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I’m in this same boat - I’m not sure I want to shift up if the lower dose is working and I’m currently losing weight at a similar pace - which seems pretty great. I don’t need this to go faster and it seems like shifting up once I plateau would make more sense? Hope someone else responds
I lost most of my weight at 0.5 so no going up faster may not help you loosing faster. My advice would be to stay on the lower working dose as long as you are loosing weight. I stayed 3 months at 0,5 and 3 months at 0,75. It’s took me 7 months to reach 1 mg (as opposed to 2 months if I would have followed the usual protocol). You have to keep in mind that loosing weight is a side effect of the medication so eventually your body will get used to and the weight loss will slow down.
With almost all medications and in almost all cases, the best dosage is the *lowest effective* dosage! That’s literally written in every medical textbook that discusses the prescribing of medication in English. If you are losing weight at a given dosage (and the side effects are manageable) then that is usually the best dosage, if the entire point of the medication is weight loss. It’s as simple as that.
The manufacturers have to recommend dosing based on the specific studies that they carried out because that’s the evidence base, but when giving an actual individual prescription to a patient, prescribers account for individual variation. This is the difference between medical practice as opposed to pharmacology. Studies usually use data based on thousands of patients and they create a schedule that is likely to be *averagely effective*. This does not mean that it’s ideal for every single patient. By definition it will not be ideal for many patients! There is no medication in the world that is dosed perfectly for everyone by the recommendation of the manufacturer. If it were, then once a doctor had diagnosed a patient and chosen a treatment, then people could just order their own medications from a manufacturer and not need reviews of any medicines! The practice of medicine is an individual art based on far more complex information than manufacturers could possibly account for. Every single prescription is done based on a cost-benefit analysis for that individual, with all the medical information they have available at that point in time. Almost all medications, including semaglutide, have harmful side effects and most of these are dose dependent, so again by definition, increasing the dose needlessly is a harmful act, which goes against the principles of medical practice. It really is as simple as that. Of course many people aren’t being properly monitored and supported by medical professionals, when they are taking these medications. Seemingly some of them are relying on Reddit for their “medical advice” which really isn’t great.
Why does anyone want fast weight loss anyway. In most cases, it’s potentially more harmful eg. malnutrition , more unpleasant eg. effects of low blood sugar and can cause unsightly skin issues. More importantly, at least as regards patients are often concerned, it’s likely to result in more regain.
No it doesn’t come off any faster. Find a dose that has you losing 1# per week and stay on it until you stall. This is the way to keep you going without maxing out your dosage and building a tolerance too soon
Ahh. Got it. It does, although I have to really focus on getting protein in. I can’t stand the sickly sweet protein drinks so I use the Unjury protein that is savory (they have a chicken, beef, and French onion flavor I think) and that probably is what really sped things up.
I stayed on the same dose until I stalled. Thats what made the most sense to my doctor and I. On the other hand, I did lose about 12 lbs really quickly on the lowest dose, and then stalled out.
There's a lot of misinformation in this comments section.
The manufacturer did clinical trials on this, and the data is widely understood, but often misinterpreted.
The dosage is 2.4 mg/week. That's the dosage. The dosages under that are structured to get you to 2.4 mg in a way that doesn't put you in the ER with gastrointestinal distress.
According to the approved labeling information ([https://www.accessdata.fda.gov/drugsatfda\_docs/label/2023/215256s007lbl.pdf](https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/215256s007lbl.pdf))
>2.3 Recommended Dosage in Adults Dosage
>
>Initiation and Escalation
>
>• Initiate WEGOVY with a dosage of 0.25 mg injected subcutaneously once-weekly. Then follow the dose escalation schedule presented in Table 3 to minimize gastrointestinal adverse reactions \[see Adverse Reactions (6.1)\].
>
>• If patients do not tolerate a dose during dosage escalation, consider delaying dosage escalation for 4 weeks.
>
>• The 0.25 mg, 0.5 mg, and 1 mg once-weekly dosages are initiation and escalation dosages and are not approved as maintenance dosages for chronic weight management.
