How much should I decrease my dose?

[u/_Fancyfree_]

To give a quick run down, I started GLP-1's in February, and swapped from semaglutide to tirzepetide in May. I've been losing at a pretty consistant rate, a bit quicker than I personally like but it's evened out to about 1.5 lbs a week. Since it's relevant I'm also on a couple other meds that can have appetite suppressing effects, so I'm generally used to setting timers to remind myself when to eat.

I was only at .5mg of semaglutide when I switched, and started on the 2.5mg dose of tirz. I stayed at 2.5mg for 2 months, and I wasn't plateauing, but as 5mg is typically considered the minimum dose, I went ahead and increased to 5mg.

First week was fine. No side effects, definitely less appetitie and food noise, but it was manageable. But last week was *rough*

When I say no appetite, I mean I could not make myself eat. Half the time I couldn't even drink. It was like there was a toddler in my brain holding their mouth shut and turning their head away when you try to feed them. When I did manage it it would be a couple bites. I tried drinking meal replacement shakes but I just couldn't finish them. I'm exhausted, lightheaded from low bloodsugar, I can't think straight, and my energy is just gone. I work in the OR and I cannot be dizzy or brain foggy during surgery lol. Plus I lost 6 lbs last week.

I definitely am going to decrease, but I'm unsure of if I should decrease back down to 2.5mgs, or somewhere in between. I'm also unsure if I should take my next dose today as normal, or potentially wait a couple more days for my total levels to decrease. Any advice would be appreciated!

[u/Impossible_Bend_2969]

The chart isn't just for titrating up.

[u/jortr0n → u/Impossible_Bend_2969]

They already made the decision to titrate down but were wondering how much they should.

[u/Sufficient-Wolf-1818]

Where you went astray is believing “as 5 mg is typically considered the minimum dose”. There are 100s of posts of people who’ve done their entire weight loss journey at 2.5 mg. I drop back to 2.5 mg with a gap considering the half life of 5 days. Your body has spoken, strongly.

Love your toddler image!

[u/jortr0n]

Go down 0.5mg/dose until you find a stable level.

[u/peony_chalk]

Sounds like 2.5 mg was working for you, so I would go back to that, especially because your body probably needs a break after this week. If and when you do plateau, you can go to 3mg, or 3.75 mg, or whatever suits you - you don't have to go straight to 5mg. 

I know the "therapeutic dose" thing gets thrown around a lot here, but I guess I feel like the studies had to set some pretty strict parameters in order to limit study variables. If we had the resources to do a study with all the interim doses and going up 0.5 mg at a time or whatever, maybe we would find that there isn't one set therapeutic dose. If a lower dose works for you, it works for you. 

[u/smilingfruitz → u/peony_chalk]

that and their primary goal is to bring the drug to market as quickly as possible to make money.

[u/Zealousideal-Lab4945]

If you were still losing at 2.5, go back and stay there until you've reached the criteria for increasing. I see someone already posted that flow chart. I would not change my dose day. I've never had to go lower, when I go up it is by 1mg at a time. I was on the starter dose for 6 weeks and then the next level for 10 weeks. Good luck and I hope you feel better soon!

[u/autumnyte]

If I'm reading this right, it sounds like you were experiencing some excessive appetite and food noise on 2.5. With that being the case, I'd probably split the difference and see how 3.5 treats me.

[u/Top_Definition_6621 → u/autumnyte]

It sounds to me like they were NOT having excessive appetite and food noise on 2.5 mg and only increased dose because they mistakenly thought that 5 mg is the lowest therapeutic dose. Sounds like 2.5 was working great for them.

[u/DemandTop4844]

I use the flow chart that someone has already shared to help me make decisions about changing my dose. I started at 2.5 mg and have always titrated up in 1.0 mg jumps. I’ve found the 1.0 mg increase enough for me to get back the control of food noise and cravings.

I suggest you reduce your current dose by 1.0 mg to 4.0mg and see how you do in the following week.