Compounds › Verified against primary sources

The GLP-1s against the package insert

The doses were right. The black box warning was missing

Partially approvedVerified against primary sources

Experimental material. Read before using anything from here.

Nothing on this page is a medical recommendation, prescription or treatment plan. It is an organized translation of protocols circulating in research communities and, where it exists, of what published trials tested. The two are marked differently — and they are not equivalent.

Most of the compounds here have no FDA approval for human use. Several are sold labeled "research use only", which means they have not gone through purity, sterility or dosage controls for human consumption. A community-reported dose is not a validated dose: it is what someone reported having done.

Talk to a licensed health professional before considering any of these compounds. If you already use one and feel anything unexpected, seek care — do not wait for the next routine test.

Specific attention for this compound: Semaglutide and tirzepatide carry an FDA black box warning for thyroid C-cell tumors in rodents. In Brazil the treatment differs for each: the MOUNJARO package insert contraindicates medullary thyroid carcinoma and MEN 2, and those of Ozempic, Wegovy and Rybelsus only call for caution. This site published the full titration with none of that. The failure was mine, not the source's, and it is corrected on the nine pages.

Summary

First audit of this site against an official answer key. I compared the five semaglutide and tirzepatide titration ladders, step by step, with the FDA-approved labels, read on September 4, 2026. No dose value is wrong — and the site even gets a hard detail right, that 7.5 and 12.5 mg of tirzepatide are transition steps and not maintenance. But six label instructions were missing, and so was the most important thing: across the nine GLP-1 pages there was not a single mention of thyroid, medullary carcinoma or MEN 2. In a second round I read the four package inserts, and they diverge from the FDA on six points — including a 7.2 mg dose of Wegovy that does not exist in the United States.

Why this page exists

The other primary-source pages on this site answer how much evidence exists. This one answers something else, and more direct: are the dose tables this site publishes correct?

Until now, the guarantee I gave was that the figures were carried over from the source without being reinterpreted. That guarantees I copied correctly. It does not guarantee the source was correct, and that distinction had never been tested on any page.

The GLP-1s are the only group on the site where testing is possible, because they are the only ones with an agency-approved label. I pulled the official labels from the FDA and DailyMed databases on September 4, 2026 and compared them step by step. The result has two very different halves.

First half: the numbers match

This is the good part, and it is the bigger one. No titration ladder on the site is wrong in dose value. I checked all five, step by step.

Product	What the site publishes	What the label says	Verdict
Wegovy injection	0.25 → 0.5 → 1 → 1.7 → 2.4 mg/week, 4-week steps, maintenance at week 17	Table 1: weeks 1–4 / 5–8 / 9–12 / 13–16 / 17 onward, exactly those values	Identical
Wegovy tablet	1.5 → 4 → 9 → 25 mg/day	Table 2: days 1–30 / 31–60 / 61–90 / 91 onward, those same values	Correct values, timeline compressed by 6 days
Rybelsus	3 → 7 → 14 mg/day	Days 1–30 / 31–60 / 61 onward, with 14 mg only if needed for more glycemic control	Correct values, timeline compressed by 6 days
Ozempic tablet	1.5 → 4 → 9 mg/day	Days 1–30 / 31–60 / 61 onward, with 9 mg only if needed	Correct values, timeline compressed by 6 days
Tirzepatide (Mounjaro and Zepbound)	2.5 → 5 → 7.5 → 10 → 12.5 → 15 mg/week, 4-week steps	Start 2.5 mg for 4 weeks, then 2.5 mg increments at intervals of at least 4 weeks, maximum 15 mg	Identical

And the site got one hard thing right

The tirzepatide table marks 7.5 mg and 12.5 mg as a transition phase, and 5 mg and 10 mg as maintenance doses. That is correct and almost nobody gets it right: the Zepbound label says the recommended maintenance is 5, 10 or 15 mg — 7.5 and 12.5 exist only to climb the ladder, not to stay on. And it also says that 2.5 mg is not approved as maintenance, which the site already stated.