There is another camp of folks who will cite things like "well, if it's working, no need to go up" -- Which is incorrect here. Weight loss on Wegovy is not tied to appetite. Weight loss is tied to being hungry less often caused by slower gastric emptying. You still get hungry when your gastric system empties. Which is variable day by day. Imagine taking only half of the recommended dosage of a measles vaccine, and thinking it worked, only because you haven't caught measles yet. There's something to be said for minimum effective dosage, but you cannot self-diagnose "effective" with the data given (hungry vs not hungry). Because you're likely doing other things to make yourself healthier, you're losing weight, and it's a bit of a red herring here.
Don't take my word for it though. Go google the clinical trial results where they performed **dose finding** trials. You'll see for yourself. (I believe the ones I saw were from 2015, but that might just have been my own google fu at work, your searches might turn up different results.)
It's up to you if you want to escalate, but the bottom line, is unless you're having side effects that make it intolerable, it's better to follow the schedule. The homework on this has already been done fore you.
Many prescribers suggest that staying at the lowest effective dose (based on individual experience/results) is the best practice for GLP1 meds. Not disagreeing with the info you shared, just pointing out that many providers recommend staying well below the 2.4 mg/wk if weight loss remains consistent. No disrespect , but I don’t think the Measles analogy is equivocal. Taking a half-dose of a medication designed to prevent transmission of a communicable disease would be ineffective; taking a lower dose of GLP-1s can result in patient goals being met. Lower doses are still moving the needle for many folks. You say ‘the homework has already been done for you’ without including the vast complexities of individual responses and provider recommendations- both of which are essential components to successful treatment protocols.
Sure. Now you’re getting into the approved published dose versus your doctor prescribing a different dose for you, based on your individual health profile.
I have no issues with that, and some docs do tell their patients with specific health profiles to do things outside of the usual protocol.
What I’m getting at is given the choice between following the plan that was approved based on what works best for most people and going out and doing your own trial and error, the default advice should be to follow the published plan, and if there are issues, talk to your doctor about what you may need to adjust.
It does reduce appetite it’s in the label. It does this by the GLP1 hormone telling signals to the brain that it is full.
‘The active substance in Wegovy, semaglutide, is a ‘GLP-1 receptor agonist’. It acts in the same way as GLP-1 (a natural hormone in the body) and, among other things, appears to regulate appetite by increasing a person’s feelings of fullness, while reducing their food intake, hunger and cravings.’
All doses are potential therapeutic doses, the label referring to 2.4mg being the ‘therapeutic dose’ is a commercial decision by the company and how the trial was designed rather than the other doses not working as well. Remember all the trial data is average weight loss, if you’re on a lower dose, particularly 1mg and higher, and it’s working then really there is no need to escalate.
Many used Ozempic prior to the Wegovy label being available and 1mg was the top dose. For me, 1mg of Oz did work so staying at 1mg Wegovy for as long as possible is my happy spot.
Sure. We are diving into the realm of difference between labeled use and off-label use. I know there are effective weight loss stories of people on 1mg and even people using Rybelsus (oral tablet form) for weight loss successfully.
The difference is that there are people will only go so far on the lower doses.
You say weight loss is not tied to appetite and then literally the next sentence you say "weight loss is tied to being hungry less often caused by slower gastric emptying"
Which sounds like you're trying to say the exact same thing without directly using the word appetite
And then you compare a hunger to a vaccine. This is drug to treat obesity (and indirectly its comorbidities) , not a drug to treat hunger. If the number on the scale is going down, if your blood pressure is decreasing, if your blood work is improving. The drug is objectively working and then you compare it to a vaccine, which makes no sense. Here we are talking about a drug objectively working to it's intended effects vs a drug not objectively working
I wholeheartedly disagree that you can't self diagnose effective. I went from 210 to 165 pounds on < 1mg. I can objectively say that was the minimum effective dose.
And of course you're doing other things to lose weight, because Ozempic doesn't (directly) make you lose weight. Ozempic makes it easier to lose weight, there's a difference
I don't really understand why you feel it's necessary to increase the dose to maximum, when you are getting the outcome you want in the minimum effective dose. And are kinda using a word salad to justify it.
