Bariatric history + Tirz mg: thinking adding 0.5 mg reta

[Mara_aa]

I’m considering giving retatrutide a try, and before I do something that might turn out to be a bad move, I’d like to hear what others think.

At the moment my tirzepatide dose is 2.25 mg. Going up much further wasn’t possible for me because of stomach pain tied to my cardia following a bariatric gastroplasty.

Luckily, my body appears to have adjusted as time passed, and these days I don’t really get meaningful side effects.

Rather than pushing tirzepatide to a higher dose, I’ve been wondering whether adding a very small amount of retatrutide (roughly 0.5 mg) could work like a kind of micro-titration.

Since the gastroplasty, my metabolism has pretty much been asleep. At this point I can’t tell whether it’s sleeping, hibernating, or simply refusing to get out of bed.

A few questions for people who have been through this:

1) Is this a terrible idea?

2) Given the GI sensitivity I had when I began tirzepatide, could 0.5 mg of reta be too much for a starting amount?

3) Would it make sense to space it roughly 3 days after the tirzepatide injection?

For context: my diet is generally healthy, but I don’t always hit my protein target, and my activity level is light daily movement, nothing intense, because I’m not very strong right now.

If anyone has done something similar or has used both compounds, I’d really like to hear how it went for you.

 

[lessthanhalf]

One thing that's well established to build tolerance with time is how GLP drugs affect the stomach, or at minimum gastric emptying. So if you hit trouble raising the dose a while back, that doesn't automatically mean the same trouble waits for you later on - think months, not weeks. Usually GI side effects such as nausea also lessen across months, though that isn't guaranteed.

My knowledge of bariatric surgery is very limited.

That said, larger tirz doses or stacking reta might go down easier now than they did at the start, but given your situation, starting extremely low and ramping up extremely gradually is absolutely the correct path. Peak blood levels land 24 -48 hours after a shot, and that's when most GI side effects hit hardest. When that pattern holds, dividing doses or taking smaller amounts more frequently can frequently let you reach a bigger total weekly dose while feeling fewer side effects. Whether adding low dose reta beats simply raising tirz, I can't say. ( I'm figuring it's been quite a while since you last attempted an increase )

My own stack right now is tirz 15mg together with reta 5mg, and nothing major has come up, though last year on ozempic I had to experiment a lot because even small doses brought on serious nausea, and I ended up doing 0.2mg every second day to work around it.

 

[Mara_aa]

lessthanhalf said:

One thing that's well established to build tolerance with time is how GLP drugs affect the stomach, or at minimum gastric emptying. So if you hit trouble raising the dose a while back, that doesn't automatically mean the same trouble waits for you later on - think months, not weeks. Usually GI side effects such as nausea also lessen across months, though that isn't guaranteed.

My knowledge of bariatric surgery is very limited.

That said, larger tirz doses or stacking reta might go down easier now than they did at the start, but given your situation, starting extremely low and ramping up extremely gradually is absolutely the correct path. Peak blood levels land 24 -48 hours after a shot, and that's when most GI side effects hit hardest. When that pattern holds, dividing doses or taking smaller amounts more frequently can frequently let you reach a bigger total weekly dose while feeling fewer side effects. Whether adding low dose reta beats simply raising tirz, I can't say. ( I'm figuring it's been quite a while since you last attempted an increase )

My own stack right now is tirz 15mg together with reta 5mg, and nothing major has come up, though last year on ozempic I had to experiment a lot because even small doses brought on serious nausea, and I ended up doing 0.2mg every second day to work around it.

Thanks, that clears a lot up. It makes sense that tolerance can build up over time.

And you’re probably right — it’s been a long stretch since I last attempted a tirz increase, so maybe my body would react differently at this point.

What holds me back is mainly the discomfort I felt around the cardia following the gastroplasty; it was pretty rough, which is why I’ve stayed so wary of raising the tirz dose again.

The thought of putting in just a tiny bit of reta came from considering something like micro-titration instead of a bigger tirz step-up.

Based on your experience stacking the two, would you say reta is generally harder or easier on the GI tract than tirz when doses are low, or about the same?

I also didn’t quite follow the Ozempic piece — when you said second daily doses of 0.2 mg, are you saying you broke the dose into several smaller shots throughout the week?

 

[lessthanhalf]

Correct — with Ozempic, since I was on the prescribed version, every attempt to push past 0.5mg/w invited trouble, and some side effects at that dose had already warned me it would. Going to 0.6mg/w delivered worse nausea and a generally ill feeling. Back then I had no idea everyone else had already figured this out, or that tools like glp-plotter existed, so I read what I could and sketched drug levels out on paper to make sense of it. Because gi side effects cluster at peak levels, and peak blood levels land 24 to 48 hours after a shot, the plan became tiny 0.22mg doses every 2 days ( 0.22x7/2 ) , totaling roughly 0.77mg/week — and that produced less nausea than 0.5mg taken once a week. About 50% of my body weight was already gone by then and hunger never left me, so extra appetite suppression bought something worthwhile, even with nausea along for the ride.

Habit kept me on those second daily doses of reta and tirz — a year on ozempic had made the pattern second nature.