The rule of holding the step is also correct on both sides: the site says to add 4 weeks at any intolerable step, and the package insert literally says to consider delaying escalation by 4 weeks when the patient does not tolerate it.

Second half: six things missing

None of them is a wrong number. All are label instructions the site does not carry — and three change decisions.

Missing	What the label says	Why it matters
1.7 mg is a maintenance dose, not just a step	Maintenance for injectable Wegovy is 1.7 mg or 2.4 mg, with 2.4 recommended. Applies to weight reduction and to cardiovascular risk	The site treated 1.7 as a step on the way to 2.4. Anyone who does not tolerate 2.4 has an approved option to stop at 1.7 — and would not know that from reading this page
The route-switching instruction	Anyone who does not tolerate the 25 mg tablet should consider switching to Wegovy injection 1.7 mg per week	It is the only way out the label offers to those who cannot tolerate the oral form. It was nowhere on the site
Sleep apnea only with 10 or 15 mg	In obstructive sleep apnea, Zepbound maintenance is 10 or 15 mg — 5 mg does not work for that indication	The site cited the apnea indication without the dose restriction. Anyone stopping at 5 mg would be treating obesity, not apnea
Ozempic is also a tablet	Since the January 2026 label, Ozempic is injectable and tablet, with its own ladder (1.5 → 4 → 9 mg). The label warns that Rybelsus and Ozempic tablets are not interchangeable milligram for milligram	They are two semaglutide tablets, from the same manufacturer, with different ladders. Swapping one for the other by the milligram is an error the label anticipates
Pediatric maximum for tirzepatide	In children aged 10 and older, the Mounjaro maximum is 10 mg per week, not 15	The site's table ends at 15 mg with no age caveat
The oral steps are 30 days	Days 1–30, 31–60, 61–90, 91 onward — not weeks 1–4, 5–8, 9–12, 13 onward	The difference is 6 days in reaching 25 mg. Small, but the ladder exists precisely to reduce gastrointestinal effects: shortening it goes in the opposite direction

The bigger failure, and it is not about dose

I searched the nine GLP-1 pages on this site — semaglutide, tirzepatide, retatrutide, cagrilintide, survodutide, CagriSema and the three combinations — for thyroid, medullary, MEN 2, pancreatitis, gallbladder, retinopathy, gastroparesis, anesthesia and pregnancy.

Zero occurrences. None of them, on any of the nine pages.

Semaglutide and tirzepatide carry a black box warning — the strongest warning the FDA applies to a drug. The warning is for thyroid C-cell tumors, dose-dependent and duration-dependent in rodents, with human relevance not determined. And they carry an absolute contraindication: personal or family history of medullary thyroid carcinoma, or multiple endocrine neoplasia type 2.

An absolute contraindication is not a warning. It is not "be careful" or "talk to your doctor". It is do not use. And this site published the full titration ladder and the vial-by-vial reconstitution table without a single line about it.

It is not a translation error, nor an error of the secondary source: it is what neither of the two carried, and I did not check before publishing. It is the most serious failure this site has ever had, and it was live.

What the black box warning says, in English

Direct translation of the text of the Wegovy, Mounjaro, Zepbound and Rybelsus/Ozempic tablet labels, which carry the same warning with the molecule swapped:

Feature	What the label establishes
Black box warning	In rodents, the substance causes thyroid C-cell tumors in a dose-dependent and treatment-duration-dependent manner, at clinically relevant exposures. It is not known whether it causes them in humans, including medullary thyroid carcinoma — the human relevance of the rodent tumors has not been determined
Absolute contraindication	Personal or family history of medullary thyroid carcinoma, or multiple endocrine neoplasia type 2 (MEN 2)
Second contraindication	Prior serious hypersensitivity reaction to the substance or to any excipient. Anaphylaxis and angioedema have been reported with semaglutide and with tirzepatide
Prescribers should advise	The package insert orders the professional to counsel the patient on the potential risk of medullary thyroid carcinoma and on the symptoms of thyroid tumors

The three that have no label at all

Retatrutide, cagrilintide and survodutide: I searched the FDA label database and none of the three is registered. The claim the site already made — investigational, in phase 3 — is confirmed.

