Starting semaglutide (Wegovy) or tirzepatide (Zepbound) means learning a new weekly routine. Both medicines start at a low dose that goes up in steps, and both come as a shot you give under the skin once a week [1, 2]. Here’s what to expect in the first weeks: how the dose steps work, how to give the shot, how to store the medicine, what to do about a missed dose, how to get rid of needles and what to keep track of.
Before your first dose, your clinician should show you how to use your exact pen or vial. The Instructions for Use that come with it are your step-by-step guide [1, 2].
How the starting dose and step-ups work
GLP-1 medicines often cause nausea and other stomach side effects at first. To lower that risk, the labels start low and raise the dose about every 4 weeks [1, 2]. Here are the label schedules for adults using the shots for weight loss:
| Wegovy (semaglutide) | Zepbound (tirzepatide) | |
|---|---|---|
| Weeks 1 to 4 | 0.25 mg once a week | 2.5 mg once a week |
| Step-ups | 0.5 mg, then 1 mg, then 1.7 mg, each for 4 weeks | 5 mg, then up 2.5 mg at a time, after at least 4 weeks on each dose |
| Long-term (maintenance) dose | 1.7 mg or 2.4 mg (2.4 mg is recommended), from week 17 | 5 mg, 10 mg or 15 mg |
| Highest dose | 7.2 mg, for some people after at least 4 weeks on 2.4 mg | 15 mg |
The steps aren’t a race. If a dose is hard to tolerate, Wegovy’s label says your clinician may wait 4 more weeks before the next step. Both labels let your clinician choose your long-term dose based on how well the medicine works and how well you tolerate it [1, 2]. Zepbound’s 2.5 mg starting dose isn’t meant for long-term use [2]. For more on what’s normal, see GLP-1 side effects.
Wegovy also comes as a daily tablet with 30-day steps: 1.5 mg, then 4 mg, then 9 mg, then 25 mg. You take it in the morning on an empty stomach with up to 4 ounces of water. Then wait at least 30 minutes before eating, drinking or taking other pills [1].
Use your medicine exactly as prescribed, and don’t change your dose or schedule on your own. Don’t use it with any other semaglutide, tirzepatide or GLP-1 medicine [1, 2].
Giving your weekly shot
- Timing. Inject once a week at any time of day, with or without food. Wegovy’s label says to use the same day each week [1, 2].
- Where. Inject under the skin of your belly, thigh or upper arm. With Zepbound or a Wegovy prefilled syringe, the back of the upper arm should be injected by someone else. Keep at least 2 inches away from your belly button [1, 2].
- Rotate. Use a new spot each week. You can stay in the same body area, just not the exact same spot [1, 2]. Lilly’s vial instructions say rotating lowers the risk of pitted, thickened or lumpy skin [2].
- Skip problem skin. Don’t inject into skin that is tender, bruised, red, scaly or hard, or into scars or stretch marks [1, 2].
- Check the medicine. Wegovy should look clear and colorless. Zepbound should look clear and colorless to slightly yellow. Don’t use it if it’s cloudy, has particles, has been frozen or is past its expiration date [1, 2].
Pens, syringes and vials
Each form works a little differently. Get trained on the one you’re prescribed, and again if it changes [1, 2].
- Single-dose pens come with the dose already set. You use each pen once [1, 2]. Wegovy also comes in single-dose prefilled syringes [1].
- Multi-dose pens (Wegovy FlexTouch and Zepbound KwikPen) hold 4 weekly doses. FlexTouch comes only in the 2.4 mg dose [1]. You attach a new pen needle for every shot. FlexTouch needs a flow check before the first dose from each new pen, and the KwikPen needs priming before every shot. Never share these pens, even with a new needle [1, 2].
- Zepbound vials come as single-dose vials (0.5 mL) and multi-dose vials (4 doses of 0.6 mL). The syringe and needle aren’t included. Use the type your clinician recommends, such as a 1 mL syringe, and a new syringe and needle every time [2].
