Alright, a bit of background first before I ask for advice. For some time now my dad has been attempting to shed pounds; he did lose some weight, but the doctors still classified him as overweight, so semaglutide was prescribed to him. He has now been taking it for roughly 1.5 months, and at this point his dose sits at 1mg. Every time I visit him, he tells me it leaves him feeling "disgusting". Watching my dad go through this is awful, and I have no idea what to say to him. Would lowering the dose help? Or should he quit and then restart later? My knowledge of sema is pretty limited, so I was hoping to hear some advice from people here. Thanks.
My dad is struggling on semaglutide
- Thread starter timfa
- Start date
Calm Logic
Explorer
No matter what, he should reach out to the provider who wrote the prescription.
"Disgusting" doesn't tell us much. It's possible that Zepbound (tirz) would cause him fewer unwanted effects (though it might not).
Reducing the dose (as you mentioned) or just holding steady at the current dose (without titrating up) could make adjustment easier.
Standard sema dosing schedule:
"Disgusting" doesn't tell us much. It's possible that Zepbound (tirz) would cause him fewer unwanted effects (though it might not).
Reducing the dose (as you mentioned) or just holding steady at the current dose (without titrating up) could make adjustment easier.
Standard sema dosing schedule:
RubbaDubba1
Explorer
It truly seems as though the doctor moved him up too fast, or he was titrated too quickly, to 1 mg. For the first 4 weeks, the starting dose is 0.25 mg taken once weekly. That gives the body time to adjust to the medication. At Week 5, the dose gets raised by your health care professional to 0.5 mg once a week. Stay at the lowest effective dose for as long as you can before increasing. Perhaps drop back to 0.5mg for a period and see how that goes. By far, tirzepatide is the superior product, but if insurance covers it, there is no downside to letting the Semaglutide have a chance to work.
Calm Logic
Explorer
There's another thing that might be going on: when someone's motivation (their "buy in") is stronger, they may put up with mild-to-moderate GI sides more readily. On the flip side, if motivation or desperation is lower, tolerance for sides may be lower too — and those sides can be handled with OTCs, Rx medications, dietary changes, electrolytes, etc.
Calm Logic
Explorer
When the dose is lowered, gastrointestinal side effects often go away entirely or become much milder, so quitting altogether is typically unnecessary.
Another route is to describe your exact symptoms to an AI, which tends to be quite effective at generating possible fixes, including ideas for dosage and things to bring up with the doctor.
When I told Google Gemini about feeling "disgusting" on sema, among the many things it proposed was digestive enzymes, something that rarely comes up on forums. My issue with dietary enzymes is that I forget to take them. Probiotics are part of my routine, sauerkraut included for the natural kind.
Still, cutting back on fatty foods topped the dietary recommendations (and that is the more common guidance):
Many of us rely on daily protein shakes such as Fairlife, Nurri, or Premier Protein. Those can be gentler on digestion as well.
Bloating was the upper GI symptom I liked least (back when I was titrating upward). Simethicone helped to some degree. For most GI issues, Alka-Seltzer is my first choice.
Calm Logic
Explorer
Anyone who prescribes that way should brace for extra calls and follow-ups. Mine stepped me up weekly rather than monthly on tirz, and did exactly the same for every patient ("as needed"). My lower GI took a beating — diarrhea, mainly — but I barely minded, being cut from the same cloth, haha. Worth adding that I already felt terrible before any GLP: a constant low-grade heartburn that cleared up once the weight came off (along with sleeping in a recliner and sourcing generic Voquezna out of India).
Quailfeather
Explorer
Is anyone helping him with lifestyle adjustments? Reworking what goes into his meals, or eating smaller portions more frequently, could make a difference.
Because of the GIP component, tirz is particularly effective at easing the nausea sema brings on, and that's a big part of why it's gained more popularity now. That said, pepto-bismol and similar options can still be used to manage nausea.
Another thing: water intake — glps may dull the thirst response — I don't believe electrolytes are necessary for people on sema, but it's worth keeping in mind if he's still feeling unwell.
Honestly, what he probably needs most is an advocate alongside him at appointments. He may not know that this isn't normal, that he doesn't have to feel this way, or that he can request the doctor slow down his titration. If his only issue is being overweight and he managed to lose weight previously, an aggressive dose isn't necessary for him at all.
Because of the GIP component, tirz is particularly effective at easing the nausea sema brings on, and that's a big part of why it's gained more popularity now. That said, pepto-bismol and similar options can still be used to manage nausea.
Another thing: water intake — glps may dull the thirst response — I don't believe electrolytes are necessary for people on sema, but it's worth keeping in mind if he's still feeling unwell.
Honestly, what he probably needs most is an advocate alongside him at appointments. He may not know that this isn't normal, that he doesn't have to feel this way, or that he can request the doctor slow down his titration. If his only issue is being overweight and he managed to lose weight previously, an aggressive dose isn't necessary for him at all.
Calm Logic
Explorer
Assuming insurance isn't the obstacle, it's really worth exploring a change to tirz. Sema was never presented to me as an option at all—I was simply told it didn't work as well.
And even when insurance is a factor, tirz can be had for a fairly reasonable price through compounding pharmacies such as Brello Health ($500 for three months), which is the route I took prior to going grey. When you factor in what you save on groceries, compounded pricing can end up breaking even.
There are those who will recon tirz or reta on behalf of a parent or another relative, going so far as to hand over a pre-filled syringe. That said, if grey is new territory for you, it demands more care, more time, and more homework. Legal considerations exist too (or you can look the other way, haha). Personally, I would never give my spouse an injection. They should do it themselves whenever that's feasible.
And even when insurance is a factor, tirz can be had for a fairly reasonable price through compounding pharmacies such as Brello Health ($500 for three months), which is the route I took prior to going grey. When you factor in what you save on groceries, compounded pricing can end up breaking even.
There are those who will recon tirz or reta on behalf of a parent or another relative, going so far as to hand over a pre-filled syringe. That said, if grey is new territory for you, it demands more care, more time, and more homework. Legal considerations exist too (or you can look the other way, haha). Personally, I would never give my spouse an injection. They should do it themselves whenever that's feasible.
lessthanhalf
Explorer
I’m with you—figuring out exactly which side effects are happening would be useful. Going straight from 0.5 to 1 with semaglutide doesn’t strike me as a great plan, and it’s hardly shocking that it might bring on rough side effects. I never made that leap; I only moved from 0.5 to 0.6mg, because at 0.5 I already had mild side effects, and at 0.6 they got noticeably worse. With prescribed ozempic, you can do in-between doses by counting clicks—there are charts online that show how many clicks correspond to a given dose. Still, he should speak with the doctor about stepping the dose back down.
Another option is tirzepatide, which works better and comes with fewer side effects. I can’t think of a solid reason to begin with semaglutide rather than tirzepatide, apart from familiarity or routine. The usual dose escalation schedule for tirz also seems more logical.
Another option is tirzepatide, which works better and comes with fewer side effects. I can’t think of a solid reason to begin with semaglutide rather than tirzepatide, apart from familiarity or routine. The usual dose escalation schedule for tirz also seems more logical.