Zepbound dosage chart: every tirzepatide dose, the escalation rule, what each rung lost in the trial, and what it costs

Zepbound has six doses, 2.5 to 15 mg, taken once a week. The label's rule is four weeks at 2.5 mg, then 2.5 mg steps with at least four weeks on each, to a maintenance dose of 5, 10 or 15 mg. In SURMOUNT-1 those three doses lost 15.0, 19.5 and 20.9 percent of body weight over 72 weeks. Direct from Lilly each rung has a price, $299 at 2.5 mg rising to $699 at 10 mg and above, so the chart below carries the dose, the rule, the trial result and the bill in one place, plus the vial and KwikPen concentrations for anyone measuring in units.

Julian CaraulaniFounder, PriceTracker GLP-1Last checked Sep 3 · reviewed by Dr. A. Goher, MDWe track prices. Clinical facts on this site are quoted from the drug's label, the FDA or the published trial, with the source and the date beside each one. We do not write medical guidance and we do not tell anyone what to take.

10 min read · published Sep 3

The short version

1Six doses: 2.5, 5, 7.5, 10, 12.5, 15 mg, once weekly. Start at 2.5 mg for 4 weeks; 2.5 mg steps with at least 4 weeks on each.
2Maintenance doses on the label: 5, 10 or 15 mg for weight; 10 or 15 mg for sleep apnoea. 2.5 mg is a starting dose only. Maximum 15 mg.
3SURMOUNT-1 at 72 weeks: 5 mg lost 15.0%, 10 mg 19.5%, 15 mg 20.9%, placebo 3.1%.
4Lilly self-pay by rung: $299 (2.5), $399 (5), $499 (7.5), $699 (10, 12.5, 15).
5Missed a dose: take it within 4 days (96 hours), otherwise skip. Pens and vials keep 21 days out of the fridge.

Zepbound is one molecule at six strengths, and the label says exactly how to climb them. What the label does not say is what each rung lost in the trial or what each rung costs, and those are the two things that decide where people actually settle. This chart has all three columns.

The chart

Dose (weekly)	Label role	Earliest week	SURMOUNT-1, 72 wk	Lilly self-pay / mo
2.5 mg	Starting dose only, "not approved as a maintenance dosage"	1	not tested as a maintenance dose	$299
5 mg	Maintenance (weight)	5	−15.0%	$399
7.5 mg	Step, or a maintenance dose if it is what you tolerate	9	not a trial arm	$499
10 mg	Maintenance (weight, sleep apnoea)	13	−19.5%	$699
12.5 mg	Step, or a maintenance dose if it is what you tolerate	17	not a trial arm	$699
15 mg	Maintenance (weight, sleep apnoea); maximum	21	−20.9%	$699

Sources: label sections 2.1 and 2.2 for the roles and schedule,¹ SURMOUNT-1 for the results (placebo lost 3.1%),³ Lilly's pricing page for the self-pay tiers.⁴ "Earliest week" is the first week you can be on that dose if every step is taken at the label's minimum four weeks.

The escalation rule

The label's words: "the recommended starting dosage of ZEPBOUND for all indications is 2.5 mg injected subcutaneously once weekly for 4 weeks ... After 4 weeks, increase the dosage to 5 mg ... The dosage may be increased in 2.5 mg increments, after at least 4 weeks on the current dose."¹ The reason is stated in the same sentence: "to reduce the risk of gastrointestinal adverse reactions". Four weeks is a minimum, not a target. Nothing in the label requires you to keep climbing.

Where you stop is the label's other instruction: "Consider treatment response and tolerability when selecting the maintenance dosage. If patients do not tolerate a maintenance dosage, consider a lower maintenance dosage."¹ The three named maintenance doses for weight are 5, 10 and 15 mg. For obstructive sleep apnoea they are 10 or 15 mg. The maximum is 15 mg.¹

In plain English

The 7.5 and 12.5 mg rungs are real doses you can stay on. The label names 5, 10 and 15 because those are the doses the trials tested, not because the in-between strengths are forbidden as destinations. Plenty of people settle at 7.5 mg because 10 mg was one step too many for their stomach.

What each rung did in the trial

SURMOUNT-1 randomised 2,539 adults without diabetes to 5, 10 or 15 mg or placebo for 72 weeks.³ Mean weight change: −15.0% at 5 mg, −19.5% at 10 mg, −20.9% at 15 mg, −3.1% on placebo. The share losing at least 5% was 85%, 89% and 91% against 35% on placebo; the share losing 20% or more was 50% at 10 mg and 57% at 15 mg against 3%.³

Read the gaps. 5 to 10 mg is worth 4.5 points. 10 to 15 mg is worth 1.4. The last step is the smallest gain and, from the label's side-effect table, carries the most vomiting and diarrhoea; Zepbound side effects has those numbers by dose. For many people the honest maintenance dose is 10 mg, and the label's "consider treatment response and tolerability" is permission to stop there.

