Switching from Tirz to Reta...need advice on cross titration

[jackie.d.]

Hey all! I've been getting tirz via a telehealth company, and their aggressive money-grabbing titration schedule pushed me to 15mg every week in just 4 months. That dose is expensive and I can't keep it up, especially since I'm a 39 year old woman looking into longevity and fat targeting and want to experiment with other p e ps. After lurking on forums, disc, and TG for a while, I know it's possible to cross titrate down on Tirz while bringing in Reta. Has anyone here done that? How quickly did you lower T, and what was your starting R dose? A nutritionist told me to begin at 6 on R and reduce T to complete the switch, but that sounds like a bad idea and such a high R amount. Any success stories to share? And for the women, any peps worth stacking? Thanks GLP GENIUSES!

 

[Calm Logic]

jackie.d. said:

Hey all! I've been getting tirz via a telehealth company, and their aggressive money-grabbing titration schedule pushed me to 15mg every week in just 4 months. That dose is expensive and I can't keep it up, especially since I'm a 39 year old woman looking into longevity and fat targeting and want to experiment with other p e ps. After lurking on forums, disc, and TG for a while, I know it's possible to cross titrate down on Tirz while bringing in Reta. Has anyone here done that? How quickly did you lower T, and what was your starting R dose? A nutritionist told me to begin at 6 on R and reduce T to complete the switch, but that sounds like a bad idea and such a high R amount. Any success stories to share? And for the women, any peps worth stacking? Thanks GLP GENIUSES!

Starting reta at 6 mg is definitely too much, no matter what someone's tirz history looks like. Because reta also acts on glucagon, playing it safe matters even more. For the first reta dose, I wouldn't go above 2 mg, particularly since you have the option of splitting it into 2 shots per week — or even microdosing every other day. That way, if 2 mg appears to be doing nothing after several days, a 1 mg reta bump can be added later that same week. On the flip side, GI effects sometimes take as long as about 5 days to show up.

If things go badly, at minimum it's smarter to aim for weight maintenance instead of weight loss while first transitioning — for instance, paying attention to body composition so the scale isn't the main focus.

When problems arise during a swap, the usual culprits are: dropping tirz by too much (rushing the changeover to reta), or pushing reta up by too much (because its effects can differ). That's why low and slow tends to win, as it so often does. With 2 or more doses per week, though, there's more room to fine-tune.

Nothing stops you from raising reta afterward — a few days later or the following week — then nudging it upward gradually week by week. In uncommon cases, people experience extreme reta reactions such as projectile vomiting or persistent hiccups, even when they've titrated slowly and eventually reached 8+ mg.

On the tirz side, I'd cut the dose by more than the amount I'd add of reta, because reta may be more potent per mg. So as a rough guess (everyone differs and starts from a different place), perhaps 11 mg tirz total across week 1 alongside 2 mg reta total across week 1. Or drop even lower on either one, since another dose or boost can always be taken later in the week.

For me personally, at this stage I could likely dose entirely by feel with split dosing. The tricky part is that delayed effects can still catch me off guard (whether from GLPs or from their effects accumulating). So being conservative remains necessary, or else I deal with GI side effects.

 

[anhydrous]

Calm Logic has a point—I'd take the cautious route and begin at 2mg. You're only giving up a bit of time, and what you get in return is the chance to hold back and observe. In my opinion, that's a tradeoff well worth making.

 

[joseblo]

About 9 months back I made this switch, and my ramp-up was fairly quick. I quit Tirz abruptly and built Reta up gradually. What mattered most was keeping my first few shots 3 days apart — that's enough to establish a baseline blood level, hold the peaks (and ideally the side effects) down, and leave a few days to judge whether the side effects are too much. A level tracker like the one below is a must. My first dose was 2mg (2 days after my last Tirz), then on a 3 day cadence: 1, 1, 1.5, 1.5, 2, 2. I was about to move to 3 when I hit some really odd gastro symptoms. Despite plenty of fiber (30g daily) and water (80oz), nothing was moving, so I waited it out and took lots of Mg and PEG 3350 (Miralax). It resolved in 48 hours, but it was strange. After that I titrated a bit more slowly, yet still reached 5mg every 6 days within 5 weeks. That's when appetite suppression began to kick in. I then started stretching the intervals to weekly so peaks would be higher, and ended up at 7mg weekly by 10 weeks. No further bad sides, though I did notice a touch of allodynia.

YMMV!

When I spoke with a friend in medicine, their one comment was that they use a Glucagon agonist in MRI patients to halt gut/bladder motility during scans. That one is much shorter acting, but it still causes intestinal distress.

 

[Calm Logic]

If you're already at 15 mg of tirz, my guess is you tolerate it better than most. Still, whatever side effects showed up before could carry over to reta. For me, that's how it went with every GLP — the side effect profiles overlapped more than they differed.

And to add another layer of complexity, haha: down the road, if a long stall hits, you might eventually add 250 mcg of cagri each week.

