How does dosing and dose increases work for GLP-1s?

GLP-1 therapy starts at a low dose and increases gradually. This is called a dose increase schedule. Going "low and slow" helps your body adapt, reduces side effects like nausea, and improves long-term results. Your provider sets a schedule, typically increasing your dose every 4 or more weeks until you reach your target.

Weight loss expectations should be managed carefully, as early results may be gradual or inconsistent. It often takes several months for significant progress to become evident, and patience is key during the initial phases of treatment.

How dose increases work

You'll start at an introductory dose for at least 4 weeks. If you're tolerating it well, your dose increases at your next shipment. This continues until you reach a dose that is working for you.

Following this schedule ensures your body adjusts properly and supports effective weight loss.

• Semaglutide: 0.25 mg, 0.5 mg, 1 mg, 1.75 mg, 2.5 mg
• Tirzepatide: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg Each increase should be made under the guidance of your healthcare provider to ensure safety and effectiveness.

Important: When transitioning to higher doses using Tirzepatide, please note that the vial concentration may change, meaning the medication more concentrated. Always follow the updated dosing instructions provided with your medication to ensure proper administration. Always confirm the vial concentration before injecting to ensure accuracy.

Your starting dose and the step-up ladder

Your provider chooses your starting dose at intake, and every step up after that happens one step at a time. Starting low gives your body time to adjust and keeps side effects manageable. It is not a sign the dose is "too low" to work. These medications build up in your system gradually, so many people feel very little after the first injection or two.

• Each tirzepatide step is 2.5 mg, and each step lasts at least 4 weeks. After 10 mg the next step is 12.5 mg, and after 12.5 mg the next step is 15 mg. On semaglutide, the next step after 0.5 mg is 1 mg.
• Previous GLP-1 use: if you have taken a GLP-1 medication before, your provider may start you above the lowest step, based on your history and how recently you last took it. Message your care team rather than choosing a higher start yourself.
• Tirzepatide and semaglutide numbers are not interchangeable. For example, 15 mg is the top tirzepatide dose and would be far too high for semaglutide.

You cannot skip steps. Going from 7.5 mg straight to 15 mg, or from 10 mg straight to 15 mg, would very likely cause significant side effects. If you want to move faster than the ladder, message your care team instead of changing your dose yourself.

Your injection is once a week. Take the next one 7 days later, on the same day and at about the same time. For example, if your first injection is Sunday at 5 pm, your second is the following Sunday at 5 pm.

Units depend on your vial's concentration. The same dose in mg can be a different number of units on a different vial, and this changes between shipments. As examples only, on a 20 mg/mL tirzepatide vial, 7.5 mg is 38 units, 10 mg is 50 units, 12.5 mg is 62 units, and 15 mg is 75 units. Always use the units printed in your Directions, and see "How to find your dose and how many units to inject."

Maximum doses

On Belle's plan, the top tirzepatide dose is 15 mg a week, and the top semaglutide dose is 2.5 mg a week. Once you reach your top dose, that becomes your maintenance dose. There is no further step up from there, and going above it is not something to do on your own.

• 15 mg of semaglutide is not a real dose. That number belongs to tirzepatide.
• Going above the maximum can cause unwanted side effects. Any question about going beyond the top dose is a decision for your provider, who reviews your full history.

If you are at your top dose and progress has stalled, a higher dose is not the next move. Things to look at first:

• Your calorie intake, protein, fiber, and water
• Rotating your injection sites (for example, abdomen to thigh or arm)
• Splitting your weekly dose into two injections 3 to 4 days apart (see "Can I Split My Weekly Injection Into Smaller Doses?")
• If you are on semaglutide at the top dose, asking your care team whether tirzepatide is a good next step

Message your care team if you want your provider to review your history and talk through other options.

Your dose plan is set at intake

Following the prescribed dose plan is essential for achieving optimal weight loss results. Sticking to the schedule ensures your body adapts effectively and maximizes the medication's benefits. Reached your goal weight? See "Reaching your goal weight: how maintenance works at Belle" for what comes next.

During intake, you'll be asked about your dosing preference. Your answer places you into one of two plans:

• Increasing plan: your dose goes up every 4 or more weeks as tolerated, following a standard increasing dose schedule. This applies if you selected "Increase dose" on your intake form.
• Maintenance plan: your dose stays consistent each week, based on the dose you confirmed during intake. This applies if you selected "Stay at same dose" on your intake form. *If you selected "Increase dose" during your online visit, you're on the Increasing Plan. Your dose will automatically increase with each shipment following the standard increasing dose schedule. No additional action is needed on your end. Your auto-renew will process at the next dose level automatically.* This "maintenance plan" only means your dose does not step up. It is different from maintenance after you reach your goal weight, which is covered in "Reaching your goal weight: how maintenance works at Belle".

To switch plans after intake, contact the care team and they'll take care of it.

What "maintenance dose" means

A maintenance dose is the dose you stay on once it is working well for you. It describes staying steady, not how high or low the dose is. It can be any dose on the ladder, including the maximum. For many people it is the lowest dose that keeps their weight stable.

• Weight loss does not automatically stop. The medication still works every week. A steady dose simply means you are no longer stepping up.
• How it is found: after about 4 weeks at your goal weight, your dose can be adjusted downward, or the time between injections can be extended, until you find the amount that keeps your weight steady without active loss. This varies from person to person.
• Maintenance can still give subtle appetite and anti-inflammatory effects while keeping your weight stable.
• Microdose plans are set up differently. They start at a low dose for adjustment, then move to a set maintenance dose (for example, 2 mg then 3 mg). Your provider writes that plan, and it can be modified if the lower dose is working well. See "What is microdosing a GLP-1?"