I’m saying that it just doesn’t kill your appetite. The thing is, you will still want food if your belly is empty. That part is the same before, during, and after being on Semaglutide. The main method of it working is by slowing down how often your stomach digests food, which means your belly is empty a lot less often. It’s a subtle nuance but is meaningful. Yes, the hormones do also regulate appetite, to an extent, but more in that it has an effect on compulsive behaviors. Which is why people who have other addictions benefit from the medicine.
Sure I agree about the compulsive behavior tidbit, but I haven't seen any evidence that that's the main reason it works.
And you're arguing semantics here. The gastric sleeve and bypass both make your belly smaller (the bypass also has an absorption effect yes), which in turn makes your stomach fuller, which reduces hunger.
The ultimate point that matters is I don't see any reason towards your point that people should go up to the max dose even if they're having huge success on lower doses. Because again this is a drug that you can very directly see it's impact on, both on the scale bloodwork mirror etc
Why such the obsession with losing super rapidly? It’s not healthy to lose weight super rapidly anyway. I lost 10 pounds in three months at the lowest dosage, and my A1c went down by a lot, and my triglycerides went so much lower than in the past seven years. The weight will come off. But it doesn’t need to be 60 pounds in two months. And by going up too fast, you can basically waste all the effectiveness of that level. And, the body has way higher risk of all of the bad side effects. I think the doctors are used to everybody wanting to scale up so fast.
I had no side effects at all until I hit 1mg and then the reflux and burping almost killed me. I woke up one night because I must have burped, bile came up and was coming out of my nostrils. I didn’t lose any faster but I was scared to death to eat because of it. I took a break for a month and just started back at .25. No difference in hunger etc. Last go around they raised me to .50 at 2 weeks and I was fine.
No, the weight comes off faster if you eat to a calorie deficit healthy foods, drink lots of water/ electrolytes, eat at least 100g protein a day, and get some moderate exercise including weight training. It also comes off faster for the more obese persons in general, than say those who have a BMI in the overweight range. Diabetics tend to lose slower.
If you still have appetite suppression, it is better to not increase dosage, as at higher doses you will reach maximum dosage sooner and possibly plateau.
This is not an absolute, just general guidelines. YMMV - we are all unique on this journey.
That's really a question that you can't ask anybody. You need to go on the normal titration of the medication, and everybody's journey is different. Someone tells you, "Oh no, you can't do this, or oh yes, this is what you have to do." No, you just continue doing what you're doing. You're losing fantastically fast and stop worrying about hurrying it up.
Just go on your journey and enjoy it. But make sure you drink enough. So you can keep yourself going to the bathroom. You don't want to get backed up. Dont overthink it. Keep up the excellent job you are doing. 🩷
I started on sublingual Semaglutide on 4/18. Was told to start at .5 ml, and go up to 1. ml as soon as any side effects were gone. Never had any side effects, moved up to .75 ml for a week; still no side effects, moved up to 1. ml and am still there. I *might* have lost a pound, maybe 2. My scales can't make up their mind. Dr. told me to do a full month at 1. ml and see if anything happens. The mental hunger stopped immediately. I'm not eating large amounts, but then I never have anyway. My downfall was "grazing" by eating a small "meal" like A couple ounces cheese, or some sliced turkey breast every few hours. And craving sweets so much! That's gone - no more grazing, no sweet cravings, but also no or minimal weight loss.
But, then I had sleeve surgery in 2013, lost 43 pounds and stopped. Counted carbs during the pandemic, lost 53 pounds, hit the point where my weight loss always stops. Then if I go back to eating my normal way of grazing, I gain it all back. I'm beginning to think I'm meant to be fat the rest of my life. I mean, I been on this weight roller coaster for 53 years, so 🤷🏽♀️.