In an earlier post you brought up tesa, which is another common add-on (assuming no cancer in the family history). As with other GH peptides, tesa may support muscle retention while also helping — gradually, to some extent — with visceral/belly fat loss, even though temporary water weight is possible. Because women tend to respond less than men, they usually need to work up to 2 mg of tesa eventually, beginning at 1 mg to avoid carpal tunnel symptoms. Ideally, though, IGF-1 should be checked first to establish a baseline before tesa is started. A bit of fasting before tesa at bedtime (or fasting after taking tesa upon waking) may also improve efficacy and weight loss.

joseblo said:

About 9 months back I made this switch, and my ramp-up was fairly quick. I quit Tirz abruptly and built Reta up gradually. What mattered most was keeping my first few shots 3 days apart — that's enough to establish a baseline blood level, hold the peaks (and ideally the side effects) down, and leave a few days to judge whether the side effects are too much. A level tracker like the one below is a must. My first dose was 2mg (2 days after my last Tirz), then on a 3 day cadence: 1, 1, 1.5, 1.5, 2, 2. I was about to move to 3 when I hit some really odd gastro symptoms. Despite plenty of fiber (30g daily) and water (80oz), nothing was moving, so I waited it out and took lots of Mg and PEG 3350 (Miralax). It resolved in 48 hours, but it was strange. After that I titrated a bit more slowly, yet still reached 5mg every 6 days within 5 weeks. That's when appetite suppression began to kick in. I then started stretching the intervals to weekly so peaks would be higher, and ended up at 7mg weekly by 10 weeks. No further bad sides, though I did notice a touch of allodynia.

YMMV!

When I spoke with a friend in medicine, their one comment was that they use a Glucagon agonist in MRI patients to halt gut/bladder motility during scans. That one is much shorter acting, but it still causes intestinal distress.

So like this?:

Initial Dose: 2mg (as a baseline).

Day 3: 1mg

Day 6: 1mg

Day 9: 1.5mg

Day 12: 1.5mg

Day 15: 2mg

Day 18: 2mg

Click to expand...

 

[joseblo]

Calm Logic said:

If you're already at 15 mg of tirz, my guess is you tolerate it better than most. Still, whatever side effects showed up before could carry over to reta. For me, that's how it went with every GLP — the side effect profiles overlapped more than they differed.

And to add another layer of complexity, haha: down the road, if a long stall hits, you might eventually add 250 mcg of cagri each week.

In an earlier post you brought up tesa, which is another common add-on (assuming no cancer in the family history). As with other GH peptides, tesa may support muscle retention while also helping — gradually, to some extent — with visceral/belly fat loss, even though temporary water weight is possible. Because women tend to respond less than men, they usually need to work up to 2 mg of tesa eventually, beginning at 1 mg to avoid carpal tunnel symptoms. Ideally, though, IGF-1 should be checked first to establish a baseline before tesa is started. A bit of fasting before tesa at bedtime (or fasting after taking tesa upon waking) may also improve efficacy and weight loss.

joseblo said:

About 9 months back I made this switch, and my ramp-up was fairly quick. I quit Tirz abruptly and built Reta up gradually. What mattered most was keeping my first few shots 3 days apart — that's enough to establish a baseline blood level, hold the peaks (and ideally the side effects) down, and leave a few days to judge whether the side effects are too much. A level tracker like the one below is a must. My first dose was 2mg (2 days after my last Tirz), then on a 3 day cadence: 1, 1, 1.5, 1.5, 2, 2. I was about to move to 3 when I hit some really odd gastro symptoms. Despite plenty of fiber (30g daily) and water (80oz), nothing was moving, so I waited it out and took lots of Mg and PEG 3350 (Miralax). It resolved in 48 hours, but it was strange. After that I titrated a bit more slowly, yet still reached 5mg every 6 days within 5 weeks. That's when appetite suppression began to kick in. I then started stretching the intervals to weekly so peaks would be higher, and ended up at 7mg weekly by 10 weeks. No further bad sides, though I did notice a touch of allodynia.

YMMV!

When I spoke with a friend in medicine, their one comment was that they use a Glucagon agonist in MRI patients to halt gut/bladder motility during scans. That one is much shorter acting, but it still causes intestinal distress.

So like this?:

Initial Dose: 2mg (as a baseline).

Day 3: 1mg

Day 6: 1mg

Day 9: 1.5mg

Day 12: 1.5mg

Day 15: 2mg

Day 18: 2mg

Click to expand...

Yep, and I jumped in really quick once the last Tirz shot was done, since I knew sides were not an issue for me, while the blood level fell off fast. Rather than dosing on day 21 I held off to 23, then 2 again after (5) days, and after that 2.5(3), 2.5(3), 2.7(3), 3.6(4), 4.5(5), 5.4(6), 6.3(7) -new vial- 6.3 (7), 7(7), 7(7), 7(7), 7(7)-new vial-

The way I play it: cap weekly jumps at 50% while levels are still low, keep any rise to 10% / week once effects or sides show up, and leave it at a 0% change when a new vial starts.

 

[jackie.d.]