Lilly’s vial instructions walk you through each step. In short: wipe the rubber stopper with alcohol, draw air into the syringe and push it into the vial, then turn the vial upside down and draw the medicine to the marked line, tapping out air bubbles. After injecting, keep the needle in your skin for at least 5 seconds, and don’t recap it [2]. Follow the printed steps exactly as you were trained.
Single-dose pens and vials hold one dose. Throw away a single-dose vial after use, even if medicine is left. Never move medicine from a pen into a syringe [1, 2]. If you have vision problems, don’t give yourself shots without help from someone trained to do it [1, 2].
A note on compounded versions
This article covers FDA-approved Wegovy and Zepbound. Compounded versions aren’t FDA approved. The FDA has received reports of side effects, some needing hospital care, that may be linked to dosing mistakes when people measured their own doses of compounded semaglutide [3]. To learn more, see brand-name vs compounded GLP-1.
Storing your medicine
Store new pens and vials in the refrigerator (36°F to 46°F), in the original carton to protect them from light. Never freeze them, and don’t use any that have been frozen [1, 2]. If needed, they can spend limited time out of the fridge:
| Product | Time allowed out of the fridge |
|---|---|
| Wegovy single-dose pen or syringe | Up to 28 days at 46°F to 86°F, in the carton, before the cap comes off |
| Wegovy FlexTouch | Up to 56 days after first use, at room temperature or in the fridge |
| Zepbound single-dose pen or vial | Up to a total of 21 days at up to 86°F |
| Zepbound multi-dose vial or KwikPen | Throw away after 30 days at room temperature (up to 86°F), 30 days after first use or after 4 doses, even if medicine is left |
- Wegovy tablets are kept at room temperature (68°F to 77°F) in their original bottle, away from moisture [1].
- Store multi-dose pens without a needle attached [1, 2].
- If your medicine is delivered, the FDA advises not using any injectable GLP-1 that arrives warm or without enough cooling [3].
- Keep all medicines, needles and sharps containers out of reach of children [1, 2].
If you miss a dose
- Wegovy shot: If your next dose is more than 2 days (48 hours) away, take the missed dose as soon as you can. If it’s less than 2 days away, skip it and take your next dose on your usual day [1].
- Zepbound: Take the missed dose as soon as you can within 4 days (96 hours). If more than 4 days have passed, skip it and take your next dose on your usual day. Never take 2 doses within 3 days (72 hours) of each other [2].
- Wegovy tablets: Skip the missed tablet and take the next one the following day [1].
If you miss 2 or more weeks of Wegovy in a row, call your clinician before your next dose. The label says to restart the dose steps at a lower dose to reduce the risk of stomach side effects [1]. Zepbound’s label covers single missed doses only, so ask your clinician how to restart after a longer gap [2]. To change your shot day, make sure your last Wegovy dose was at least 2 days earlier, or keep at least 3 days between Zepbound doses [1, 2]. If you’re thinking about stopping, see stopping a GLP-1.
Getting rid of needles and pens
- Put used pens, needles and syringes in a sharps container right away [1, 2, 4].
- Use an FDA-cleared sharps container if you can. If not, a heavy-duty plastic household container can work if it has a tight, puncture-resistant lid, stays upright, doesn’t leak and is labeled as hazardous waste [1, 2].
- When the container is about three-quarters full, follow your community’s rules. Options may include drop-off sites, household hazardous waste sites, mail-back programs or special pick-up [4].
- Never put loose needles in the trash or recycling, and never flush them [5].
- To learn your state’s rules, call Safe Needle Disposal at 1-800-643-1643 [4].
What to keep track of
- Your weight. Your clinician uses your response and side effects to choose your long-term dose [1, 2]. If you haven’t lost at least 5% of your starting weight after 12 weeks on the full dose, NIDDK says your clinician will probably advise stopping the medicine [6]. See GLP-1 weight loss: what to expect.
- Side effects. Note what happened, when, and what helped. A food diary can show which foods or meal times make symptoms worse [7].
