How Does the Foundayo Titration Schedule Work?

What is the Foundayo titration schedule?

Treatment starts at 0.8 mg and progresses through six strengths, with a minimum of 30 days at each. You take Foundayo (orforglipron) as one tablet once a day, at any time of day.

Swallow the tablet whole; never break, crush, or chew it. You can take all doses of Foundayo with or without food. Novo Nordisk’s Wegovy pill needs an empty stomach, but Foundayo carries no food or water restrictions.

Reaching the maximum dose of 17.2 mg therefore takes at least five months from your first tablet. That pace can feel slow when you want results, but the schedule exists to manage the risks of side effects rather than to hold you back.

The Foundayo dosing schedule table sets out each step in order. The shortest possible route from the first tablet to the top dose: 150 days of continuous treatment.

Dose step	Strength	Minimum time before moving up
Step 1 (starting dose)	0.8 mg once daily	30 days
Step 2	2.5 mg once daily	30 days
Step 3	5.5 mg once daily	30 days
Step 4	9 mg once daily	30 days
Step 5	14.5 mg once daily	30 days
Step 6 (maximum)	17.2 mg once daily	No further increase

Few people will stay on 0.8 mg or 2.5 mg long term. Trials tested neither strength as a maintenance dose. The Foundayo dosage overview lists both as stepping stones towards the higher, studied strengths.

The final three Foundayo dose steps are optional. Plenty of people settle at 5.5 mg or 9 mg and stay there, which the licence explicitly allows.

What is the Foundayo starting dose?

The Foundayo starting dose is 0.8 mg once daily, whatever your weight or starting BMI.

Step	Daily dose	Earliest you can move up
Starting dose	0.8 mg	after 30 days
Step 2	2.5 mg	after a further 30 days
Step 3	5.5 mg	after a further 30 days
Optional higher doses	9 mg, 14.5 mg or 17.2 mg	each after a further 30 days

Why does Foundayo start at such a low dose?

Foundayo starts low because sickness tracks closely with dose. Nausea affected about one in three people on the top 17.2 mg dose. Roughly one in ten reported it in the placebo treatment group (those given an inactive tablet for comparison purposes). Vomiting followed the same line, 4% on placebo vs 25% on 17.2mg dose.

Nausea and vomiting both peaked while people were moving up through the doses, then eased once they settled. More than 3,100 adults took Foundayo in the trials. Roughly six in ten called their stomach side effects mild, and about one in twenty called them severe.

Foundayo copies a gut hormone called glucagon-like peptide-1 (GLP-1). It acts on the parts of your brain that control appetite, so smaller portions feel like enough. It also slows how quickly your stomach empties, which is the part that can feel uncomfortable. Much like other GLP-1 medications, Foundayo uses a titrated dose schedule to help reduce the occurence and severity of these effects.

Nausea management matters most in the first two months, while your dose is still climbing. You can always go slower, and nothing forces you to increase at exactly 30 days.

How does a Foundayo dose increase work?

A Foundayo dose increase happens after at least 30 days on your current strength, and only when that strength is right for you. A Foundayo weekly dose increase does not exist.

The first two increases take you from 0.8 mg to 2.5 mg and then to 5.5 mg. From 5.5 mg upward, further increases depend on how well the dose is working and how comfortably you tolerate it.

How to escalate your Foundayo dose safely: wait out the full 30 days, then move up only when side effects have settled. Climbing on top of unresolved nausea usually makes things worse rather than better.

You do not have to keep stepping up to higher doses. The 5.5 mg, 9 mg and 14.5 mg strengths can each serve as a long-term maintenance dose. Someone losing weight steadily at 9 mg, with the early sickness long gone, has no particular need to move to 14.5 mg.

Staying on a lower dose is a reasonable long-term plan for as long as you are consistently losing weight and the side effects stay manageable. Weight loss does increase with dose, from about 8% of body weight at 9 mg to around 11% at the top.

Why do the trial doses not match the tablet strengths?

The trial doses and the tablet strengths are different numbers for the same medicine. ATTAIN-1 tested orforglipron in capsule form, at 6 mg, 12 mg and 36 mg. The licensed tablets run from 0.8 mg to 17.2 mg but deliver the same amount of orforglipron using fewer milligrams.

Seeing both sets of numbers in orforglipron titration guides is normal, and neither set is wrong.

