Western Zone Obesity Network · Patient Handout
Wegovy (semaglutide) and Zepbound (tirzepatide). What dose to restart at after a missed dose or a longer break, how to ease back in comfortably, and when to call the office.
Prepared by Dr. Michael Mindrum, MD, FRCPC. Reviewed August 2026.
Start Here
Wegovy and Zepbound reduce appetite by acting on the energy-regulating centres in the brain. The same signals also reach areas of the brain that can cause nausea. That is why the dose is raised in small steps over several weeks, a process called dose escalation. For most people, nausea settles as the body gets used to each new dose.
Research in people taking these medications shows that this build-up of tolerance to nausea is real, and that raising the dose slowly is what makes higher doses comfortable. If you stop for a while, some of that tolerance fades.
So whether you can pick up where you left off depends on two things:
If You Missed Just One Dose
Take the missed dose as soon as you remember, as long as your next scheduled dose is more than 2 days (48 hours) away. If your next dose is less than 2 days away, skip the missed dose and carry on with your regular schedule.
Take the missed dose as soon as you can, within 4 days (96 hours) of when it was due. If more than 4 days have passed, skip it and take your next dose on its usual day.
Never take two doses to make up for one you missed.
If You Missed Two or More Doses in a Row
The manufacturers’ instructions allow two options: go back to your usual dose, or restart at a lower dose and work back up. Restarting lower and re-escalating reduces the chance that nausea returns. The instructions do not say which option to choose, so this is a decision we make together.
The guidance below is my clinical approach. It is based on the product monographs plus what is known about how these medications clear from the body and how tolerance to nausea builds and fades. It is not a rule printed in the product monograph, so please check with me before restarting after a break of more than two weeks.
Most people can restart at the same dose, provided that dose was comfortable before the break.
By this point most of the medication has cleared from your body. Semaglutide leaves the body slowly, with a half-life of about one week, and tirzepatide takes about five to six days. After three or four weeks without an injection, only a small amount is left. Restarting at your old dose is much closer to taking that dose for the first time than it feels.
So my approach is to restart at about half your previous dose, rounded to the nearest strength that is actually made, and for Zepbound no higher than 5 mg. A few things to weigh: whether higher doses bothered you the first time around, and the trade-off between restarting too low and too high. Restarting too low costs a few extra weeks of stepping back up and can lose momentum. Restarting too high can cause nausea bad enough that some people stop the medication for good, which can be a big missed opportunity.
| Previous dose | Restart at |
|---|---|
| 2.4 mg | 1 mg |
| 1.7 mg | 1 mg |
| 1 mg | 0.5 mg |
| 0.5 mg | 0.25 mg |
| 0.25 mg | stay at 0.25 mg |
| Previous dose | Restart at |
|---|---|
| 15 mg | 5 mg |
| 12.5 mg | 5 mg |
| 10 mg | 5 mg |
| 7.5 mg | 5 mg |
| 5 mg | 2.5 mg |
| 2.5 mg | stay at 2.5 mg |
Because you have already been at these doses before, we may be able to move back up more quickly than you did the first time. We will plan that together.
After five weeks, the medication is essentially out of your system. The manufacturer notes that semaglutide stays in the circulation for about five to seven weeks after a 2.4 mg dose, so this is the point at which any head start you had is gone.
Restart at the lowest starting dose and follow the step-up schedule again, as you did at the very beginning. Please contact your physician before you restart so we can make a plan together.
At a Glance
| Time off the medication | Higher doses were comfortable before | Higher doses caused nausea or vomiting before |
|---|---|---|
| One missed dose | Wegovy: take it if your next dose is more than 2 days away. Zepbound: take it within 4 days. Otherwise skip it. | Same as at left. |
| 1 to 2 weeks | Restart at the same dose. | Restart at the same dose, or drop one level if you would rather ease back in. |
| 3 to 4 weeks | Restart at about half your previous dose, whatever your experience was the first time. See the dose tables above. | |
| 5 weeks or more | Restart at the lowest starting dose and follow the full step-up schedule again. | |
When in doubt, restarting lower is the safer choice. The worst outcome is a few extra weeks of stepping up. Restarting too high can cause nausea bad enough that people stop altogether.
After a Longer Break
Appetite usually returns, and some weight often comes back. In studies, people regained roughly two thirds of the weight they had lost within a year of stopping semaglutide. This is not a personal failure. Obesity is a chronic condition, and these medications work while you are taking them, in the same way blood pressure medication works while you take it. Restarting is worth doing.
Practical Help
Reach Out
Please get in touch if:
Severe stomach pain that will not go away, especially pain that spreads through to your back, with or without vomiting. This can be a sign of inflammation of the pancreas.
This handout is general information and does not replace medical advice. Your own restart plan should always be discussed with Dr. Michael Mindrum, MD, FRCPC. Reviewed August 2026.
References
Keep Going
This handout is a companion to the full medication guide, which covers how each option works, what to expect, side effects, dosing, and cost.
Get in Touch
Questions about restarting your medication, dosing, or side effects? Reach out, we’d love to hear from you.