Calm Logic said:

jackie.d. said:

Hey all! I've been getting tirz via a telehealth company, and their aggressive money-grabbing titration schedule pushed me to 15mg every week in just 4 months. That dose is expensive and I can't keep it up, especially since I'm a 39 year old woman looking into longevity and fat targeting and want to experiment with other p e ps. After lurking on forums, disc, and TG for a while, I know it's possible to cross titrate down on Tirz while bringing in Reta. Has anyone here done that? How quickly did you lower T, and what was your starting R dose? A nutritionist told me to begin at 6 on R and reduce T to complete the switch, but that sounds like a bad idea and such a high R amount. Any success stories to share? And for the women, any peps worth stacking? Thanks GLP GENIUSES!

Starting reta at 6 mg is definitely too much, no matter what someone's tirz history looks like. Because reta also acts on glucagon, playing it safe matters even more. For the first reta dose, I wouldn't go above 2 mg, particularly since you have the option of splitting it into 2 shots per week — or even microdosing every other day. That way, if 2 mg appears to be doing nothing after several days, a 1 mg reta bump can be added later that same week. On the flip side, GI effects sometimes take as long as about 5 days to show up.

If things go badly, at minimum it's smarter to aim for weight maintenance instead of weight loss while first transitioning — for instance, paying attention to body composition so the scale isn't the main focus.

When problems arise during a swap, the usual culprits are: dropping tirz by too much (rushing the changeover to reta), or pushing reta up by too much (because its effects can differ). That's why low and slow tends to win, as it so often does. With 2 or more doses per week, though, there's more room to fine-tune.

Nothing stops you from raising reta afterward — a few days later or the following week — then nudging it upward gradually week by week. In uncommon cases, people experience extreme reta reactions such as projectile vomiting or persistent hiccups, even when they've titrated slowly and eventually reached 8+ mg.

On the tirz side, I'd cut the dose by more than the amount I'd add of reta, because reta may be more potent per mg. So as a rough guess (everyone differs and starts from a different place), perhaps 11 mg tirz total across week 1 alongside 2 mg reta total across week 1. Or drop even lower on either one, since another dose or boost can always be taken later in the week.

For me personally, at this stage I could likely dose entirely by feel with split dosing. The tricky part is that delayed effects can still catch me off guard (whether from GLPs or from their effects accumulating). So being conservative remains necessary, or else I deal with GI side effects.

That reply was really helpful and well thought out! I had been thinking about stacking NAT or Tesa, but I chose to try this reta/tirz swap first and see what happens. Your reasoning seems solid to me, and since bumping tirz by 1mg/wk gave me no sides, that plan sounds fair enough. I'll report back on how it turns out!

 

[jackie.d.]

joseblo said:

About 9 months back I made this switch, and my ramp-up was fairly quick. I quit Tirz abruptly and built Reta up gradually. What mattered most was keeping my first few shots 3 days apart — that's enough to establish a baseline blood level, hold the peaks (and ideally the side effects) down, and leave a few days to judge whether the side effects are too much. A level tracker like the one below is a must. My first dose was 2mg (2 days after my last Tirz), then on a 3 day cadence: 1, 1, 1.5, 1.5, 2, 2. I was about to move to 3 when I hit some really odd gastro symptoms. Despite plenty of fiber (30g daily) and water (80oz), nothing was moving, so I waited it out and took lots of Mg and PEG 3350 (Miralax). It resolved in 48 hours, but it was strange. After that I titrated a bit more slowly, yet still reached 5mg every 6 days within 5 weeks. That's when appetite suppression began to kick in. I then started stretching the intervals to weekly so peaks would be higher, and ended up at 7mg weekly by 10 weeks. No further bad sides, though I did notice a touch of allodynia.

YMMV!

When I spoke with a friend in medicine, their one comment was that they use a Glucagon agonist in MRI patients to halt gut/bladder motility during scans. That one is much shorter acting, but it still causes intestinal distress.

That's a really intriguing approach! When you were on tirz, did you deal with comparable side effects, or were the ones you had unique to reta?

 

[jackie.d.]

Calm Logic said:

If you're already at 15 mg of tirz, my guess is you tolerate it better than most. Still, whatever side effects showed up before could carry over to reta. For me, that's how it went with every GLP — the side effect profiles overlapped more than they differed.

And to add another layer of complexity, haha: down the road, if a long stall hits, you might eventually add 250 mcg of cagri each week.

