Every dose step, and what to do when you miss one

These schedules are not proprietary and they are not something a telehealth service invents. They are printed in the FDA-approved labelling, and the labels below are the current ones — Wegovy revised June 2026, Zepbound revised April 2026. If a provider’s plan does not match the ladder in its product’s own label, that is a question to ask before the first injection, not after.

Wegovy injection — the sixteen-week ladder

The starting dose is 0.25 mg once weekly, and the label is explicit that the escalation exists “to reduce the risk of gastrointestinal adverse reactions”. The same ladder applies to every approved indication.

Maintenance is not a single number. For weight reduction in adults the label gives “either 1.7 mg or 2.4 mg (recommended)”, and adds a route above it: for patients who tolerate 2.4 mg for at least four weeks and in whom additional weight reduction is clinically indicated, the dose “may be increased to a maximum dosage of 7.2 mg subcutaneously once weekly.” For cardiovascular risk reduction the maintenance dose is 2.4 mg (recommended) or 1.7 mg — the 7.2 mg option is not offered for that indication.

Wegovy tablets — the same molecule on a thirty-day clock

The oral form escalates by calendar days rather than weeks, and it is taken every day rather than once a week.

The tablet has to be taken on an empty stomach in the morning with no more than four ounces of water, swallowed whole rather than split, crushed or chewed, and followed by at least thirty minutes before any food, any other drink, or any other oral medicine. That window arrives every single day. Anyone who takes a morning thyroid tablet, or who cannot reliably postpone coffee, is choosing a harder regimen than the weekly injection, not an easier one. The full trade-off is here.

Zepbound — 2.5 mg increments, and a starting dose that is not a treatment dose

Lilly’s label states the recommended starting dosage for all indications is 2.5 mg once weekly for four weeks, and then makes a point the marketing rarely repeats: “The 2.5 mg dosage is for treatment initiation and is not approved as a maintenance dosage.” After four weeks the dose goes to 5 mg, and may then rise in 2.5 mg increments after at least four weeks at the current dose.

Missed doses: the two drugs have different rules

This is the part worth reading twice, because the instructions genuinely diverge and a service selling both may hand you one answer for both.

Switching between the injection and the tablet

Because Wegovy is now sold in both forms, its label sets out how to move between them. Going from 2.4 mg injection to tablets: one week after the last injection, start 25 mg orally once daily. Going the other way: the day after the last 25 mg tablet, start 2.4 mg by injection once weekly. For someone who did not tolerate the 25 mg tablet, the label suggests considering the 1.7 mg injection instead.

There is no equivalent published bridge between different molecules. Nothing in either label describes converting a tirzepatide dose into a semaglutide one, and the two are not equipotent — a point that matters when a provider substitutes a product because of supply rather than because of you. What the switch actually changes clinically is set out in Semaglutide vs tirzepatide.

The oral ladders

For completeness: oral semaglutide sold for weight management titrates from 1.5 mg, rising every 30 days as tolerated to a 25 mg maximum. Orforglipron is a different proposition — a small molecule rather than a peptide, with six strengths from 0.8 mg to 17.2 mg, and tablets that Lilly instructs be swallowed whole and not broken, crushed or chewed. Because it is not a peptide relying on an absorption enhancer, it carries none of oral semaglutide’s food-and-water timing rules.