The dose ladder
Why you start low, how fast you climb, and why the price of each rung matters more than people expect.
Updated 2026-09-18
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Nobody starts on a full dose. Both of these drugs step up gradually, and the point of going slowly is to keep the side effects survivable while your body adjusts.
The starting dose is not a treatment dose. On tirzepatide, 2.5 mg is there to let your gut acclimatise; the doses that produced the trial results were 10 and 15 mg. On semaglutide, 0.25 mg is the acclimatisation step and 2.4 mg is the maintenance dose. That gap is why the first two months can feel like nothing much is happening.
Tirzepatide
2.5 mg → 5 mg → 7.5 mg → 10 mg → 12.5 mg → 15 mg, stepping up roughly every four weeks. In SURMOUNT-1, adults with obesity lost an average of 19.5% of body weight on 10 mg and 20.9% on 15 mg over 72 weeks.
Semaglutide
0.25 mg → 0.5 mg → 1 mg → 1.7 mg → 2.4 mg, on the same rough four-week rhythm. In STEP-1, adults on 2.4 mg lost an average of about 14.9% of body weight over 68 weeks.
Why the price of each rung matters
Many programmes charge more at higher doses. That creates two bad incentives: your bill rises exactly as the treatment starts working, and staying put for an extra month to settle side effects can feel like paying the same for less.
Flat-rate programmes remove both. Coreage Rx holds one price from 2.5 mg to 15 mg, so slowing down is genuinely free. That is worth more over a full titration than most advertised discounts.
It is fine to go slower
- Staying at a dose for an extra month is a normal clinical decision, not a failure.
- Some people settle at a middle dose and stay there. The goal is the effect, not the number.
- Going back down a rung to manage side effects is also normal.
- A programme that increases your dose automatically on a schedule, without asking how you are, is one to be wary of.
Worth knowing. Side effects are usually worst in the fortnight after an increase. If you have something important coming up, it is reasonable to ask to delay a step rather than push through it.
Which programmes hold the price flat
| Programme | Per month | Dose-price | Our score |
|---|---|---|---|
| Coreage Rx Best overall on true monthly cost | $199 | Flat | 4.5 |
| Trimi Lowest flat price with named pharmacies | $125 | Varies | 4.6 |
| PlexusDx Pharmacy transparency and genetic testing | $189 | Varies | 4.4 |
| Ivím Health Unlimited clinician access | $199 | Varies | 4 |
| Mochi Health Insurance concierge support | $278 incl. $79 fee | Varies | 3.6 |
| Coby Health Multi-month value with supplies included | $239 | Varies | 3.6 |
| Hims & Hers Widest range of formats | $238 incl. $39 fee | Varies | 3.5 |
| Ro Branded medication with insurance help | $448 incl. $149 fee | Varies | 3.5 |
| Zealthy Low-cost entry with insurance routing | $216 | Varies | 3.5 |
| LifeMD Insurance coordination | $149 | Varies | 3.5 |
| Noom Med Behaviour change alongside medication | $149 | Varies | 3.5 |
| Remedy Meds Flat pricing with unlimited clinician access | $399 | Varies | 3.5 |
More on what each one charges in the cheapest weekly shots.
Read next
- Your first injection
What actually happens, step by step. It is a very small needle and it goes into fat, not muscle.
- Side effects, week by week
What most people get, when it usually settles, and the signs that mean stop and call someone.
- Best programmes if this is your first time
Ranked on how they price the dose ladder and how reachable support is — the two things that decide whether a beginner stays on treatment.
- The cheapest weekly shots
Every programme sorted on what leaves your account each month, with membership fees counted and teaser rates ignored.
- Tirzepatide or semaglutide?
One produced larger average weight loss in a head-to-head trial. The other is gentler on the wallet and, for some people, on the stomach.