Moved up from 2.5mg to 5mg and feel awful — should I drop back to 2.5mg?

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AlanFord

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I've said in a few other threads that I've now been on tirzepatide (Mounjaro) for 6 weeks. My doctor prescribes it, and it comes in a 4-dose pen (the pen is overfilled, and for what it's worth I got 5 doses out of my first 2.5mg pen).

After my last dose I had a check-in with my doctor. I told him the results and the effect had been excellent — roughly 0.5kg/week lost, food noise fully gone, and I was really pleased on 2.5mg. Even so, he recommended stepping up to 5mg, handed me the 5mg pen, and said "we'd go back to 2.5mg if side effects are too strong". Worth noting: on 2.5mg I had no side effects whatsoever.

Yesterday around midday I injected the 5mg dose, and 24h later I feel genuinely rough. My stomach is queasy, I've got diarrhea, and all in all I feel lousy.

I'd like to hear from people who increased their dose while the starting dose was still working well — did you stay on the higher dose, did the side effects settle down, or did you go back? And what's the reasoning for raising the dose at all when the lower one was still doing its job? I'll put this to my doctor tomorrow (today is Sunday), but I'm curious what the community thinks.

Last thing: if I do decide to go back, how can I use the 5mg pen to deliver 2.5mg? There's no halfway mark between 0 and 1, and I don't know how many clicks/divisions it has.
 
AlanFord said:


I mentioned in a couple other threads that I have been on tirzepatide (Mounjaro) for 6 weeks now. I get the medicine from my doctor, in a 4 dose pen (which is overfilled, and I managed 5 doses out of the first 2.5mg pen, FWIW).

When I finished the last dose and had a check in with my doctor, I told him that the effect and progress has been great, I have been losing about 0.5kg/week, food noise is gone completely, I was very happy on 2.5mg. He still advised me to go to 5mg, gave me the 5mg pen, and said "we'd go back to 2.5mg if side effects are too strong". Note, I didn't have any side effects on 2.5mg.

I pinned the 5mg dose about mid day yesterday, and 24h later I don't feel great, at all. My stomach feels queasy, I have diarrhea, and overall feel crap.

Would like to hear from anyone who titrated up when the effects of the initial dose were still good - did you stick with it, and did the sides become more manageable, or did you revert back. What is even the point of increasing if the previous dose still did the job? I will ask the doc this tomorrow (today being Sunday), but interested to hear from the community.

Finally, any advice on how to use the 5mg pen to dispense 2.5mg if I choose to go back? There is no "half way" mark between 0 and 1 and I am not sure how many clicks/divisions there are.

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A loss of .5kg is reasonable, though how significant that is depends on how much weight you need to lose overall.

Regarding feeling unwell or having side effects, what you ate could be a factor — since these drugs slow digestion, fatty and heavy foods stay in your system much longer.

Also, as your body adjusts to the dose you can titrate up, and the side effects may pass quickly.

What are your starting and goal weights?

Did you keep to a good diet that day, avoiding fried or fatty foods?

As for the pen, one option might be to empty it into a sterile vial and dose with a syringe; others may have different ideas. I have never used a pen myself.
 
Skidude said:

A loss of .5kg is reasonable, though how significant that is depends on how much weight you need to lose overall.

Regarding feeling unwell or having side effects, what you ate could be a factor — since these drugs slow digestion, fatty and heavy foods stay in your system much longer.

Also, as your body adjusts to the dose you can titrate up, and the side effects may pass quickly.

What are your starting and goal weights?

Did you keep to a good diet that day, avoiding fried or fatty foods?

As for the pen, one option might be to empty it into a sterile vial and dose with a syringe; others may have different ideas. I have never used a pen myself.
Click to expand...

Another option is to stay at the current dose but take it more often. I haven't used tirz myself, but if you're on 2.5mg/week, you could try switching to 2.5mg every 5 days. That lets levels build in your system more gradually rather than in one big jump. If your symptoms settle on that schedule, you can keep stretching the interval out until you're eventually able to handle the 5mg, assuming that's your goal.
 
Skidude said:

A loss of .5kg is reasonable, though how significant that is depends on how much weight you need to lose overall.

Regarding feeling unwell or having side effects, what you ate could be a factor — since these drugs slow digestion, fatty and heavy foods stay in your system much longer.

Also, as your body adjusts to the dose you can titrate up, and the side effects may pass quickly.

What are your starting and goal weights?

Did you keep to a good diet that day, avoiding fried or fatty foods?

As for the pen, one option might be to empty it into a sterile vial and dose with a syringe; others may have different ideas. I have never used a pen myself.
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My starting weight was 107kg and I'm aiming for around 95kg. On 2.5mg I had already adjusted to slower gastric emptying, but it never hit me as hard as it has today. So far today I've only had a protein shake in the morning and a second one at about 08:30pm, yet I still feel very full and bloated — it's as if every bit of water I've drunk today is still sitting and sloshing in my stomach. My diet has been clean, yesterday included.

My main question is really this: if 2.5mg was already working well for me and I had no side effects at all, did I actually need to increase the dose?
 
AlanFord said:

My starting weight was 107kg and I'm aiming for around 95kg. On 2.5mg I had already adjusted to slower gastric emptying, but it never hit me as hard as it has today. So far today I've only had a protein shake in the morning and a second one at about 08:30pm, yet I still feel very full and bloated — it's as if every bit of water I've drunk today is still sitting and sloshing in my stomach. My diet has been clean, yesterday included.

