Two meanings of “maintenance”
In the dosing section of a label, the maintenance dosage is the dose reached after the gradual increases at the start. It is the dose the label expects someone to stay on, not a special dose for after weight loss [1][2].
In the trial sections, “long-term maintenance” refers to keeping weight reduction over time. The Zepbound® and Wegovy® labels list both reducing excess weight and maintaining that reduction long term among their approved uses [1][2].
Maintenance doses, label by label
The table restates what each US label calls its maintenance or highest dose and what it says about choosing one. It explains the labels; the dose that applies to you is your prescriber’s decision.
| Medicine | Maintenance dose in the label | What the label adds | Source |
|---|---|---|---|
| Zepbound® | 5, 10 or 15 mg weekly for weight; 10 or 15 mg for sleep apnea; maximum 15 mg | 2.5 mg is for starting only; weigh response and tolerability; consider a lower maintenance dose if one is not tolerated | [1] §2.1–2.2 |
| Wegovy® injection, adult weight | 1.7 or 2.4 mg weekly, 2.4 mg marked as recommended | up to 7.2 mg after at least 4 weeks on 2.4 mg when further loss is clinically indicated | [2] §2.2 |
| Wegovy® tablets | 25 mg daily | if 25 mg is not tolerated, consider the 1.7 mg weekly injection | [2] §2.3 |
| Saxenda® | 3 mg daily in adults | lower doses are for titration only; stop if 3 mg is not tolerated; young people may drop to 2.4 mg | [3] §2.2 |
| Mounjaro® (diabetes) | no separate maintenance list; up to 15 mg weekly in adults, 10 mg in children | each 2.5 mg increase only if more blood sugar control is needed | [5] §2.1 |
| Foundayo™ | the label does not use the term; steps to 9, 14.5 or 17.2 mg daily, maximum 17.2 mg | each step after at least 30 days, by response and tolerability; 9 mg cap with a strong CYP3A4 inhibitor | [4] §2.1–2.2 |
How Europe and Canada set maintenance
- Wegovy®, EU: the adult maintenance dose is 2.4 mg weekly, with 7.2 mg possible after at least 4 weeks on 2.4 mg in adults whose BMI was 30 or more at the start; if 7.2 mg brings no further improvement in weight, the dose goes back to 2.4 mg [10].
- Mounjaro®, EU: one product covers diabetes and weight, with maintenance doses of 5, 10 and 15 mg in adults and 5 and 10 mg in children aged 10 and over with type 2 diabetes [11].
- Saxenda®, EU: treatment should stop after 12 weeks on 3.0 mg a day if less than 5% of starting weight has been lost; the US label instead checks at 16 weeks against 4% [3][12].
- Zepbound®, Canada: the June 2026 monograph lists the same maintenance options as the US label, 5, 10 or 15 mg for weight and 10 or 15 mg for sleep apnea [13].
How SURMOUNT-4 was set up
SURMOUNT-4 enrolled 783 adults with obesity, or overweight with a weight-related condition, and without diabetes. Everyone took tirzepatide openly for 36 weeks, with the dose raised over up to 20 weeks to the highest dose they could tolerate, 10 mg or 15 mg. Both groups received counselling on a diet with a daily deficit of about 500 kcal and on at least 150 minutes of activity a week [1][6].
Before week 36, 14.4% stopped, most often because of side effects. The 670 who remained were randomised to continue tirzepatide or switch to placebo for 52 weeks. At that point 93% were on 15 mg and 7% on 10 mg, and they had lost 20.9% of their starting weight on average [1].
What the continuing group showed
From week 36 to week 88, the group that kept taking tirzepatide lost a further 5.5% of body weight on average, so the earlier loss was not only kept but extended. At week 88, 89.5% of them still had at least 80% of the weight they had lost during the first phase. Counted from the very start, their average loss over 88 weeks was 25.3% [6].
For comparison, the placebo group regained 14.0% over the same period. After randomisation, 10.4% of the continuing group and 17.9% of the placebo group stopped the study drug. The published summary says the most common side effects were mostly mild to moderate digestive events, more frequent with tirzepatide than with placebo [1][6].
STEP 4 with semaglutide
STEP 4 followed the same idea. Of 902 adults who started semaglutide, 99 stopped during the 20-week run-in, most often because of side effects. The 803 who reached 2.4 mg weekly, having lost 10.6% on average by then, were randomised, two to one, to continue or switch to placebo for 48 weeks, with lifestyle intervention in both groups [2][7].
From week 20 to week 68, the continuing group lost a further 7.9% on average, compared with a 6.9% gain on placebo. Digestive events were reported by 49.1% of those continuing and 26.1% on placebo, while similar shares stopped because of side effects: 2.4% and 2.2% [7].
SCALE Maintenance with liraglutide
The daily liraglutide program tested a different starting point. In SCALE Maintenance, 422 adults first lost at least 5% of their weight on a low-calorie diet, 6.0% on average, and were then randomised to liraglutide 3.0 mg a day or placebo for 56 weeks, with diet and exercise counselling throughout [8].
Only people who had first lost at least 5% could enter, so the label notes the results may not match what to expect in general [3]. From randomisation to week 56, the published abstract reports a further loss of 6.2% with liraglutide against 0.2% with placebo, and 81.4% against 48.9% still holding on to the 5% they had lost on the diet. The Saxenda® label describes the same trial as Study 3 and, with its own analysis, gives −4.9% against +0.3% [3][8]. Digestive side effects were more frequent with liraglutide, mostly short-lived and mild or moderate [8].
Switching to a daily tablet to maintain
ATTAIN-MAINTAIN, a phase 3b trial published in 2026 and funded by Eli Lilly, enrolled people who had just completed 72 weeks of tirzepatide (205 people) or semaglutide (171 people) in an earlier trial. They were randomised to once-daily orforglipron or placebo for a year [9].
At week 52, the model-based estimate was that people from the tirzepatide group kept 74.7% of their earlier weight reduction on orforglipron against 49.2% on placebo; for the semaglutide group the figures were 79.3% and 37.6%. Digestive effects were the most common side effects, mostly mild to moderate. The authors list two limits themselves: there was no group that simply stayed on the injection, and the trial lasted only one year [9].
The current US Foundayo™ label covers weight reduction and long-term maintenance but says nothing about switching from an injectable product [4]. Whether a switch fits your situation is a conversation with your prescriber.
What these trials did not test
- They did not include everyone who starts the medicine. The randomised phases only took people who got through the run-in or the earlier treatment [2][9].
- They did not test lowering the dose once weight was down. The continuing groups in SURMOUNT-4 and STEP 4 stayed on the highest dose they tolerated, 10 or 15 mg of tirzepatide or 2.4 mg of semaglutide [1][7].
- They did not test stretching the time between doses. Every group took its medicine on the labelled schedule, weekly for the injections and daily for liraglutide and orforglipron [6][7][8][9].
- They lasted 48 to 56 weeks after randomisation, so they say little about many years of maintenance. ATTAIN-MAINTAIN was funded by Eli Lilly, and SURMOUNT-4 and STEP 4 list employees of the manufacturers among their authors [6][7][9].
- They report averages. Some people in the continuing groups lost more, some less.
Zepbound® and Mounjaro® are registered trademarks and Foundayo™ is a trademark of Eli Lilly and Company. Wegovy® and Saxenda® are registered trademarks of Novo Nordisk A/S. PepLabo is not affiliated with or endorsed by Eli Lilly or Novo Nordisk.
