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GLP-1 Microdosing Schedule
Week-by-week dose tables for both semaglutide and tirzepatide microdosing protocols. Covers two main approaches — fixed micro-dose and ultra-slow titration — plus optimal injection timing to minimize side effects.
Clinical note: Microdosing schedules should be managed with a licensed prescriber, not self-administered from a guide. The tables below are educational references — all dose changes require physician oversight.
Two Main Microdosing Protocols
GLP-1 microdosing broadly refers to any approach that uses lower-than-standard doses or extends the time at each dose step significantly beyond the manufacturer’s titration schedule. Two distinct protocols exist:
Fixed Micro-Dose (Maintenance)
The patient takes the same sub-therapeutic dose every week indefinitely — either for tolerance building, maintenance after reaching goal weight, or gradual appetite suppression without full-dose side effects.
- Good for: post-goal weight maintenance
- Good for: GI-sensitive patients testing tolerance
- Not typical for primary weight loss
Ultra-Slow Titration
The same sequence of dose steps as the standard titration, but each step is held for 8–12 weeks instead of 4 weeks — or the sequence starts below the lowest approved dose. The endpoint is reaching therapeutic dose with far fewer side effects en route.
- Good for: first-time GLP-1 users who are GI-sensitive
- Good for: older patients or those on multiple medications
- Still reaches therapeutic dose — just slower
Semaglutide Microdosing Schedule
Standard Wegovy titration: 0.25mg → 0.5mg → 1.0mg → 1.7mg → 2.4mg, advancing every 4 weeks. Microdosing stretches each step to 8–12 weeks, or starts below 0.25mg for highly sensitive patients. Both sequences use weekly injections.
| Weekly Dose | Standard Hold | Microdose Hold | Notes |
|---|---|---|---|
| 0.25mg | 4 weeks | 8–12 weeks | Starting dose; lowest approved. Some start at 0.1–0.15mg for extreme sensitivity. |
| 0.5mg | 4 weeks | 8–12 weeks | First step up. GI symptoms often peak at this transition. |
| 1.0mg | 4 weeks | 8–12 weeks | Meaningful appetite suppression for most patients at this dose. |
| 1.7mg | 4 weeks | 8–12 weeks | Pre-maintenance step. Some patients stop here — verify with prescriber. |
| 2.4mg | Maintenance | Maintenance or stay at lower dose if effective | Full therapeutic maintenance dose (Wegovy). Highest weight-loss efficacy in STEP trials. |
Tirzepatide Microdosing Schedule
Standard Mounjaro/Zepbound titration: 2.5mg → 5mg → 7.5mg → 10mg → 12.5mg → 15mg, advancing every 4 weeks. Microdosing typically starts at 0.5–1.25mg — well below the lowest approved dose — and holds each step 8–12 weeks. Uses compounded tirzepatide to enable sub-2.5mg dosing not available in branded auto-injectors.
| Weekly Dose | Standard Hold | Microdose Hold | Notes |
|---|---|---|---|
| 0.5mg | Sub-approved (compounded only) | 4–8 weeks | True micro-start. Requires compounded tirzepatide — not available in branded pens. |
| 1.25mg | Sub-approved (compounded only) | 4–8 weeks | Intermediate step below standard. Good for GI-sensitive patients. |
| 2.5mg | 4 weeks | 8–12 weeks | Lowest approved dose (Mounjaro). Extend hold to acclimate GI system. |
| 5mg | 4 weeks | 8–12 weeks | First therapeutic step. Many patients find substantial appetite suppression here. |
| 7.5mg+ | 4 weeks per step | 8–12 weeks per step | Continue titration as tolerated toward therapeutic target (typically 10–15mg). |
Day-of-Week Timing and Side Effect Windows
Consistency rules
Inject on the same day every week. The exact day doesn’t matter — what matters is maintaining consistent weekly intervals so your body’s exposure to the drug remains steady.
Common choices: Sunday evening (side effects peak before the work week starts) or Friday evening (side effects fall over the weekend when schedule is more flexible). Pick what fits your routine.
If you miss a dose by 1–2 days, inject as soon as you remember and shift your weekly day accordingly. If it’s nearly time for the next dose, skip the missed one — do not double-dose. Confirm missed-dose protocol with your prescriber.
Side effect timing
Pattern is consistent across semaglutide and tirzepatide. Individual variation is significant — some patients have zero nausea; others peak at 6–8h post-dose.
Bedtime injection strategy
Injecting at bedtime means the 4–12 hour peak nausea window occurs while you’re asleep. Many patients find this significantly reduces perceived nausea — you sleep through the worst of it. This is not evidence-based guidance, but is a widely reported patient strategy.
When to Pause Your Dose
Do not push through severe symptoms. The following are indications to hold your next injection and contact your prescriber before resuming:
Vomiting lasting more than 24 hours
Unable to keep any food or fluids down for 24+ hours
Severe abdominal pain (possible pancreatitis — contact prescriber immediately)
Symptoms worsening significantly at a dose you previously tolerated
Signs of dehydration: dizziness, dark urine, rapid heart rate
Consistent nausea across more than 3 consecutive injections with no improvement
Who Benefits Most from a Microdosing Schedule
GI-sensitive patients
Patients who experienced significant nausea, vomiting, or diarrhea on a standard titration schedule. Slower dose steps give the GI system more time to adapt to GLP-1-mediated gastric emptying changes.