- Blood sugar, if you have diabetes. The labels say to check it before you start and during treatment. Low blood sugar is more likely if you take insulin or a sulfonylurea (a type of diabetes medicine), and your clinician may lower those doses [1, 2].
- Your shots. It can help to jot down the date, dose and injection site each week, so you can rotate sites and apply the missed-dose rules.
When to get medical care
Call 911 if you have swelling of your face, lips, tongue or throat, trouble breathing or swallowing, or fainting. These can be signs of a serious allergic reaction [1, 2, 8]. Stop your GLP-1 and call your clinician right away if you have severe stomach pain that won’t go away, with or without vomiting [1, 2]. Also call if nausea, vomiting or diarrhea won’t go away, since losing fluids can lead to kidney problems [1, 2]. Our article on GLP-1 side effects lists more warning signs.
Also tell your clinician, ideally before you start:
- If you take birth control pills. Zepbound can make them work less well. Switch to a non-oral method, or add a barrier method, for 4 weeks after you start and for 4 weeks after each dose increase [2]. See GLP-1s, pregnancy and birth control.
- If you’re pregnant or planning a pregnancy. Stop the medicine as soon as you know you’re pregnant. For Wegovy, stop at least 2 months before you plan to become pregnant [1, 2].
- About all your other medicines. These medicines slow stomach emptying, which can change how some pills are absorbed [1, 2].
- Before any surgery or procedure that uses anesthesia or deep sedation [1, 2].
The bottom line
Wegovy and Zepbound both start low and step up about every 4 weeks to help your body adjust. Get trained on your exact pen or vial, rotate injection sites, store the medicine as its label says and follow the missed-dose rules for your medicine. Keep simple notes on your weight, side effects and, if you have diabetes, your blood sugar. Never split a dose, and don’t change your dose or restart after a break without talking to your clinician.
References
- Novo Nordisk. WEGOVY (semaglutide) injection, for subcutaneous use; WEGOVY (semaglutide) tablets, for oral use: prescribing information, Medication Guide and Instructions for Use. DailyMed, U.S. National Library of Medicine. Label revised June 2026 (effective June 18, 2026). https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee06186f-2aa3-4990-a760-757579d8f77b
- Eli Lilly and Company. ZEPBOUND (tirzepatide) injection, for subcutaneous use: prescribing information, Medication Guide and Instructions for Use. DailyMed, U.S. National Library of Medicine. Label revised August 2026 (effective August 28, 2026). https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b
- U.S. Food and Drug Administration. FDA’s concerns with unapproved GLP-1 drugs used for weight loss. FDA. Content current as of October 1, 2026. https://www.fda.gov/drugs/drug-alerts-and-statements/fdas-concerns-unapproved-glp-1-drugs-used-weight-loss
- U.S. Food and Drug Administration. Best way to get rid of used needles and other sharps. FDA. Content current as of August 10, 2023. https://www.fda.gov/medical-devices/safely-using-sharps-needles-and-syringes-home-work-and-travel/best-way-get-rid-used-needles-and-other-sharps
- U.S. Food and Drug Administration. DOs and DON’Ts of proper sharps disposal. FDA. Content current as of April 28, 2021. https://www.fda.gov/medical-devices/safely-using-sharps-needles-and-syringes-home-work-and-travel/dos-and-donts-proper-sharps-disposal
- National Institute of Diabetes and Digestive and Kidney Diseases. Prescription medications to treat overweight and obesity. NIDDK, National Institutes of Health. Last reviewed June 2024. https://www.niddk.nih.gov/health-information/weight-management/prescription-medications-treat-overweight-obesity
- Gorgojo-Martínez JJ, et al. Clinical recommendations to manage gastrointestinal adverse events in patients treated with GLP-1 receptor agonists: a multidisciplinary expert consensus. Journal of Clinical Medicine. 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC9821052/
- MedlinePlus. Anaphylaxis. U.S. National Library of Medicine. Last updated December 2025. https://medlineplus.gov/anaphylaxis.html
This article is for education only and isn’t a substitute for advice from your own clinician.