Accepted answer
7 mg a week is 1 mg a day averaged out and 364 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 mg is which arm it corresponds to: if a programme ran 7 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 mg a week a 10 mg vial is 1.43 weeks and you will need about 37 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.
Reducing the dose is not the same as stopping, and the withdrawal trials tell you about the second rather than the first.
The maintenance dose is not necessarily the same a year later, since the counter-regulatory response attenuates slowly if at all.
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.
Weight is a noisy signal. A rolling four-week average is the instrument; single weigh-ins after a dose reduction will show nothing interpretable.
Gastrointestinal adverse event rates in the trials are dose-related, which supports the tolerability argument for the lowest effective dose.
The withdrawal trials answer stopping, not reducing. Different questions.
edited 6 Aug 2026 by Dr_Otto_Lindqvist — added a caveat about sampling
Adding for future readers: write down what "working" means before you start. – dead_volume 2 months ago 2This is the first explanation of the titration interval that made sense to me. – mz_4113 4 months ago add a comment