In an earlier post you brought up tesa, which is another common add-on (assuming no cancer in the family history). As with other GH peptides, tesa may support muscle retention while also helping — gradually, to some extent — with visceral/belly fat loss, even though temporary water weight is possible. Because women tend to respond less than men, they usually need to work up to 2 mg of tesa eventually, beginning at 1 mg to avoid carpal tunnel symptoms. Ideally, though, IGF-1 should be checked first to establish a baseline before tesa is started. A bit of fasting before tesa at bedtime (or fasting after taking tesa upon waking) may also improve efficacy and weight loss.

joseblo said:

About 9 months back I made this switch, and my ramp-up was fairly quick. I quit Tirz abruptly and built Reta up gradually. What mattered most was keeping my first few shots 3 days apart — that's enough to establish a baseline blood level, hold the peaks (and ideally the side effects) down, and leave a few days to judge whether the side effects are too much. A level tracker like the one below is a must. My first dose was 2mg (2 days after my last Tirz), then on a 3 day cadence: 1, 1, 1.5, 1.5, 2, 2. I was about to move to 3 when I hit some really odd gastro symptoms. Despite plenty of fiber (30g daily) and water (80oz), nothing was moving, so I waited it out and took lots of Mg and PEG 3350 (Miralax). It resolved in 48 hours, but it was strange. After that I titrated a bit more slowly, yet still reached 5mg every 6 days within 5 weeks. That's when appetite suppression began to kick in. I then started stretching the intervals to weekly so peaks would be higher, and ended up at 7mg weekly by 10 weeks. No further bad sides, though I did notice a touch of allodynia.

YMMV!

When I spoke with a friend in medicine, their one comment was that they use a Glucagon agonist in MRI patients to halt gut/bladder motility during scans. That one is much shorter acting, but it still causes intestinal distress.

So like this?:

Initial Dose: 2mg (as a baseline).

Day 3: 1mg

Day 6: 1mg

Day 9: 1.5mg

Day 12: 1.5mg

Day 15: 2mg

Day 18: 2mg

Click to expand...

Yeah, I was weighing several add-ons, and Tesa plus NAD and some others were candidates, but I thought it made sense to try an R/T crossover first and see what happens for me. Throughout my tirz run I had ZERO sides, so I'm hoping reta treats me well too.

 

[Omxxl]

Reta won't give you nearly as much appetite suppression, so give it several weeks before you bump up your dose. This has nothing to do with the fact that Reta works mainly through the glucagon pathway, which is why your heart rate, energy expenditure, and fat burning climb progressively each week.

 

[lessthanhalf]

I don't agree that moving over to 6mg of reta would probably cause problems. Assuming 15mg of tirzepatide sits well with you, then 6 or even 8 mg of reta ought to produce fewer gastrointestinal side effects than the tirz you're currently taking. A minor concern is a faster heartbeat, so if cardiac disease is present, it may be better to remain on tirz, or if you tend to get anxious, then take reta more gradually. Skin sensory symptoms are another low-probability possibility, and they appear to show up more often with reta than with tirz. Nausea and other worsening gastrointestinal symptoms are also a low-probability possibility, since reactions to different GLP drugs can be somewhat idiosyncratic.

Every dose escalation plan carries some risk, but on most measures 6 or 8 mg of reta ought to cause fewer side effects than 15mg of tirz. Splitting the dose in half and taking it twice weekly is one way to lower that risk, continuing until you reach a dose that either controls hunger and weight loss rate adequately or produces side effects, at which point you stop raising the dose or slow down considerably, and you can switch to weekly dosing instead. How far up you go depends mostly on how overweight you were at the start; if the obesity is severe and long term, then 12mg is what I would suggest, staying on it long term to prevent serious obesity related health problems, provided side effects are not an issue. The lowest dose possible is what most people here would recommend, which I think is fine when obesity is not severe.

Use GLP plotter to see what different doses do in your body, and how long doses take to be absorbed and decline; it makes it easier to make sense of effects and side effects with different doses and schedules.

 

[Thee Oohwee]

About 3 weeks back, I had worked my way up to 10mg of Tirz when my first 20mg Reta "tester" arrived. I was curious how my system would handle the new new, so on my Tirz pinning day I took 2mg Reta and simultaneously stepped Tirz down to 8mg. Both went in on the same day. Looking back, that was likely not the smartest move, and I've since read plenty of others' reports where people split their Tirz and Reta pinning days, either phasing Tirz out entirely or keeping a smaller dose purely to manage food noise. Two days later I pinned another 2mg Reta. And boom! It definitely kicked in for me.

The following week, Friday (my original pinning day) was 4mg Reta, and Monday was 7.5mg Tirz. That week brought some gastro issues, though nothing too major, and they cleared up after a few days. Taking electrolytes every single day has helped a ton, I've found. I also got this bizarre skin sensitivity thing that week, like a mild sunburn. It has eased off since, but there's still a bit of it around my neck and shoulders. Not horrible, and it seems to be fading.

This week, today, I took 5mg Reta and I'll do 7.5 Tirz on Monday. Right now I'm dropping roughly 0.5-1lb/wk. I'm in the gym weightlifting 4x week and pushing my protein up. No processed foods, fast food, junk food, etc. Plenty of water and electrolytes.

Next week's plan: 6mg Reta on Friday, then 5 Tirz on Monday. After that, for the next Reta titration up, I'm aiming for 8mg. I want to run that for a month with no Tirz and see whether Reta by itself can handle the food noise suppression. If it's not going great, I'll put 5mg Tirz back in on Mondays.

 

[jackie.d.]