If you are on a maintenance dose you did not ask for, or it does not feel right, message your care team so your provider can review it.

How to request a dose increase

To request a dose increase, send us a note in Messages with your current dose. We'll route it to your provider to review with your next order. Patients stay at a dose for 4 weeks minimum, and dose increases are subject to provider approval.

Do I have to step up? Staying, going slower, and stepping back

A step-up date on your plan is the earliest point you can move up. It is not a deadline. The goal is the lowest dose that works for you with side effects you can manage. If your current dose is working, you can stay on it, and you can let your care team know so your next shipments match.

When stepping up usually makes sense:

• Your weight loss has stalled for several weeks
• Side effects from your current dose have settled
• Cravings or food noise that were under control are coming back

Your provider reviews your history and timing before approving any increase. A few weeks at a new dose, or one or two injections, is too early to judge how well it works.

If you are having side effects around a step up:

• Do not push ahead through ongoing nausea. Stay at your current dose longer, or step back to your previous dose, then try again once you feel steady.
• If you stepped up and had vomiting or reflux, going back to your previous dose is reasonable. When you try again, use a smaller step and stay at each level longer.
• Feeling very tired or nauseated the day after each injection is a sign to go slower, not faster.
• If you are worried about hair loss, do not step up. Focus on nutrition first (protein especially) and talk with your care team.
• Diarrhea and other stomach problems are more likely when your dose is too high. Lowering your dose may fix this before any thought of switching medications.
• If your appetite is already very low, you do not need to step up. If it is too low to eat well, ask about lowering your dose slightly.

Smaller steps are an option. If the standard step feels like too much, ask your care team for smaller steps between doses, such as 3 mg between 2.5 mg and 5 mg. Your care team will tell you the exact number of units to draw for your vial, because units depend on the concentration.

Even if you tolerated another GLP-1 well, staying about 4 weeks at each step lowers your risk of side effects. If you want a faster plan, message your care team to discuss it. People who used a GLP-1 before Belle may also need more time or a higher dose to see progress.

Your supply and dose changes

Your shipment is calculated based on the plan you selected at intake. Stick to that plan and your supply will cover the full period.

Dose increases are prescribed at a 4-week minimum. If you try to increase sooner than scheduled, your vial will run out before your next shipment. Supply is not automatically recalculated, so contact the care team right away if you need help planning ahead.

If you switch from a maintenance to an increasing plan mid-shipment, the same applies. Reach out before making any changes.

Supply, multi-month orders, and renewals

Different doses in different months are possible. A multi-month order can include one dose for the first month and the next dose for later months. For example, a provider can prescribe 12.5 mg for month 1 and 15 mg for months 2 and 3. Your first order on the standard plan includes enough medication for you to step up after your first month if you are tolerating the starting dose well. What ships always matches what your provider has approved.

Your next refill keeps your current dose unless your provider changes it. If your plan is a continuous step-up plan, your renewals step up on schedule. If you are on an increasing plan, an approved increase is included in your next refill, and you do not need to pause while waiting. Confirm your dose before each shipment if you are unsure.

If you stay at a lower dose than the plan, your supply will last longer and you will have medication left over. Keep an eye on the beyond-use date (BUD) on your vial so it does not go to waste, and tell your care team so your next order reflects what you actually take.

If you step up sooner or to a higher dose, a given vial lasts a shorter time. For example, on a microdosing plan a vial lasts proportionally fewer weeks at a higher dose. Supply is not recalculated automatically, so message your care team before your next shipment is due.

Does my prescription already allow increases? Your current prescription is written at your current dose. To move up, message your care team and they will update your treatment plan.

Your portal shows larger doses as "past prescriptions"? Follow the Directions on your vial, which are the most accurate. If the portal looks wrong, message your care team and they will check your chart.

Missed dose

For a single missed dose: if it's been 4 days or less, take it when you remember. If it's been more than 4 days, skip it and resume on your regular day. Never double up.

If you've been off the medication for a week or longer, see What if I miss my scheduled injection day? for the full restart guidance.

Feeling sick or having stomach symptoms around your injection day

With a cold or other mild illness, injecting is not unsafe. Many people choose to wait until they feel better so illness symptoms are not mixed up with medication side effects, especially in a week with a dose increase. Skipping one week is reasonable if you are unwell. When you resume, your care team may suggest a lower dose if you need extra tolerance.

With vomiting, diarrhea, or stomach cramping, hold your injection until your symptoms have fully resolved and you can eat and drink normally. If you feel well by your scheduled day, take it then. Watch for symptoms returning after you restart. If you are off the medication for a week or longer, restarting may mean a lower dose (see "What if I miss my scheduled injection day?").

If your symptoms were from something else and have gone away, and you feel back to normal, you can continue your injections at your current dose. Contact your care team if side effects return.

If you have ongoing mild side effects on your injection day, check the basics first: enough protein, enough water, eating regularly, and fewer processed foods. If symptoms continue, lowering your dose is an option. See "Do I have to step up?" above.

If your symptoms are severe, or you cannot keep fluids down, contact your care team right away.

When to hold your dose

Check in with your care team if you:

• Are experiencing significant illness with vomiting
• Are dealing with severe side effects