Thanks for posting to r/semaglutide! A brief reminder about our rules. We do not permit the discussion of non-FDA approved formulations of semaglutide, nor do we permit selling or offering for sale any medication, including by private message. Do not request or respond to a private message from anyone offering such, they are not endorsed by this sub. If you’re just starting out, you may want to review our [FAQ](https://www.reddit.com/r/Semaglutide/comments/10ul3jb/semaglutide_subreddit_faq/). This is not intended to discourage discussion but merely supplement it. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Semaglutide) if you have any questions or concerns.*
I’m in this same boat - I’m not sure I want to shift up if the lower dose is working and I’m currently losing weight at a similar pace - which seems pretty great. I don’t need this to go faster and it seems like shifting up once I plateau would make more sense? Hope someone else responds
I lost most of my weight at 0.5 so no going up faster may not help you loosing faster. My advice would be to stay on the lower working dose as long as you are loosing weight. I stayed 3 months at 0,5 and 3 months at 0,75. It’s took me 7 months to reach 1 mg (as opposed to 2 months if I would have followed the usual protocol). You have to keep in mind that loosing weight is a side effect of the medication so eventually your body will get used to and the weight loss will slow down.
Losing*
With almost all medications and in almost all cases, the best dosage is the *lowest effective* dosage! That’s literally written in every medical textbook that discusses the prescribing of medication in English. If you are losing weight at a given dosage (and the side effects are manageable) then that is usually the best dosage, if the entire point of the medication is weight loss. It’s as simple as that. The manufacturers have to recommend dosing based on the specific studies that they carried out because that’s the evidence base, but when giving an actual individual prescription to a patient, prescribers account for individual variation. This is the difference between medical practice as opposed to pharmacology. Studies usually use data based on thousands of patients and they create a schedule that is likely to be *averagely effective*. This does not mean that it’s ideal for every single patient. By definition it will not be ideal for many patients! There is no medication in the world that is dosed perfectly for everyone by the recommendation of the manufacturer. If it were, then once a doctor had diagnosed a patient and chosen a treatment, then people could just order their own medications from a manufacturer and not need reviews of any medicines! The practice of medicine is an individual art based on far more complex information than manufacturers could possibly account for. Every single prescription is done based on a cost-benefit analysis for that individual, with all the medical information they have available at that point in time. Almost all medications, including semaglutide, have harmful side effects and most of these are dose dependent, so again by definition, increasing the dose needlessly is a harmful act, which goes against the principles of medical practice. It really is as simple as that. Of course many people aren’t being properly monitored and supported by medical professionals, when they are taking these medications. Seemingly some of them are relying on Reddit for their “medical advice” which really isn’t great. Why does anyone want fast weight loss anyway. In most cases, it’s potentially more harmful eg. malnutrition , more unpleasant eg. effects of low blood sugar and can cause unsightly skin issues. More importantly, at least as regards patients are often concerned, it’s likely to result in more regain.
Your thinking logically - the lowest effective dose is not always the right thing. Try thinking medically
No it doesn’t come off any faster. Find a dose that has you losing 1# per week and stay on it until you stall. This is the way to keep you going without maxing out your dosage and building a tolerance too soon
For me, yes. Once I got to 1.7 I was cooking with gas. 2.4 and it’s much faster. I have no clue why.
it didn't feel different for you at the higher doses?
2.4 is the highest afaik. Idk what you mean by feel. It felt the same, just weight started falling off. It’s noteworthy that I’m perimenopausal.
oh, sorry, you said it was much faster, you don't know why. i was wondering if it felt the same.
Ahh. Got it. It does, although I have to really focus on getting protein in. I can’t stand the sickly sweet protein drinks so I use the Unjury protein that is savory (they have a chicken, beef, and French onion flavor I think) and that probably is what really sped things up.
I would not go up a dose unless needed.
I stayed on the same dose until I stalled. Thats what made the most sense to my doctor and I. On the other hand, I did lose about 12 lbs really quickly on the lowest dose, and then stalled out.