What each rung costs

With commercial insurance that covers Zepbound, dose does not change the bill: Lilly's card brings it to as low as $25 regardless. Paying cash, dose is the bill. Lilly's list price is "$499 - $1,086.37 per fill", and its self-pay tiers are $299, $399, $499 and $699 for 2.5, 5, 7.5 and 10 mg and above.⁴ Lilly's own dose ladder, with the date we last checked it:

So a full year that climbs to 15 mg on the label's minimum schedule costs one month at $299, one at $399, one at $499 and nine at $699: $7,488. A year that stops at 5 mg costs $4,688. Zepbound without insurance sets out the whole calculation and the cheaper routes.

Pen, vial, multi-dose vial, KwikPen

Zepbound comes four ways, and the label lists them all.² Single-dose pens and single-dose vials hold one dose in 0.5 mL, at every strength. Multi-dose vials and the KwikPen hold four doses each, and the KwikPen is the presentation Lilly sells to self-pay patients and the one the Medicare GLP-1 Bridge covers.

Presentation	Doses	Volume per dose	Measuring
Single-dose pen	1 (4 per carton)	0.5 mL	none; auto-injector
Single-dose vial	1	0.5 mL	draw the whole vial with a syringe
Multi-dose vial	4	0.6 mL	draw 0.6 mL each week
KwikPen	4	fixed	none; dial and inject

The multi-dose vial is where units matter. Each strength is a different concentration, and 0.6 mL of the vial is one dose at that strength: 4.17 mg/mL for the 2.5 mg vial, 8.33 for 5 mg, 12.5 for 7.5 mg, 16.7 for 10 mg, 20.8 for 12.5 mg.² On a standard insulin syringe, 0.6 mL is 60 units, at every strength. The dose is set by which vial you were sent, not by how much you draw.

If you are on compounded tirzepatide

Compounded vials do not follow Lilly's concentrations, and that is where the risk sits. FDA has received "multiple reports of adverse events, some requiring hospitalization, that may be related to dosing errors" from "patients measuring and self-administering incorrect doses" and from "health care professionals miscalculating doses".⁵ The chart above tells you the milligrams the label intends at each rung. Converting that to units on your syringe requires your vial's concentration, in mg per mL, from its label, and the arithmetic is: units = (mg ÷ mg per mL) × 100. Ask the pharmacy to write the units for your dose on the instructions, and check it once against the vial. Compounded sellers' own ladders, with what each costs:

Missed doses, storage, timing

Missed a week: "administer within 4 days (96 hours) after the missed dose"; after that, skip it and take the next one on the usual day.² Same day each week, any time, with or without food; the day can be moved as long as two doses are at least three days apart. Refrigerate; a single-dose pen or vial "can be stored unrefrigerated at temperatures not to exceed 30°C (86°F) for up to a total of 21 days".² Rotate between abdomen, thigh and upper arm; the injection guide covers technique.

General subcutaneous technique from a nursing educator, the same method taught for insulin. Watch the site choice, the skin pinch and the angle. It is not GLP-1 specific, it is not instruction from us, and it does not replace the Instructions for Use in your box.

The honest summary

Four weeks at 2.5 mg, then 2.5 mg steps of at least four weeks, stopping at whichever of 5, 7.5, 10, 12.5 or 15 mg your stomach and your results agree on. The trial says 10 mg gets nearly all of the benefit; the label says a lower dose is fine if the higher one is not tolerated; Lilly's price list says the difference between 5 mg and 15 mg is $300 a month for the rest of the time you take it. Those three facts, together, are the dosing decision.