Thee Oohwee said:

About 3 weeks back, I had worked my way up to 10mg of Tirz when my first 20mg Reta "tester" arrived. I was curious how my system would handle the new new, so on my Tirz pinning day I took 2mg Reta and simultaneously stepped Tirz down to 8mg. Both went in on the same day. Looking back, that was likely not the smartest move, and I've since read plenty of others' reports where people split their Tirz and Reta pinning days, either phasing Tirz out entirely or keeping a smaller dose purely to manage food noise. Two days later I pinned another 2mg Reta. And boom! It definitely kicked in for me.

The following week, Friday (my original pinning day) was 4mg Reta, and Monday was 7.5mg Tirz. That week brought some gastro issues, though nothing too major, and they cleared up after a few days. Taking electrolytes every single day has helped a ton, I've found. I also got this bizarre skin sensitivity thing that week, like a mild sunburn. It has eased off since, but there's still a bit of it around my neck and shoulders. Not horrible, and it seems to be fading.

This week, today, I took 5mg Reta and I'll do 7.5 Tirz on Monday. Right now I'm dropping roughly 0.5-1lb/wk. I'm in the gym weightlifting 4x week and pushing my protein up. No processed foods, fast food, junk food, etc. Plenty of water and electrolytes.

Next week's plan: 6mg Reta on Friday, then 5 Tirz on Monday. After that, for the next Reta titration up, I'm aiming for 8mg. I want to run that for a month with no Tirz and see whether Reta by itself can handle the food noise suppression. If it's not going great, I'll put 5mg Tirz back in on Mondays.

Your approach seems solid. While I sort out how reta works for me, I'm set on silencing the food noise completely!

 

[Calm Logic]

lessthanhalf said:

I don't agree that moving over to 6mg of reta would probably cause problems. Assuming 15mg of tirzepatide sits well with you, then 6 or even 8 mg of reta ought to produce fewer gastrointestinal side effects than the tirz you're currently taking. A minor concern is a faster heartbeat, so if cardiac disease is present, it may be better to remain on tirz, or if you tend to get anxious, then take reta more gradually. Skin sensory symptoms are another low-probability possibility, and they appear to show up more often with reta than with tirz. Nausea and other worsening gastrointestinal symptoms are also a low-probability possibility, since reactions to different GLP drugs can be somewhat idiosyncratic.

Every dose escalation plan carries some risk, but on most measures 6 or 8 mg of reta ought to cause fewer side effects than 15mg of tirz. Splitting the dose in half and taking it twice weekly is one way to lower that risk, continuing until you reach a dose that either controls hunger and weight loss rate adequately or produces side effects, at which point you stop raising the dose or slow down considerably, and you can switch to weekly dosing instead. How far up you go depends mostly on how overweight you were at the start; if the obesity is severe and long term, then 12mg is what I would suggest, staying on it long term to prevent serious obesity related health problems, provided side effects are not an issue. The lowest dose possible is what most people here would recommend, which I think is fine when obesity is not severe.

Use GLP plotter to see what different doses do in your body, and how long doses take to be absorbed and decline; it makes it easier to make sense of effects and side effects with different doses and schedules.

On 20 mg of tirz, plenty of users still wouldn't kick off reta at 6 mg, much less 8 mg. In a reta trial, those amounts wouldn't come until week nine. Compared with no glucagon adjustment at all, eight weeks gives the body a long runway to adapt.

Beyond that, this thread covers a less cautious transition (the title says "cross-titrating," which in practice means stacking), rather than a straight swap (quit tirz entirely, then begin reta). Back when all of this was new, the old-school swap method meant tapering tirz down, stopping it fully, and only then introducing reta at a low starting dose. Clearly, plenty of people disliked that cautious route, since for them it was nearly perfect for putting weight back on.

Whether someone with a prior high tirz tolerance can handle 6 mg of reta as a first dose is uncertain either way. The data simply isn't there to support broad claims. What we do know: in the phase 3 reta trials, nobody reached 6 mg or more before the third month (month three offered 4 mg, 6 mg, or 8 mg). Phase 2 for reta tested starting doses up to 4 mg, but GI side effects pushed phase 3 to settle on 2 mg. Even at 4 mg, I'd split it rather than give it as one shot.

Also, whatever kit you're using, the first dose should always be a baby dose, particularly when third-party testing hasn't been done.

Either way, there's no reason to redline the glucagon engine in week one. Reta's half life (6 days) runs slightly longer than tirz's (5 days). With shorter-acting lira or orfo, the worry would be smaller.

Reta/glucagon also brings other effects on the liver, blood pressure, and more. A few reta-specific threads on sides:




Reta and Low Carb equals Some Dizzy Spell?



So, after Reddit was mentioned in another thread, I popped over. YIKES! Anyways, one had mentioned getting light headed and passing out, along with a few others. This got me thinking, as I've had like 2 of slight light headed deals in the last week, nothing major and goes away quick. Now, we've...

GLP1Chat.com




Anyone on Reta experience panic attacks?



