"Maintenance dose" sounds like a fixed destination, and many people assume it means the biggest number on the label. In practice it's the dose that works for you, and knowing how it gets chosen makes for a better conversation with your prescriber.
What "maintenance dose" means
Your maintenance dose is the stable, ongoing dose you settle on once titration is complete: the dose you keep taking instead of stepping up further. Your prescriber decides which dose that is for you, and it can be lower than the maximum dose on the label.
How the decision gets made
Your prescriber usually weighs three things.
The first is how well each step works. Some people reach good blood sugar control or a satisfying rate of weight loss at a lower dose, and then there's often no clinical reason to go higher.
The second is tolerability. If side effects at a step are significant and don't ease with more time, staying at the previous, better-tolerated dose is a common and legitimate outcome.
The third is your goals. Someone taking a GLP-1 mainly for blood sugar may land on a different maintenance dose than someone aiming for significant weight loss.
Our guide on why some people stay on a lower maintenance dose covers when a lower dose is the right call.
What the research says
For years, the maintenance dose was settled by judgment alone. There is now some trial evidence to go with it.
The firmest guidance is simply to stay on treatment. A 2026 US expert guidance statement from three obesity organizations gave a strong recommendation to continue obesity medication during weight maintenance. Pooling two trials in which people were randomly assigned to keep taking their medication or switch to placebo, it found that continuing kept weight about 16 kg (35 lb) lower than stopping (Alexander et al., Obesity Pillars, 2026, DOI (external link)).
On stepping down, a lower dose held most of the loss in one trial, though not all of it. The SURMOUNT-MAINTAIN trial took people who had lost weight over 60 weeks on their highest tolerated dose of tirzepatide (10 or 15 mg) and randomly assigned them to stay on it, step down to 5 mg, or switch to placebo. A year later, those who stayed on the full dose were 21.9% below their starting weight, those on 5 mg were 16.6% below, and those on placebo 9.9% below. About 1 in 4 people on 5 mg regained at least half of what they'd lost, compared with about 1 in 12 on the full dose and 2 in 3 on placebo (Horn et al., The Lancet, 2026, DOI (external link)).
Dose also mattered over the long run. In three-year results from the SURMOUNT-1 trial, people assigned to tirzepatide 5 mg from the start were 12.3% below their starting weight at 176 weeks, compared with 18.7% on 10 mg and 19.7% on 15 mg (Jastreboff et al., The New England Journal of Medicine, 2025, DOI (external link)). Those results come from participants who also had prediabetes.
A few cautions apply. Both tirzepatide trials were funded by Eli Lilly, which makes the drug. The dose-reduction evidence is for tirzepatide only; as of September 2026 we found no equivalent trial for semaglutide. And these are averages: the trial authors themselves note that individual responses vary, which is why this stays a decision you make with your prescriber. For every named trial in one place, see our guide to the key GLP-1 clinical trials.
Maintenance can change later
Your maintenance dose can be revisited. It can go up if you and your prescriber decide you need more effect and you tolerate it, or down as part of a deliberate plan, including the kind of tapering covered in our discussion guide on talking to your doctor about stopping or tapering treatment. "Maintenance" describes the current phase of treatment. For where it can go next, see why some people stay on a lower maintenance dose and tapering vs. staying on a maintenance dose long-term.
Study findings above are attributed to their authors and were located via PubMed.
This is general education, not medical advice. Your maintenance dose is a decision to make with your prescriber.