Sources5

Zepbound prescribing information (DailyMed), sections 2.1 and 2.2 read Sep 3“The recommended starting dosage of ZEPBOUND for all indications is 2.5 mg injected subcutaneously once weekly for 4 weeks. The 2.5 mg dosage is for treatment initiation and is not approved as a maintenance dosage. Follow the dosage escalation below for all indications to reduce the risk of gastrointestinal adverse reactions ... After 4 weeks, increase the dosage to 5 mg injected subcutaneously once weekly. The dosage may be increased in 2.5 mg increments, after at least 4 weeks on the current dose ... Consider treatment response and tolerability when selecting the maintenance dosage. If patients do not tolerate a maintenance dosage, consider a lower maintenance dosage. ... Weight Reduction and Long-Term Maintenance The recommended maintenance dosage is 5 mg, 10 mg, or 15 mg, injected subcutaneously once weekly. OSA The recommended maintenance dosage is 10 mg or 15 mg injected subcutaneously once weekly. ... Maximum Recommended Dosage: 15 mg injected subcutaneously once weekly.” ↩
Zepbound prescribing information, section 3 and 16, forms and storage read Sep 3“pre-filled single-dose pens, single-dose vials, multi-dose vials, or single-patient-use KwikPens, each available in the following strengths. The multi-dose vials and single-patient-use KwikPen each contain 4 doses: Single-dose Pen or Vial 2.5 mg/0.5 mL 5 mg/0.5 mL 7.5 mg/0.5 mL 10 mg/0.5 mL 12.5 mg/0.5 mL 15 mg/0.5 mL Multi-dose Vial (4 doses per vial) Dose per Injection Total Strength per Total Volume Strength per mL 2.5 mg/0.6 mL 10 mg/2.4 mL 4.17 mg/mL 5 mg/0.6 mL 20 mg/2.4 mL 8.33 mg/mL 7.5 mg/0.6 mL 30 mg/2.4 mL 12.5 mg/mL 10 mg/0.6 mL 40 mg/2.4 mL 16.7 mg/mL 12.5 mg/0.6 mL 50 mg/2.4 mL 20.8 mg/mL ... If needed, each single-dose pen or single-dose vial can be stored unrefrigerated at temperatures not to exceed 30°C (86°F) for up to a total of 21 days. ... If a dose is missed, administer within 4 days (96 hours) after the missed dose.” ↩
Jastreboff et al., SURMOUNT-1, NEJM 2022 read Sep 3“The mean percentage change in weight at week 72 was -15.0% (95% confidence interval [CI], -15.9 to -14.2) with 5-mg weekly doses of tirzepatide, -19.5% (95% CI, -20.4 to -18.5) with 10-mg doses, and -20.9% (95% CI, -21.8 to -19.9) with 15-mg doses and -3.1% (95% CI, -4.3 to -1.9) with placebo ... The percentage of participants who had weight reduction of 5% or more was 85% ... 89% ... and 91% ... with 5 mg, 10 mg, and 15 mg of tirzepatide, respectively, and 35% ... with placebo; 50% ... and 57% ... of participants in the 10-mg and 15-mg groups had a reduction in body weight of 20% or more, as compared with 3% ... in the placebo group.” ↩
Lilly, Zepbound pricing information read Sep 3“$499 - $1,086.37 per fill, but the amount you pay will largely depend on your prescription drug insurance plan. ... direct-to-patient pricing of $299, $399, $499, $699, $699 and $699 respectively.” ↩
FDA, dosing concerns with compounded semaglutide and tirzepatide read Sep 3“FDA received multiple reports of adverse events, some requiring hospitalization, that may be related to dosing errors associated with compounded injectable semaglutide products. These dosing errors resulted from patients measuring and self-administering incorrect doses of the drug, and in some cases, health care professionals miscalculating doses of the drug.” ↩

Common questions

What is the Zepbound dosing schedule?

Start at 2.5 mg once weekly for four weeks, then 5 mg. After that the dose may rise in 2.5 mg steps, with at least four weeks on each, through 7.5, 10 and 12.5 mg to a maximum of 15 mg. The label names 5, 10 and 15 mg as maintenance doses for weight and 10 or 15 mg for sleep apnoea, and says to consider a lower maintenance dose if a higher one is not tolerated.

How much weight does each Zepbound dose lose?

In SURMOUNT-1, over 72 weeks in adults without diabetes: 15.0 percent of body weight at 5 mg, 19.5 percent at 10 mg, 20.9 percent at 15 mg, against 3.1 percent on placebo. Half of people at 10 mg and 57 percent at 15 mg lost 20 percent or more. The 7.5 and 12.5 mg rungs were not separate trial arms.

Can you stay on 2.5 mg of Zepbound?

Not on the label. It states that 2.5 mg is for treatment initiation and is not approved as a maintenance dosage. The lowest approved maintenance dose is 5 mg. Prescribers sometimes hold people at 2.5 mg longer than four weeks for tolerability, but the label's framework treats it as a starting rung, not a destination.

How many units is a Zepbound dose in a syringe?

For Lilly's multi-dose vials, every dose is 0.6 mL, which is 60 units on a standard insulin syringe, because each strength is its own concentration: 4.17 mg/mL for 2.5 mg up to 20.8 mg/mL for 12.5 mg. Compounded tirzepatide vials use different concentrations, so the units depend on the vial: units equal milligrams divided by the vial's mg per mL, times 100.

What happens if I miss a Zepbound dose?

Take it within four days, 96 hours, of the missed dose. If more than four days have passed, skip it and take the next dose on the regular day. Do not take two doses within three days of each other. The label also allows the weekly day to be changed as long as that three-day gap is kept.

How much does each Zepbound dose cost?

With a commercial plan that covers it, as low as $25 at any dose with Lilly's card. Direct from Lilly without insurance: $299 for 2.5 mg, $399 for 5 mg, $499 for 7.5 mg and $699 for 10, 12.5 and 15 mg per month. Lilly's list price is $499 to $1,086.37 per fill. Compounded tirzepatide starts at $119 a month on our board.