My first 4 weeks were completely fine. Then during the last 2–2.5 weeks I’ve had two panic-attack–type episodes within a few days after my injection — racing heart, sudden anxiety, heavy “WTF is happening” feeling. The last one hit hard enough that I went to the VA and they had to give me Ativan...

GLP1Chat.com

Here at least, tirz doesn't draw complaints about 22-day hiccups or projectile vomiting the way reta does. People who lived through it found out the hard way that reta can behave very differently.

For @BamaCrazy, professional medical help did little for persistent reta hiccups (after moving from 8 mg to nearly 12 mg of reta; titrating up without factoring in test mg):

BamaCrazy said:


22 days straight hiccups. Multiple doctors appointments. 3 changes in medications. CT and Ultrasound scans of my brain, chest, and abdomen. ER visit. Gastroenterologist and neurologist appointments. Then on day 23 when the Gastroenterologist went to do my endoscopy my hiccups stopped completely. The endoscopy did find a hiatal hernia but he said it was too small to be the cause of the hiccups. He blamed the GLP and later said the hiccups stopped because the medication finally left my system completely.

It was a nightmare that finally ended.

Click to expand...

With @bluefootedboobie, another reta hiccups case, at 7 mg:




Severe hiccups / diaphragm spasms on Reta



Tldr; Has anyone else experienced hiccup problems on reta? Does anyone have any advice? Long version: Beginning September 1st, I've had off-and-on severe hiccup problems. The first time it happened (9/1), I had moved from 5 mg to 7 mg of Reta weekly two weeks prior and was doing extremely...

GLP1Chat.com

I dialed back my 7 mg weekly dosage to 5 mg, which was the dosage I'd been taking before when I'd had zero issues whatsoever.

Click to expand...

Projectile vomiting at 1.5 mg of reta:




How to transition



I was on 2mg tirz but it worked phenomenally. And then I found out about grey market and retatrutide. Decided to buy a reta kit from nexaph but not feeling the reta at all yet which I understand is normal. Should I stay on tirz 2mg while I titrate up?

GLP1Chat.com

DeafJam said:


When I went from 1 mg to 1.5 mg of Reta, I wound up projectile shitting across the bathroom and into the hallway when I went to puke. lol. It never hurts to be cautious.

Click to expand...

Me, I've pushed through some nasty GI sides while stacking or titrating up too fast. Still, like before, I steer clear of anything that looks insane, so I can dodge the ER, which so far I have. My current stacking base is only 6 mg of tirz, yet every GLP drug has hit me hard at some mg when I was starting out, including the ones that only touch GLP-1 receptors (sema, lira, and orfo).

Over on TG, a few people argued with me that GLP veterans could safely start orfo at 12 mg (dose range 1 mg to 36 mg), despite trials settling on 1 mg. They wouldn't budge, since for theoretical reasons they refused to split the tablet smaller. With reta, though (and other injectables where you choose the dose), nothing forces you into "go big or go home" at the start.

 

[lessthanhalf]

I'll take your word that your investigation into retatrutide-specific adverse effects goes deeper than mine, and it's possible I underestimated how much those effects matter.

The trouble is that the trials don't give us reliable figures on what happens when you begin dosing or step it up — for any GLP, really. All we get are rates for nausea, vomiting, diarrhea and constipation as the only frequently reported problems, and most are labeled mild, with little explanation of where the line for mild sits.

When it comes to serious drug-related harm during initiation and escalation with GLP's, persistent vomiting is far and away the leader. That can bring dehydration and possibly kidney damage, and it lands people in hospital in 0.5-2% of cases ( chatgpt estimate ). That's a genuine issue and nowhere near uncommon, and I can't say with confidence that any one GLP is clearly safer than the rest on this front. If forced to rank them by risk, I'd put semaglutide highest, then retatrutide, then tirzepatide lowest.

Realistically, this is the big thing most likely to go wrong when starting or raising GLP doses, and a 0.5-2% hospital rate is not even slightly rare — it has to be factored in. It matters even more for someone older, or diabetic, or carrying other significant health conditions, and in those cases escalation has to be handled with extra care.

Gallstones come next among serious problems, though that risk accompanies any weight loss rather than being GLP-specific, sitting around 1-2% across a couple of years.

My guesses for a reta starting dose came from how I think the different drugs compare on gastrointestinal effects, plus some margin for safety. But with the reports above of real problems at lower reta doses, perhaps it should be lower still — 4mg, or split into 2mg twice weekly, which would be safer again. No crossover dose or titration plan carries zero risk. I know from my own experience how much GLP side effects can diverge from expectations: I couldn't handle ozempic past 0.6-0.7mg/week, yet tirzepatide at 15mg/w gave me almost nothing.

To my mind, one of the worst titration risks out there is the official semaglutide ladder of 0.25 - 0.5 - 1 - 1.7 - 2.4mg. Every step above 0.5mg is a big jump and carries a high chance of triggering substantial nausea and vomiting.