What this means in practice is the opposite of what it seems. It is not that they are safer for having no black box warning. It is that there is no authority at all to say what the right dose is: there is no approved ladder, no defined maximum, no contraindication list. The tables for these three on the site come entirely from the secondary source and have nothing to be compared against.

Compound	FDA label	What I confirmed on ClinicalTrials.gov
Retatrutide	None	Phase 3 ongoing. TRIUMPH-4 is NCT05931367, completed, 445 participants. There is also a cardiovascular and renal outcomes trial with 10,000 participants (NCT06383390) and a head-to-head comparison with tirzepatide (NCT06662383, 800)
Cagrilintide (and CagriSema)	None	Phase 3 ongoing. REDEFINE 3 is NCT05669755, with 7,101 participants, and there is a completed trial in type 2 diabetes with 1,200
Survodutide	None	Active clinical program, with several completed phase 1 studies, including formulation and energy expenditure

The Brazilian half: four package inserts

The first version of this page used the FDA label and declared that as a limit. I went after the Brazilian one. In the package-insert database there are four products of this class registered: Ozempic, Rybelsus, Wegovy and MOUNJARO. Zepbound does not exist in Brazil — here tirzepatide has a single brand, covering all three indications.

I downloaded the four professional package inserts and read them. And the Brazilian package insert is not the American label translated. It diverges on six points, and the first is big enough that I have to correct the warning this site published this morning.

The divergence that matters most

In Brazil, semaglutide is not contraindicated in medullary thyroid carcinoma. Tirzepatide is. Same class, same rodent risk, two opposite regulatory treatments.

Section 4 of the Ozempic, Rybelsus and Wegovy package inserts says, all three with the same sentence: hypersensitivity to the active substance or to any of the excipients. That is all. Medullary carcinoma appears much further on, in section 5, and with a different weight: human relevance is considered low, but cannot be completely excluded, and for that reason the drug must be used with caution in those with a personal or family history.

The MOUNJARO package insert does the opposite, in section 4 and in so many words: MOUNJARO is contraindicated in patients with a personal or family history of medullary thyroid carcinoma (CMT) or in patients with multiple endocrine neoplasia type 2 (MEN 2).

That changes what this site should say. The notice I published this morning asserted an absolute contraindication for both molecules, following the FDA. It is corrected: the notice now separates the two, because in Brazil they are different things.

Molecule	FDA	—	Practical consequence
Semaglutide Ozempic, Wegovy, Rybelsus	Black box warning and absolute contraindication	Not a contraindication. Section 4 lists only hypersensitivity. In section 5: use with caution, human relevance considered low	In Brazil, someone with a family history of CMT is not barred from use — they are under caution, and the decision belongs to the prescriber
Tirzepatide MOUNJARO	Black box warning and absolute contraindication	Absolute contraindication, in section 4, with the same scope as the FDA's	In Brazil, it is a prohibition — and it is the only one of the two molecules that carries it

Five dose divergences

None of them is on the site, and two point to doses that do not exist in the American label or do not exist in the Brazilian one.