My main question is really this: if 2.5mg was already working well for me and I had no side effects at all, did I actually need to increase the dose?
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I wouldn't have done it.

With just 12kg to lose, there's no reason to hurry — .5 a week is fine.
 
If it were me, I'd stay at 2.5mg and, as Skidude suggested, transfer it into a sterile vial. Doing that lets you build up a small reserve while staying on the dose that's already working for you.
 
Bruce Campbell said:

Another option is to stay at the current dose but take it more often. I haven't used tirz myself, but if you're on 2.5mg/week, you could try switching to 2.5mg every 5 days. That lets levels build in your system more gradually rather than in one big jump. If your symptoms settle on that schedule, you can keep stretching the interval out until you're eventually able to handle the 5mg, assuming that's your goal.
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Right, and that's the tricky part: the pen I've got now is dosed for 5mg. So to inject 2.5mg I'd have to find a way to split it in half.
 
AlanFord said:

Right, and that's the tricky part: the pen I've got now is dosed for 5mg. So to inject 2.5mg I'd have to find a way to split it in half.
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Mix it into a sterile vial, then pull your doses out of that. I stayed on 2.5 for months before raising it, and when I did, I only went up to 3.0.
 
plant_lady said:

If it were me, I'd stay at 2.5mg and, as Skidude suggested, transfer it into a sterile vial. Doing that lets you build up a small reserve while staying on the dose that's already working for you.
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Without question, I'm happy with how quickly I've been losing.

When I use the next pen, I'll return to 2.5mg.
 
Your situation is precisely why I've wanted to have control over the product and the dosing choices myself..."If" you reached a stage where you felt ready to move up, you might try 3 or 4mg for a week or 2 or 3......rather than following Eli Lilly's rigid schedule of 2.5mg for 4 weeks, then 5mg for 4 weeks, then 7.5mg for 4 weeks.....That's how they ran their testing, it's the only data points they have or know about, and by god, if you use our pens, that's what you'll be doing too...lol

Not your fault OP, we've all been there in one way or another.....You may find your way to a more flexible way of administering your GLP where you're the one in control....I hope it works out for you...Sounds like you've got a handle on it.... 👍
 
AlanFord said:

My starting weight was 107kg and I'm aiming for around 95kg. On 2.5mg I had already adjusted to slower gastric emptying, but it never hit me as hard as it has today. So far today I've only had a protein shake in the morning and a second one at about 08:30pm, yet I still feel very full and bloated — it's as if every bit of water I've drunk today is still sitting and sloshing in my stomach. My diet has been clean, yesterday included.

My main question is really this: if 2.5mg was already working well for me and I had no side effects at all, did I actually need to increase the dose?
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There's really no need for that. My own path was 2.5, then 3, then 3.5, then 4, then 5. Taking it gradually meant the 5 doesn't make me sick — but wow, I am constantly full!!!!
 
I just finished reading the whole thread. SkiDude's response is the best one here. If you're able to inject into a vial and then pull out a dose of even 3 mg, that works. Fat scientist can assist with the dosage/units as long as you know the MG/ML.
 
bamagirl26 said:

I just finished reading the whole thread. SkiDude's response is the best one here. If you're able to inject into a vial and then pull out a dose of even 3 mg, that works. Fat scientist can assist with the dosage/units as long as you know the MG/ML.
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He could tally every 5 to reach a total, then measure the ml and work out the math from there, I suppose.

That way it's covered if it wasn't precisely 20mg to start with. (4 wk dose)
 
Yeah, the arithmetic isn't complicated 😊 but I've just had a look at the pen and the plunger can be twisted back, so simply counting back half of the clicks should do it.

Still, I suspect this will be my final EL pen.
 
bamagirl26 said:

I just finished reading the whole thread. SkiDude's response is the best one here. If you're able to inject into a vial and then pull out a dose of even 3 mg, that works. Fat scientist can assist with the dosage/units as long as you know the MG/ML.
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Seriously, Wanda — what does that make me? Chopped liver? 😳 😳 😎❤️
 
Once you've worked out the ml and the dosing, another option is moving the medication into a cartridge for your own pen if that suits you better. Then each time you'd simply dial up the amount and attach one of the same tips you're already using on the brand pens. Keeping it in a vial or in your own pen gives you control over how you step up — which matters especially since such a big jump didn't sit well with you — and if you take it slowly, it will also stretch out longer 🙂
 
AlanFord said:

Yeah, the arithmetic isn't complicated 😊 but I've just had a look at the pen and the plunger can be twisted back, so simply counting back half of the clicks should do it.

Still, I suspect this will be my final EL pen.
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If you have a 5mg EL Mounjaro pen that delivers 60 clicks per dose, there's no reason to move anything into a vial — simply turn the dial to 30 clicks to get 2.5mg.

Since 60 clicks equals 5mg, that works out to 12 clicks per 1mg.

Try searching Google for "mounjaro click chart"

or



www.healthwise360.co.uk

Mounjaro Click Calculator & Chart UK

Easily calculate how many clicks are needed for your specific Mounjaro dose using our free tool. Includes a full dosage chart for UK KwikPens.
www.healthwise360.co.uk www.healthwise360.co.uk

I took 5mg out of a 10mg pen myself, since it cost 50% less.
 
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