 

[jackie.d.]

lessthanhalf said:

I don't agree that moving over to 6mg of reta would probably cause problems. Assuming 15mg of tirzepatide sits well with you, then 6 or even 8 mg of reta ought to produce fewer gastrointestinal side effects than the tirz you're currently taking. A minor concern is a faster heartbeat, so if cardiac disease is present, it may be better to remain on tirz, or if you tend to get anxious, then take reta more gradually. Skin sensory symptoms are another low-probability possibility, and they appear to show up more often with reta than with tirz. Nausea and other worsening gastrointestinal symptoms are also a low-probability possibility, since reactions to different GLP drugs can be somewhat idiosyncratic.

Every dose escalation plan carries some risk, but on most measures 6 or 8 mg of reta ought to cause fewer side effects than 15mg of tirz. Splitting the dose in half and taking it twice weekly is one way to lower that risk, continuing until you reach a dose that either controls hunger and weight loss rate adequately or produces side effects, at which point you stop raising the dose or slow down considerably, and you can switch to weekly dosing instead. How far up you go depends mostly on how overweight you were at the start; if the obesity is severe and long term, then 12mg is what I would suggest, staying on it long term to prevent serious obesity related health problems, provided side effects are not an issue. The lowest dose possible is what most people here would recommend, which I think is fine when obesity is not severe.

Use GLP plotter to see what different doses do in your body, and how long doses take to be absorbed and decline; it makes it easier to make sense of effects and side effects with different doses and schedules.

Thanks for sharing your take — it does help me see things differently. If that's the case, should I simply stop tirz completely so I don't stack too much? My starting weight was 208 lbs, and now I'm at 179 or more; I'm 5'4", so my current bmi might be 32, and I began around 34

Calm Logic said:

lessthanhalf said:

I don't agree that moving over to 6mg of reta would probably cause problems. Assuming 15mg of tirzepatide sits well with you, then 6 or even 8 mg of reta ought to produce fewer gastrointestinal side effects than the tirz you're currently taking. A minor concern is a faster heartbeat, so if cardiac disease is present, it may be better to remain on tirz, or if you tend to get anxious, then take reta more gradually. Skin sensory symptoms are another low-probability possibility, and they appear to show up more often with reta than with tirz. Nausea and other worsening gastrointestinal symptoms are also a low-probability possibility, since reactions to different GLP drugs can be somewhat idiosyncratic.

Every dose escalation plan carries some risk, but on most measures 6 or 8 mg of reta ought to cause fewer side effects than 15mg of tirz. Splitting the dose in half and taking it twice weekly is one way to lower that risk, continuing until you reach a dose that either controls hunger and weight loss rate adequately or produces side effects, at which point you stop raising the dose or slow down considerably, and you can switch to weekly dosing instead. How far up you go depends mostly on how overweight you were at the start; if the obesity is severe and long term, then 12mg is what I would suggest, staying on it long term to prevent serious obesity related health problems, provided side effects are not an issue. The lowest dose possible is what most people here would recommend, which I think is fine when obesity is not severe.

Use GLP plotter to see what different doses do in your body, and how long doses take to be absorbed and decline; it makes it easier to make sense of effects and side effects with different doses and schedules.

On 20 mg of tirz, plenty of users still wouldn't kick off reta at 6 mg, much less 8 mg. In a reta trial, those amounts wouldn't come until week nine. Compared with no glucagon adjustment at all, eight weeks gives the body a long runway to adapt.

Beyond that, this thread covers a less cautious transition (the title says "cross-titrating," which in practice means stacking), rather than a straight swap (quit tirz entirely, then begin reta). Back when all of this was new, the old-school swap method meant tapering tirz down, stopping it fully, and only then introducing reta at a low starting dose. Clearly, plenty of people disliked that cautious route, since for them it was nearly perfect for putting weight back on.

Whether someone with a prior high tirz tolerance can handle 6 mg of reta as a first dose is uncertain either way. The data simply isn't there to support broad claims. What we do know: in the phase 3 reta trials, nobody reached 6 mg or more before the third month (month three offered 4 mg, 6 mg, or 8 mg). Phase 2 for reta tested starting doses up to 4 mg, but GI side effects pushed phase 3 to settle on 2 mg. Even at 4 mg, I'd split it rather than give it as one shot.

Also, whatever kit you're using, the first dose should always be a baby dose, particularly when third-party testing hasn't been done.

Either way, there's no reason to redline the glucagon engine in week one. Reta's half life (6 days) runs slightly longer than tirz's (5 days). With shorter-acting lira or orfo, the worry would be smaller.

Reta/glucagon also brings other effects on the liver, blood pressure, and more. A few reta-specific threads on sides:




Reta and Low Carb equals Some Dizzy Spell?



So, after Reddit was mentioned in another thread, I popped over. YIKES! Anyways, one had mentioned getting light headed and passing out, along with a few others. This got me thinking, as I've had like 2 of slight light headed deals in the last week, nothing major and goes away quick. Now, we've...

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Anyone on Reta experience panic attacks?



