Accepted answer
7.5 mg a week is 1.071 mg a day averaged out and 390 mg over a year — but "defensible" is not a property of the number, it is a property of where the number came from. A maintenance dose is defensible when a trial randomised people to it and reported what happened, and indefensible when it was arrived at by interpolation between two doses that were studied. So the question to ask of 7.5 mg is which arm it corresponds to: if a programme ran 7.5 mg as a maintenance level, there is an efficacy figure, a tolerability figure and a discontinuation rate attached to it. If it sits between two studied levels, everything said about it is extrapolation, and the burden of that is on whoever proposed it. The other half of the arithmetic is supply: at 7.5 mg a week a 10 mg vial is 1.33 weeks and you will need about 39 of them a year, which is worth knowing before the dose is settled rather than after. Maintenance doses are set by a prescriber against an individual; nothing here is medical advice.
Start with what is being maintained — weight, glycaemia or both — because they have different dose-response curves.
If the result deteriorates on a lower dose, returning to the previous one is straightforward and does not require re-titration from the bottom provided the gap has been short.
Label titration ladders, structure only
| Agent | Start | Step interval | Maintenance range | Max studied |
|---|
| Semaglutide (weight management) | 0.25 mg/wk | 4 weeks | 1.7–2.4 mg/wk | 2.4 mg/wk |
| Semaglutide (T2DM) | 0.25 mg/wk | 4 weeks | 0.5–2.0 mg/wk | 2.0 mg/wk |
| Tirzepatide | 2.5 mg/wk | 4 weeks | 5–15 mg/wk | 15 mg/wk |
| Liraglutide (weight management) | 0.6 mg/day | 1 week | 3.0 mg/day | 3.0 mg/day |
| Oral semaglutide | 3 mg/day | 4 weeks | 7–14 mg/day | 50 mg/day (trial) |
Structure is identical across the class: small start, four-week steps, a defined maintenance range, a defined ceiling.
Worth being precise here: weight is a noisy signal. A rolling four-week average is the instrument; single weigh-ins after a dose reduction will show nothing interpretable.
Dose-response for weight in the trial programmes was real but flattening at the upper end, which is consistent with a lower maintenance requirement.
The withdrawal trials answer stopping, not reducing. Different questions.
edited 22 Apr 2025 by Dr_Rosalind_Achebe — added the citation requested in comments