Trial Dose	Prescribed Dose
6 mg	5.5 mg
12 mg	9 mg
36 mg	17.2 mg

In this phase 3, multinational, randomized, double-blind trial, we examined the safety and efficacy of once-daily orforglipron at doses of 6 mg, 12 mg, or 36 mg, as compared with placebo (assigned in a 3:3:3:4 ratio) as an adjunct to healthy diet and physical activity for 72 weeks. All the patients had obesity without diabetes mellitus.

What happens if you miss doses during titration?

Missing one tablet does not reset anything. Take the missed dose as soon as you remember, and never take two Foundayo tablets on the same day. One missed tablet does not move you back a step. You carry on from the same strength as before.

Missing a full week changes the picture completely. If seven or more doses go by in a row, you need to restart at a lower dose and climb again. Your body loses its tolerance to the gut effects over a gap that long. Returning to your old strength may bring the sickness straight back.

Speak to us before restarting so we can work out the right step to return to.

What else should you check before starting or increasing your dose?

Foundayo slows stomach emptying, so your body may absorb less of the pill. The prescribing information advises women using oral contraceptives to switch to a non-oral method. Alternatively, add a barrier method such as condoms for 30 days after starting Foundayo. You should also use one for at least 30 days after every dose increase.

A few other things are worth checking before you start, and again each time your dose goes up. Some medicines strongly block a liver enzyme called C, which is how your body breaks Foundayo down. Blocking it lets Foundayo build up, so prescribing guidance caps the dose at 9 mg for anyone taking one. Foundayo and the antiviral ritonavir should not be taken together at all.

Insulin and sulfonylureas both raise the risk of low blood sugar alongside Foundayo. In the type 2 diabetes trial, 7% of people on a sulfonylurea reported an episode. For those not taking it, 0.5% reported an episode. Your insulin or sulfonylurea dose may need lowering when Foundayo starts.

Simvastatin is worth flagging to us as well. Taken alongside Foundayo, the active form of simvastatin in your blood roughly doubles. You should take no more than simvastatin 20mg with Foundayo, and your simvastatin dose should be halved. Higher simvastatin doses carry a greater risk of muscle pain.

Who can take Foundayo, and who should not?

Foundayo is licensed for adults with obesity. Adults who have extra weight and a related health problem can also qualify. Related health problems include type 2 diabetes and high blood pressure.

The licence covers it to reduce excess body weight and keep that weight off long term. Diet and increased physical activity run alongside the medicine throughout.

Anyone with a personal or family history of medullary thyroid cancer (MTC) cannot take Foundayo. The same applies to anyone with multiple endocrine neoplasia syndrome type 2 (MEN2). MEN2 is a rare inherited condition affecting the hormone-producing glands. A previous serious allergic reaction to orforglipron also rules it out.

Foundayo is not suitable for use in pregnancy. Stop taking it and speak to us as soon as you know you are pregnant.

When should I see a doctor?

Speak to our clinical team about:

nausea, vomiting or diarrhoea that you can still manage with fluids
reflux, or constipation that has not settled after a couple of weeks
any question about moving up a dose, or about holding where you are
hair loss and tiredness, if either started after a dose increase

Contact your GP or call NHS 111 the same day if you notice:

a lump or swelling in your neck, persistent hoarseness, or trouble swallowing
yellowing of your skin or eyes, or severe pain in the upper right of your abdomen
vomiting or diarrhoea that stops you keeping any fluids down
low blood sugar symptoms, if you take insulin or a sulfonylurea
changes to your vision, if you have type 2 diabetes

Stop Foundayo and call 999 or go to A&E if you notice any of the following:

severe stomach pain that will not go away, which may spread through to your back
swelling of your face, lips, tongue or throat, or difficulty breathing
signs of severe dehydration, such as passing little or no urine
thoughts of harming yourself. Ask for the CRISIS team when you arrive at A&E

Tell any surgeon or anaesthetist that you take Foundayo before a planned procedure, because the medicine slows stomach emptying.

Key takeaways

Foundayo’s ladder runs 0.8 mg, 2.5 mg, 5.5 mg, 9 mg, 14.5 mg and 17.2 mg, with a minimum of 30 days at each step. It puts the top dose at least five months away from your first tablet.
Roughly one in three people felt sick at the top dose, against about one in ten on placebo.
You can stop at 5.5 mg or 9 mg if you are seeing results.
Miss seven days or more, and the schedule restarts lower.
The MHRA has now approved Foundayo for a UK release. The titration schedule above reflects UK approval.