Older patients (65+)
Older adults may metabolize GLP-1 peptides differently and are more likely to be on medications with overlapping GI effects. A slower titration reduces the risk of overlapping adverse effects.
Patients on multiple medications
GLP-1 drugs slow gastric emptying, which affects the absorption of other oral medications. A slower titration allows time to observe and adjust for any drug-absorption changes before reaching full dose.
First-time GLP-1 users
Patients who have never taken a GLP-1 have no baseline for their individual tolerance. Starting below standard dose and holding longer reduces the risk of an early bad experience that leads to discontinuation.
Providers That Support Flexible Dosing
Not all compounded GLP-1 telehealth providers will prescribe sub-approved doses or extended holds. The three providers below are most likely to accommodate individualized microdosing protocols.
Ivim Health
SpecialistMicrodosing-first approach
Ivim Health specifically positions individualized dosing protocols as a core offering — not an afterthought. They are designed for patients who want flexible titration, including starting at sub-approved doses with compounded tirzepatide.
- Individualized dose protocols — core offering
- Sub-approved starting doses available
- Pricing — VERIFY directly
TMates
Verified May 6, 2026$158/mo confirmed — ask about microdosing
TMates has confirmed pricing at ~$158/mo for compounded semaglutide and supports flexible dosing. Ask specifically about microdosing or extended-titration options during intake.
- ~$158/mo confirmed (semaglutide)
- Flexible dosing supported
- Tirzepatide pricing — VERIFY
MEDVi
Verified May 6, 2026$179–$299/mo confirmed — flexible programs
MEDVi offers Gronk-verified pricing for both semaglutide ($179–$249/mo) and tirzepatide ($229–$299/mo). Flexible programs — ask about microdosing protocol options during their intake.
- Semaglutide $179–$249/mo (verified)
- Tirzepatide $229–$299/mo (verified)
- Flexible programs available
Frequently Asked Questions
What is a GLP-1 microdosing schedule?
A GLP-1 microdosing schedule is a structured plan for taking sub-standard or below-approved doses of semaglutide or tirzepatide on a weekly basis. It differs from the standard FDA titration schedule by either starting below the lowest approved dose or staying at each dose level significantly longer — 8–12 weeks per step instead of the standard 4 weeks. The goal is to allow slower GI adaptation, reduce nausea and other side effects, and find a maintenance dose that manages weight effectively with tolerable side effects. The schedule is always managed under physician supervision.
How long should you stay at each microdose before going up?
In a standard titration, each dose step is typically 4 weeks. In a microdosing or extended-titration protocol, each step is stretched to 8–12 weeks — sometimes longer for patients who are highly GI-sensitive. There is no fixed minimum or maximum — the decision to advance depends on whether you are experiencing tolerable side effects at the current dose, whether you are seeing the desired clinical effect, and your prescriber's judgment. Do not advance to the next dose step independently; all titration decisions should be made with your prescribing physician.
What is the difference between a semaglutide and tirzepatide microdosing schedule?
The main differences are the starting dose and step increments. For semaglutide, the standard titration begins at 0.25mg/week; microdosing may start at the same dose but hold longer, or start below 0.25mg for extreme sensitivity. The semaglutide maintenance dose is typically 1.7mg or 2.4mg weekly. For tirzepatide, the standard titration begins at 2.5mg/week (Mounjaro protocol); microdosing often starts at 0.5mg or 1.25mg — below the standard starting dose — and holds each step for 8–12 weeks before advancing. Tirzepatide's dual GIP/GLP-1 mechanism can cause different side-effect patterns than semaglutide, and some patients find tirzepatide better tolerated even at therapeutic doses.
Do you get weight loss results at microdoses?
Some patients report meaningful weight loss at sub-therapeutic doses, particularly when they are highly sensitive to GLP-1 effects. However, the largest weight-loss results in clinical trials were achieved at full therapeutic doses (2.4mg semaglutide weekly in STEP trials; 10–15mg tirzepatide weekly in SURMOUNT trials). Sub-therapeutic doses may produce partial suppression of appetite and modest weight loss, but achieving the 15–20% body weight reduction seen in trials typically requires reaching therapeutic dose levels. Patients who microdose for maintenance — after reaching goal weight at therapeutic dose — often report effective weight stability at lower doses.
Can you stay on a microdose forever for maintenance?
Some patients do use low-dose GLP-1 indefinitely for weight maintenance after reaching their goal weight at a higher dose. SURMOUNT-4 data for tirzepatide and STEP-4 for semaglutide both show that stopping GLP-1 treatment leads to significant weight regain — the medication addresses the appetite dysregulation rather than curing it. A low maintenance dose (e.g., 2.5mg tirzepatide or 0.5mg semaglutide weekly) may be appropriate for long-term weight maintenance, but this is an individualized clinical decision made with your physician based on your metabolic response, tolerability, and goals.
How do you track progress on a microdosing schedule?
Track progress on a microdosing schedule by recording: weekly body weight at the same time and conditions (morning, after bathroom, before eating), injection date and dose each week, side effects experienced in the first 24–48 hours post-injection, and any noticeable changes in appetite or food intake patterns. Review with your prescriber every 4–8 weeks, or sooner if you experience significant adverse effects. Monthly waist circumference measurements are a useful supplement to weight since GLP-1 therapy often shifts body composition even when scale weight moves slowly.