Point	FDA	—	What the site publishes
Wegovy maximum dose	2.4 mg/week	7.2 mg/week — individualized, only in adults with baseline BMI ≥ 30, after at least 4 weeks on 2.4 mg and when the response to 2.4 is insufficient. Given as three injections of 2.4 mg, at least 5 cm apart. Without additional improvement, go back to 2.4	2.4 mg as the ceiling. The Brazilian dose is triple that, and it was not here
Wegovy maintenance	1.7 mg or 2.4 mg, with 2.4 recommended	2.4 mg. The 1.7 is a step, not a destination	It treated 1.7 as a step — which is right in Brazil and wrong in the US. The two labels disagree with each other
Ozempic maximum dose	2 mg/week	1.0 mg/week. The package insert states verbatim that weekly doses greater than 1.0 mg are not recommended	Nothing. The Brazilian ceiling is half the American one
Oral semaglutide	Three products: Rybelsus 14 mg, Ozempic tablet 9 mg and Wegovy tablet 25 mg	Just one: Rybelsus, maximum 14 mg. There is no Ozempic tablet or Wegovy tablet registered in Brazil	Two oral tables that have no Brazilian equivalent — the 1.5→4→9 one and the 25 mg one
Tirzepatide brands	Mounjaro for diabetes, Zepbound for weight and apnea	MOUNJARO only, covering diabetes, weight management and obstructive sleep apnea	A table comparing Mounjaro and Zepbound as if both existed here

What only the Brazilian package insert says

Do not double the 7 mg Rybelsus tablet to make 14. The package insert is explicit: each strength has the same amount of SNAC, the carrier, and ingesting twice that component has not been studied. It is the most directly useful instruction in all four package inserts for anyone dosing themselves, and it does not appear in the American label.
The 7.2 mg dose of Wegovy has a step-back rule. If there is no additional weight improvement, the package insert orders a return to 2.4 mg — verbatim, in order to avoid unnecessary exposure to risks associated with the higher dose. It came from the STEP UP and STEP UP T2D studies, with 1,919 patients in all.
MOUNJARO has a stopping criterion. In weight management, if the patient does not lose at least 5% of initial weight in 6 months at the highest tolerated dose, the package insert orders a decision on whether or not to continue. No page on this site had a stopping criterion for anything.
The Brazilian pediatric MOUNJARO matches the American one: above 10 years of age, maintenance of 5 or 10 mg, maximum 10 mg. And in sleep apnea, maintenance of 10 or 15 mg — the same restriction as Zepbound in the US, here inside MOUNJARO.

What the two labels agree on

The tirzepatide ladder is identical in both countries: 2.5 mg for 4 weeks, then increments of 2.5 mg every at least 4 weeks, maintenance at 5, 10 or 15 mg, maximum 15. The Rybelsus ladder too: 3 mg for one month, 7 mg for at least one more month, 14 mg only if additional glycemic control is needed. And Wegovy's up to 2.4 mg is the same table, week by week.

In other words: the ladders this site publishes remain correct in both countries. What diverged was everything around them — the ceiling, the contraindication, which products exist and what to do when it does not work.

What changes on the site from here

The nine GLP-1 pages now carry a notice at the top, with the black box warning and the absolute contraindication, and the link to this page.
The dose ladders stay as they are, because they are correct. What changes is what goes alongside them.
This method applies to little of the rest of the site. Of the 67 compounds, almost none has a package insert: that is what makes the GLP-1s auditable and the rest not. Where there is no package insert, there is no reference standard — and that is the normal situation for this reference, not the exception.
The lesson is not about GLP-1. It is that "the number was preserved from the source" and "the number is correct" are different statements, and only the first held for this site until today.

What this audit did not do

I did not check the reconstitution tables. They are dilution arithmetic, not package-insert dosage — no package insert describes reconstituting a peptide vial with bacteriostatic water, because the approved product already comes ready in a pen.
I read the four Brazilian package inserts, but only sections 4, 5 and 8 — contraindications, warnings and dosage. I did not audit interactions, special populations or adverse reactions in any of them.
I did not audit the drug interaction or special populations sections. I stayed with dosage, the black box warning and contraindications.
I did not read the trials cited in the site's tables — STEP 1, SURMOUNT-1, OASIS 4, TRIUMPH-4. I confirmed that TRIUMPH-4 exists and its number of participants; the weight-loss percentages still come from the secondary source.

References

This page did not come from the secondary source. Every statement on this page was checked against the official package insert — FDA — on September 4, 2026. This page does not use PubMed: the reference standard here is regulatory.

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