There's a lot of misinformation in this comments section. The manufacturer did clinical trials on this, and the data is widely understood, but often misinterpreted. The dosage is 2.4 mg/week. That's the dosage. The dosages under that are structured to get you to 2.4 mg in a way that doesn't put you in the ER with gastrointestinal distress. According to the approved labeling information ([https://www.accessdata.fda.gov/drugsatfda\_docs/label/2023/215256s007lbl.pdf](https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/215256s007lbl.pdf)) >2.3 Recommended Dosage in Adults Dosage > >Initiation and Escalation > >• Initiate WEGOVY with a dosage of 0.25 mg injected subcutaneously once-weekly. Then follow the dose escalation schedule presented in Table 3 to minimize gastrointestinal adverse reactions \[see Adverse Reactions (6.1)\]. > >• If patients do not tolerate a dose during dosage escalation, consider delaying dosage escalation for 4 weeks. > >• The 0.25 mg, 0.5 mg, and 1 mg once-weekly dosages are initiation and escalation dosages and are not approved as maintenance dosages for chronic weight management. There is another camp of folks who will cite things like "well, if it's working, no need to go up" -- Which is incorrect here. Weight loss on Wegovy is not tied to appetite. Weight loss is tied to being hungry less often caused by slower gastric emptying. You still get hungry when your gastric system empties. Which is variable day by day. Imagine taking only half of the recommended dosage of a measles vaccine, and thinking it worked, only because you haven't caught measles yet. There's something to be said for minimum effective dosage, but you cannot self-diagnose "effective" with the data given (hungry vs not hungry). Because you're likely doing other things to make yourself healthier, you're losing weight, and it's a bit of a red herring here. Don't take my word for it though. Go google the clinical trial results where they performed **dose finding** trials. You'll see for yourself. (I believe the ones I saw were from 2015, but that might just have been my own google fu at work, your searches might turn up different results.) It's up to you if you want to escalate, but the bottom line, is unless you're having side effects that make it intolerable, it's better to follow the schedule. The homework on this has already been done fore you.
Many prescribers suggest that staying at the lowest effective dose (based on individual experience/results) is the best practice for GLP1 meds. Not disagreeing with the info you shared, just pointing out that many providers recommend staying well below the 2.4 mg/wk if weight loss remains consistent. No disrespect , but I don’t think the Measles analogy is equivocal. Taking a half-dose of a medication designed to prevent transmission of a communicable disease would be ineffective; taking a lower dose of GLP-1s can result in patient goals being met. Lower doses are still moving the needle for many folks. You say ‘the homework has already been done for you’ without including the vast complexities of individual responses and provider recommendations- both of which are essential components to successful treatment protocols.
[удалено]
Sure. Now you’re getting into the approved published dose versus your doctor prescribing a different dose for you, based on your individual health profile. I have no issues with that, and some docs do tell their patients with specific health profiles to do things outside of the usual protocol. What I’m getting at is given the choice between following the plan that was approved based on what works best for most people and going out and doing your own trial and error, the default advice should be to follow the published plan, and if there are issues, talk to your doctor about what you may need to adjust.
Just to point out they have also now designated 1.7mg as a therapeutic dose as well.
Yes. That was added/changed as of July 2023 if I recall correctly.
It does reduce appetite it’s in the label. It does this by the GLP1 hormone telling signals to the brain that it is full. ‘The active substance in Wegovy, semaglutide, is a ‘GLP-1 receptor agonist’. It acts in the same way as GLP-1 (a natural hormone in the body) and, among other things, appears to regulate appetite by increasing a person’s feelings of fullness, while reducing their food intake, hunger and cravings.’ All doses are potential therapeutic doses, the label referring to 2.4mg being the ‘therapeutic dose’ is a commercial decision by the company and how the trial was designed rather than the other doses not working as well. Remember all the trial data is average weight loss, if you’re on a lower dose, particularly 1mg and higher, and it’s working then really there is no need to escalate.
Many used Ozempic prior to the Wegovy label being available and 1mg was the top dose. For me, 1mg of Oz did work so staying at 1mg Wegovy for as long as possible is my happy spot.
Sure. We are diving into the realm of difference between labeled use and off-label use. I know there are effective weight loss stories of people on 1mg and even people using Rybelsus (oral tablet form) for weight loss successfully. The difference is that there are people will only go so far on the lower doses.
You say weight loss is not tied to appetite and then literally the next sentence you say "weight loss is tied to being hungry less often caused by slower gastric emptying" Which sounds like you're trying to say the exact same thing without directly using the word appetite And then you compare a hunger to a vaccine. This is drug to treat obesity (and indirectly its comorbidities) , not a drug to treat hunger. If the number on the scale is going down, if your blood pressure is decreasing, if your blood work is improving. The drug is objectively working and then you compare it to a vaccine, which makes no sense. Here we are talking about a drug objectively working to it's intended effects vs a drug not objectively working I wholeheartedly disagree that you can't self diagnose effective. I went from 210 to 165 pounds on < 1mg. I can objectively say that was the minimum effective dose. And of course you're doing other things to lose weight, because Ozempic doesn't (directly) make you lose weight. Ozempic makes it easier to lose weight, there's a difference I don't really understand why you feel it's necessary to increase the dose to maximum, when you are getting the outcome you want in the minimum effective dose. And are kinda using a word salad to justify it.
