Tirzepatide titration stalled post-Zepbound 15mg — is jumping to 10mg wise?

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jtx05

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Trying to get some input on how to handle titration.

My starting weight was 350lbs, and I got down to 196lbs while on 15mg Zepbound. Then insurance cut me off, and after a unsuccessful try with Wegovy, my weight climbed back to 230lbs.

At this point my wife and I are both on Tirz60. We began together at 2.5mg. I've completed 4 weeks at 2.5mg, 2 weeks at 5mg, and 2 weeks at 7.5mg. Because she's new to it, she followed the standard 4 weeks at 2.5mg and 4 weeks at 5mg. Right now I feel no effects or appetite suppression at all, whereas my wife is getting a good response.

Considering that I previously reached the maximum dose (15mg), would it be safe for me to move straight to 10mg with tonight's injection, or should I stick it out through the rest of the 7.5mg cycle? Anyone else who "re-started" after being on a high dose — did you find you had to titrate up more quickly?
 
jtx05 said:

Trying to get some input on how to handle titration.

My starting weight was 350lbs, and I got down to 196lbs while on 15mg Zepbound. Then insurance cut me off, and after a unsuccessful try with Wegovy, my weight climbed back to 230lbs.

At this point my wife and I are both on Tirz60. We began together at 2.5mg. I've completed 4 weeks at 2.5mg, 2 weeks at 5mg, and 2 weeks at 7.5mg. Because she's new to it, she followed the standard 4 weeks at 2.5mg and 4 weeks at 5mg. Right now I feel no effects or appetite suppression at all, whereas my wife is getting a good response.

Considering that I previously reached the maximum dose (15mg), would it be safe for me to move straight to 10mg with tonight's injection, or should I stick it out through the rest of the 7.5mg cycle? Anyone else who "re-started" after being on a high dose — did you find you had to titrate up more quickly?
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In my opinion, you're free to increase the dose as fast as you feel okay judging your side effects.

I moved from 5mg Tirz to a high dose of Reta fast, with no discomfort and strong results.

If your results this time aren't as striking as they were initially, that wouldn't be surprising.
 
jtx05 said:

Trying to get some input on how to handle titration.

My starting weight was 350lbs, and I got down to 196lbs while on 15mg Zepbound. Then insurance cut me off, and after a unsuccessful try with Wegovy, my weight climbed back to 230lbs.

At this point my wife and I are both on Tirz60. We began together at 2.5mg. I've completed 4 weeks at 2.5mg, 2 weeks at 5mg, and 2 weeks at 7.5mg. Because she's new to it, she followed the standard 4 weeks at 2.5mg and 4 weeks at 5mg. Right now I feel no effects or appetite suppression at all, whereas my wife is getting a good response.

Considering that I previously reached the maximum dose (15mg), would it be safe for me to move straight to 10mg with tonight's injection, or should I stick it out through the rest of the 7.5mg cycle? Anyone else who "re-started" after being on a high dose — did you find you had to titrate up more quickly?
Click to expand...

Amazing work on the weight loss! Dropping over 150lbs is a huge achievement, and the fact that you only regained about 30lbs speaks volumes about how committed you've been. Based on older studies, the rebound could have been far larger.

And yes, when someone restarts a glp-1 medication after previous exposure, it frequently takes increasingly higher doses to get the same effect. Needing 12.5mg or even 15mg before noticing benefits is not unusual.

Given that you've already spent two weeks at 7.5mg and seem to be handling whatever side effects come with it, in your position I'd absolutely move up to 10mg at this point. Perhaps stay there for a week or two, then step up to 12.5mg. After that, keep escalating. Don't halt, and go past 15mg if that's what you need. I'm on 18mg right now and would push even higher if necessary. I wouldn't bother sticking to this 4 week titration schedule. That's clearly meant for someone's first time. Just let your symptoms guide you, and keep in mind that feeling no hunger relief is itself a symptom telling you to increase the dose.
 
It’s worth remembering where the suggested dosing and titration plan actually came from. I’m sure BP was aware that a large share (maybe even most?) of trial participants could handle larger doses fast and without side effects. They also likely knew that how well it worked differed a lot from person to person depending on the dose. Still, sticking with a 4 week titration as the standard probably made the FDA more comfortable…and made BP shareholders very happy.
 
jtx05 said:

Trying to get some input on how to handle titration.

My starting weight was 350lbs, and I got down to 196lbs while on 15mg Zepbound. Then insurance cut me off, and after a unsuccessful try with Wegovy, my weight climbed back to 230lbs.

At this point my wife and I are both on Tirz60. We began together at 2.5mg. I've completed 4 weeks at 2.5mg, 2 weeks at 5mg, and 2 weeks at 7.5mg. Because she's new to it, she followed the standard 4 weeks at 2.5mg and 4 weeks at 5mg. Right now I feel no effects or appetite suppression at all, whereas my wife is getting a good response.

Considering that I previously reached the maximum dose (15mg), would it be safe for me to move straight to 10mg with tonight's injection, or should I stick it out through the rest of the 7.5mg cycle? Anyone else who "re-started" after being on a high dose — did you find you had to titrate up more quickly?
Click to expand...

Given that you've already been on this medication before, I really doubt going up to 10mg will cause you any trouble. From there, you could stay at 10 for 2 weeks and then move straight to 15.

With GLP1 restarts, it's common for the same level of appetite control to need a bigger dose the next time. My suggestion would be to reach 15 as soon as you can, then reassess from there. Best of luck!
 
When it comes to figuring out how much to raise a dose, the strongest signal is what happened the last time you stepped up to that same level. If that earlier increase went smoothly, odds are high it will go smoothly again.

How long you've been away from the medication matters too. A gap measured in weeks usually means you can resume at something near your last dose, while a gap of several months calls for a more gradual approach.

In most cases, going up a dose causes no problems at all when you've had no side effects before. But if you're already dealing with mild side effects at your current dose, raising it will likely make those worse.
 
jtx05,

There's a 2nd element to titration that shouldn't be overlooked: how often you dose. I don't want to derail the thread, but 7 days didn't strike me as necessarily optimal. On top of that, since I preferred to inject more than .5ml/15mg, I took an extra 4.5mg 2 days afterward. That's not presented as some ideal template — just one illustration of a possible injection schedule. And truthfully, halving the dose evenly never seemed like the right solution to me, though that's only my own take.

I suspect the response is more or less already here: move step by step, and let how you feel guide you.
 
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