may pause or maintain at a lower dose for longer.
Patient factors (body weight, comorbidities, kidney function, prior tolerance to GLP-1s) matter in deciding how fast to go up.
Practical Considerations: Which Dose Might Be Right for You
When choosing between semaglutide vs tirzepatide (and what dose), here's what to think about:
Desired amount of weight loss: If your goal is modest (5-10%), lower/mid doses may suffice. If aiming for large changes (>15-20%), then higher doses of tirzepatide may offer more.
Medical profile & comorbidities: Diabetes control, kidney/liver health, risk of side effects.
Cost, insurance, and accessibility: Higher doses often cost more; some insurances may limit coverage.
Tolerance and patience: How well do you tolerate GI symptoms, how important is slow vs fast progress.
Support system & mental health: Weight loss meds basically assist, but diet, behavioral & mental health support make a big difference in keeping weight off and managing mental/emotional effects.
How Favor Mental Health in Bel Air, MD Guides Patients
At Favor Mental Health, our approach ensures you get the best dose for you, not just “what the studies use.” Here is how we do that:
Baseline evaluation including medical history (diabetes, kidney, liver), baseline weight, previous experience with similar medications, mental health status (anxiety, mood, eating behavior).
Titration plan customized: we may follow standard schedules, but adjust speed based on your response and side effects.
Monitoring: frequent check-ins especially in early weeks to assess side effects, mood, appetite, energy.
Integrated care: supporting diet, physical activity, sleep, stress, all of which amplify benefits and help reduce side effects.
Patient education: what to expect, what is realistic weight loss, time frames (often months), and reevaluation of goals as treatment proceeds.
Summary Table: Semaglutide vs Tirzepatide Dosing Comparison
Feature | Semaglutide | Tirzepatide |
Starting Dose (Weight Loss) | ~0.25 mg/week | ~2.5 mg/week |
Mid-Range Effective Doses | ~1.0-1.7 mg/week | ~5-10 mg/week |
Maximum / High-Efficacy Doses | 2.4 mg/week | ~15 mg/week |
Typical Time to Maintenance | ~16-20 weeks (escalation) | ~16-20+ weeks (with multiple steps) |
% Body Weight Loss at Higher Doses (non-diabetic / obesity trials) | ~11-14% for higher semaglutide doses vs placebo | ~18-20% or more at high tirzepatide doses vs placebo (with tolerability caveats) |
Caveats & Warnings
These medications are prescription only; never self-dose.
Individual response varies: what works “on average” might underperform or overperform in your case.
Side effects can be limiting; be ready to adjust.
Long-term outcomes, especially for very high dose regimens, continue to be studied.
Mental health effects: body image, eating behavior, mood changes need to be watched for, especially with higher weight loss.
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