So if that cardia pain only showed up in the day or 2 following a dose, smaller and more frequent dosing may keep it away — simply total the small doses over 7 days to arrive at the weekly dose, or do the calculation. Frequency itself isn't critical; every second day won, for me, purely because it's easier to remember than every 3rd or 3rd and a half day( twice a week ) and going slightly more often smooths the blood levels out considerably. A second benefit of small frequent doses is that raising them faster becomes easier, with less chance of side effects dragging on through a whole week. Take 0.5 of reta every 3 days (weekly dose is 0.5x7/3=1.16mg/w ) — in theory levels need only about 3 days to fall back to pre dose values if a side effect turns unpleasant, which beats waiting out a big weekly shot. Still, use glp-plotter to double check everything.

Something the previous post missed: if small doses are all you can tolerate from either GLP, reta may be the better pick — the reta studies reported 9% weight loss at 1mg/week across a year. No other GLP's come anywhere near that result at such low doses. So reaching only 2 or 3 or 4 mg of reta could out-perform 3 or 4 or 5 or 6mg of tirz.

Data on reta is far thinner than on tirz, being newer and not yet approved, and the receptor pharmacology is extremely complicated. Against that, reta carries slightly more gastrointestinal side effects than tirz at equivalent doses. From that angle tirz looks like the safer choice — but since a lower dose of reta could deliver a stronger weight loss effect, side effects at that lower dose might be milder, assuming your history means much higher doses aren't realistic anyway. Not the clearest explanation, but I hope it lands.

 

[Mara_aa]

lessthanhalf said:

Correct — with Ozempic, since I was on the prescribed version, every attempt to push past 0.5mg/w invited trouble, and some side effects at that dose had already warned me it would. Going to 0.6mg/w delivered worse nausea and a generally ill feeling. Back then I had no idea everyone else had already figured this out, or that tools like glp-plotter existed, so I read what I could and sketched drug levels out on paper to make sense of it. Because gi side effects cluster at peak levels, and peak blood levels land 24 to 48 hours after a shot, the plan became tiny 0.22mg doses every 2 days ( 0.22x7/2 ) , totaling roughly 0.77mg/week — and that produced less nausea than 0.5mg taken once a week. About 50% of my body weight was already gone by then and hunger never left me, so extra appetite suppression bought something worthwhile, even with nausea along for the ride.

Habit kept me on those second daily doses of reta and tirz — a year on ozempic had made the pattern second nature.

So if that cardia pain only showed up in the day or 2 following a dose, smaller and more frequent dosing may keep it away — simply total the small doses over 7 days to arrive at the weekly dose, or do the calculation. Frequency itself isn't critical; every second day won, for me, purely because it's easier to remember than every 3rd or 3rd and a half day( twice a week ) and going slightly more often smooths the blood levels out considerably. A second benefit of small frequent doses is that raising them faster becomes easier, with less chance of side effects dragging on through a whole week. Take 0.5 of reta every 3 days (weekly dose is 0.5x7/3=1.16mg/w ) — in theory levels need only about 3 days to fall back to pre dose values if a side effect turns unpleasant, which beats waiting out a big weekly shot. Still, use glp-plotter to double check everything.

Something the previous post missed: if small doses are all you can tolerate from either GLP, reta may be the better pick — the reta studies reported 9% weight loss at 1mg/week across a year. No other GLP's come anywhere near that result at such low doses. So reaching only 2 or 3 or 4 mg of reta could out-perform 3 or 4 or 5 or 6mg of tirz.

Data on reta is far thinner than on tirz, being newer and not yet approved, and the receptor pharmacology is extremely complicated. Against that, reta carries slightly more gastrointestinal side effects than tirz at equivalent doses. From that angle tirz looks like the safer choice — but since a lower dose of reta could deliver a stronger weight loss effect, side effects at that lower dose might be milder, assuming your history means much higher doses aren't realistic anyway. Not the clearest explanation, but I hope it lands.

I really appreciate you walking me through all of that — it was clear and genuinely useful.

The part about peak levels and dividing doses makes complete sense to me.

For me, though, the cardia pain doesn't only show up on the first day or two after

the shot. It comes on pretty much every time I eat, no matter what kind of food it is (and I've tested quite a few).

I hadn't thought about doing smaller doses more often in such an organized way, so

I'll make sure to look into GLP-plotter and crunch some numbers before

making any changes.

That's also a really interesting idea — that reta might do better at lower doses. I'll definitely remember that, since higher doses don't sit well with me.

Great explanation, I definitely picked up something new!

 

[wulf00777]

Research data indicated that by the midpoint of the trial, the majority of participants had resolved their adverse effects. From what I've gathered, reta tends to be milder than tirz, though the small initial doses mean it can be slower to kick in.

 

[Mara_aa]

wulf00777 said:

Research data indicated that by the midpoint of the trial, the majority of participants had resolved their adverse effects. From what I've gathered, reta tends to be milder than tirz, though the small initial doses mean it can be slower to kick in.

Hearing that helps a lot. From what I've come across, reta tends to be gentler on the side-effect front than tirz, though it can take more time to kick in. If going slower means I deal with less trouble, that's fine by me.