"Maintenance dose" is the label's word for the dose a person stays on after the escalation steps. The two US obesity labels define it and the two diabetes labels largely do not, and the trials behind it were designed to answer a narrower question than searchers usually ask: they tested continuing against stopping, not a high dose against a lower one. This page sets out what each label states (all four read on openFDA or DailyMed on 2026-10-27), what the withdrawal trials found, and what has not been tested. It reports; it recommends no dose.
The full escalation ladders are on the Zepbound dose chart and the semaglutide ladder from 0.25 to 7.2 mg; every GLP-1 label side by side is on the GLP-1 dosage chart.
Maintenance, by label
| Product (label date) | Indication | Maintenance dose(s), once weekly | The label's rule on staying at a dose |
|---|---|---|---|
| Zepbound, tirzepatide (2026-08-28) | Weight reduction and long-term maintenance | 5 mg, 10 mg or 15 mg | "Consider treatment response and tolerability"; a lower maintenance dose if one is not tolerated; 2.5 mg is not a maintenance dose |
| Zepbound (2026-08-28) | Obstructive sleep apnoea | 10 mg or 15 mg | Same |
| Wegovy injection, semaglutide (2026-06-18) | Adult weight reduction | 1.7 mg or 2.4 mg (recommended); up to 7.2 mg after ≥4 weeks on 2.4 mg | 7.2 mg where "additional weight reduction is clinically indicated" |
| Wegovy injection | Cardiovascular risk reduction; adolescents 12+ | 2.4 mg (recommended) or 1.7 mg | Tolerability and response |
| Wegovy injection | MASH with moderate to advanced fibrosis | 2.4 mg | Reducible to 1.7 mg if not tolerated; re-escalation to 2.4 mg considered |
| Wegovy tablets | Weight reduction; cardiovascular risk | 25 mg once daily | — |
| Mounjaro, tirzepatide (2026-07-29) | Type 2 diabetes | No maintenance dose named; 5 mg, then 2.5 mg steps to a 15 mg maximum | Increase "if additional glycemic control is needed" |
| Ozempic, semaglutide (2026-07-30) | Type 2 diabetes | 0.5, 1 or 2 mg; 1 mg for the kidney-outcome indication | Increase if additional glycaemic control is needed |
Two features stand out. Zepbound is the only label that names three maintenance doses for one indication and puts "long-term maintenance" in the indication itself. Wegovy is the only label whose maintenance range now reaches 7.2 mg, a step that triples the 2.4 mg dose; the escalation and the trial behind it are on the Wegovy chart.
What the withdrawal trials tested
The phrase "maintenance dose" in the trials means the dose people were kept on after titration, and the trials asked what happens when it stops.
- SURMOUNT-4 (tirzepatide, NCT04660643): 36 weeks open-label at the maximum tolerated 10 or 15 mg, mean loss 20.9%; then 670 randomised to continue or placebo for 52 weeks. Continuing: −5.5% further. Placebo: +14.0%. Over the whole 88 weeks, −25.3% against −9.9%.
- STEP 4 (semaglutide, NCT03548987): 20 weeks to reach 2.4 mg, mean loss 10.6%; then 803 randomised 2:1 to continue or placebo for 48 weeks. Continuing: −7.9%. Placebo: +6.9%. Gastrointestinal events: 49.1% against 26.1%.
- STEP 1 extension: after 68 weeks on 2.4 mg (−17.3%), treatment and the lifestyle programme stopped; 327 participants followed for a year regained 11.6 percentage points, leaving a net −5.6%, and most cardiometabolic measures moved back towards baseline.
Both randomised trials kept the dose fixed in the continuing arm. Neither tested whether a lower dose would hold the loss.
Lower doses after maintenance: what is registered
ClinicalTrials.gov, read 2026-10-27, holds three trials that test reducing or tapering after a stable dose, none yet reporting: NCT07832084 (60 planned, comparing continued therapy, a lower dose at a longer interval, and a switch to a non-incretin drug), NCT07783854 (72 planned, stepwise reduction from 1.7 mg semaglutide against staying on it) and NCT07859176 (100 planned, tapered against abrupt stopping after bariatric surgery). Until they report, the statement that a lower dose maintains weight rests on no randomised evidence. The separate low-dose practice sold as microdosing is covered on GLP-1 microdosing.
Compounded vials and retatrutide
Compounded tirzepatide and semaglutide and the research-market vials carry no label, so no maintenance dose exists for them beyond the branded labels' figures that pharmacies and clinics copy. Retatrutide has no approval anywhere; its phase 3 programme uses fixed trial doses, and those are reported on the retatrutide dose schedule, not as maintenance doses. A dash in the table below marks a draw larger than one 100-unit syringe.
The doses as syringe units
For a vial, units on a U-100 syringe = milligrams ÷ concentration in mg/mL × 100. The concentrations below are worked examples.
| Dose | 2.5 mg/mL | 5 mg/mL | 10 mg/mL | 20 mg/mL |
|---|---|---|---|---|
| Semaglutide 1.7 mg | 68 units | 34 | 17 | 8.5 |
| Semaglutide 2.4 mg | 96 | 48 | 24 | 12 |
| Tirzepatide 5 mg | — | 100 | 50 | 25 |
| Tirzepatide 10 mg | — | — | 100 | 50 |
| Tirzepatide 15 mg | — | — | 150 | 75 |
The full tables are on tirzepatide units and semaglutide units. A dose missed at maintenance follows each label's own window, set out on GLP-1 missed dose.
What is not established
Whether a lower dose after full titration keeps weight off: untested in any completed trial. How long maintenance should last: the labels set no end, and the trials ran 48 to 52 weeks after randomisation. Whether the 7.2 mg step changes what happens on stopping: not studied. Medibact's tirzepatide guide and semaglutide guide cover the compounds. Decisions about any dose belong with the prescriber.
Sources and dates
Opened 2026-10-27: the openFDA label records for ZEPBOUND (set id 487cd7e7-434c-4925-99fa-aa80b1cc776b, effective 2026-08-28), MOUNJARO (0818426a-53eb-4db7-9609-bbae1e7a3964, effective 2026-07-29) and OZEMPIC injection (42bdd912-2393-44c4-b7e0-47672ca28991, effective 2026-07-30), section 2; the DailyMed SPL of WEGOVY (set id ee06186f-2aa3-4990-a760-757579d8f77b, effective 2026-06-18), section 2.2; the abstracts of PMIDs 38078870, 33755728 and 35441470 through NCBI E-utilities; ClinicalTrials.gov v2 API searches for semaglutide and tirzepatide dose reduction and tapering, and the records NCT07832084, NCT07783854 and NCT07859176. Unit arithmetic by this site. Corrections go to the contact page.