My first 4 weeks were completely fine. Then during the last 2–2.5 weeks I’ve had two panic-attack–type episodes within a few days after my injection — racing heart, sudden anxiety, heavy “WTF is happening” feeling. The last one hit hard enough that I went to the VA and they had to give me Ativan...

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Here at least, tirz doesn't draw complaints about 22-day hiccups or projectile vomiting the way reta does. People who lived through it found out the hard way that reta can behave very differently.

For @BamaCrazy, professional medical help did little for persistent reta hiccups (after moving from 8 mg to nearly 12 mg of reta; titrating up without factoring in test mg):

BamaCrazy said:


22 days straight hiccups. Multiple doctors appointments. 3 changes in medications. CT and Ultrasound scans of my brain, chest, and abdomen. ER visit. Gastroenterologist and neurologist appointments. Then on day 23 when the Gastroenterologist went to do my endoscopy my hiccups stopped completely. The endoscopy did find a hiatal hernia but he said it was too small to be the cause of the hiccups. He blamed the GLP and later said the hiccups stopped because the medication finally left my system completely.

It was a nightmare that finally ended.

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With @bluefootedboobie, another reta hiccups case, at 7 mg:




Severe hiccups / diaphragm spasms on Reta



Tldr; Has anyone else experienced hiccup problems on reta? Does anyone have any advice? Long version: Beginning September 1st, I've had off-and-on severe hiccup problems. The first time it happened (9/1), I had moved from 5 mg to 7 mg of Reta weekly two weeks prior and was doing extremely...

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I dialed back my 7 mg weekly dosage to 5 mg, which was the dosage I'd been taking before when I'd had zero issues whatsoever.

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Projectile vomiting at 1.5 mg of reta:




How to transition



I was on 2mg tirz but it worked phenomenally. And then I found out about grey market and retatrutide. Decided to buy a reta kit from nexaph but not feeling the reta at all yet which I understand is normal. Should I stay on tirz 2mg while I titrate up?

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DeafJam said:


When I went from 1 mg to 1.5 mg of Reta, I wound up projectile shitting across the bathroom and into the hallway when I went to puke. lol. It never hurts to be cautious.

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Me, I've pushed through some nasty GI sides while stacking or titrating up too fast. Still, like before, I steer clear of anything that looks insane, so I can dodge the ER, which so far I have. My current stacking base is only 6 mg of tirz, yet every GLP drug has hit me hard at some mg when I was starting out, including the ones that only touch GLP-1 receptors (sema, lira, and orfo).

Over on TG, a few people argued with me that GLP veterans could safely start orfo at 12 mg (dose range 1 mg to 36 mg), despite trials settling on 1 mg. They wouldn't budge, since for theoretical reasons they refused to split the tablet smaller. With reta, though (and other injectables where you choose the dose), nothing forces you into "go big or go home" at the start.

There's a lot for me to mull over here. Not long ago I saw a doctor in a video bring up the "reclining your heart rate" concern, which was new to me. Personally, I tend to test with low blood pressure, but in my family, tartar has affected all the men (I'm a woman, yet I try to keep every factor in mind), and they all died from heart attacks by 62. They also ate poorly, avoided exercise, smoked, and drank, whereas I live very differently and do none of those things. It's tough to label that as genetic when it could equally stem from lifestyle choices. Regardless, I believe I've settled on beginning with a small dose and watching how it goes.

 

[Calm Logic]

For the majority of individuals, reta appears to offer improved cardiovascular outcomes in general, for instance reduced LDL compared to tirz:

Gemini said:


For most people, the benefit of lower blood pressure and better lipids far outweighs the slight increase in heart rate, but for someone already dealing with a high resting pulse or specific heart rhythm issues, tirzepatide remains the more "conservative" choice for now.

Click to expand...

 

[Diamondd817]

I made the change from 7.5mg Tirz to 6mg Reta. No problems at all. Weight loss is still happening.

 

[JCO79]

I really appreciate how folks here can talk through something like this without getting defensive or turning it hostile. This has been a great discussion.

 

[jackie.d.]

JCO79 said:

I really appreciate how folks here can talk through something like this without getting defensive or turning it hostile. This has been a great discussion.

This forum's willingness to engage is something I value a great deal! I wanted personal experiences, and what I got was a wide range of perspectives, every one of them shared with respect and care. Nothing better!

My aim was to cut both my spending and the amount I'm injecting, while also picking up some of reta's longevity upside, so I chose to step tirz down by 3mg per week and bring reta in at a very small starting point with slow increases. Because I almost never get side effects even at a high tirz dose, I'm quite sure I won't run into many problems. Pinning happens Sunday night, so I've slotted .5mg reta in on Thursday morning, which leaves enough of a gap to clear the tirz peak and might help carry me through the tail end of the week. It's going well so far. I'll keep doubling the reta every 2 weeks up to 2mg and judge from there. Should it be necessary, I can add 1mg more, though most people seem to hit the odd side effects somewhere from 4 to 8mg, and past 8mg the returns sound like they shrink.

If anything moves forward or goes wrong, I'll come back and share it. May the odds be ever in my (and all of y'all's) favor