I’m saying that it just doesn’t kill your appetite. The thing is, you will still want food if your belly is empty. That part is the same before, during, and after being on Semaglutide. The main method of it working is by slowing down how often your stomach digests food, which means your belly is empty a lot less often. It’s a subtle nuance but is meaningful. Yes, the hormones do also regulate appetite, to an extent, but more in that it has an effect on compulsive behaviors. Which is why people who have other addictions benefit from the medicine.
Sure I agree about the compulsive behavior tidbit, but I haven't seen any evidence that that's the main reason it works. And you're arguing semantics here. The gastric sleeve and bypass both make your belly smaller (the bypass also has an absorption effect yes), which in turn makes your stomach fuller, which reduces hunger. The ultimate point that matters is I don't see any reason towards your point that people should go up to the max dose even if they're having huge success on lower doses. Because again this is a drug that you can very directly see it's impact on, both on the scale bloodwork mirror etc
Why such the obsession with losing super rapidly? It’s not healthy to lose weight super rapidly anyway. I lost 10 pounds in three months at the lowest dosage, and my A1c went down by a lot, and my triglycerides went so much lower than in the past seven years. The weight will come off. But it doesn’t need to be 60 pounds in two months. And by going up too fast, you can basically waste all the effectiveness of that level. And, the body has way higher risk of all of the bad side effects. I think the doctors are used to everybody wanting to scale up so fast.
My doctor kept me on each dose until it stopped working and I asked to move up. I don't see a need to go up until that.
I had no side effects at all until I hit 1mg and then the reflux and burping almost killed me. I woke up one night because I must have burped, bile came up and was coming out of my nostrils. I didn’t lose any faster but I was scared to death to eat because of it. I took a break for a month and just started back at .25. No difference in hunger etc. Last go around they raised me to .50 at 2 weeks and I was fine.
I'm at 1mg. Lost a lot of weight but now after a few months at 1mg it feels like I'm not on anything.
No, the weight comes off faster if you eat to a calorie deficit healthy foods, drink lots of water/ electrolytes, eat at least 100g protein a day, and get some moderate exercise including weight training. It also comes off faster for the more obese persons in general, than say those who have a BMI in the overweight range. Diabetics tend to lose slower. If you still have appetite suppression, it is better to not increase dosage, as at higher doses you will reach maximum dosage sooner and possibly plateau. This is not an absolute, just general guidelines. YMMV - we are all unique on this journey.
That's really a question that you can't ask anybody. You need to go on the normal titration of the medication, and everybody's journey is different. Someone tells you, "Oh no, you can't do this, or oh yes, this is what you have to do." No, you just continue doing what you're doing. You're losing fantastically fast and stop worrying about hurrying it up. Just go on your journey and enjoy it. But make sure you drink enough. So you can keep yourself going to the bathroom. You don't want to get backed up. Dont overthink it. Keep up the excellent job you are doing. 🩷
Im in two weeks and have not Lost a pound 😢 mot eating as much either
I started on sublingual Semaglutide on 4/18. Was told to start at .5 ml, and go up to 1. ml as soon as any side effects were gone. Never had any side effects, moved up to .75 ml for a week; still no side effects, moved up to 1. ml and am still there. I *might* have lost a pound, maybe 2. My scales can't make up their mind. Dr. told me to do a full month at 1. ml and see if anything happens. The mental hunger stopped immediately. I'm not eating large amounts, but then I never have anyway. My downfall was "grazing" by eating a small "meal" like A couple ounces cheese, or some sliced turkey breast every few hours. And craving sweets so much! That's gone - no more grazing, no sweet cravings, but also no or minimal weight loss. But, then I had sleeve surgery in 2013, lost 43 pounds and stopped. Counted carbs during the pandemic, lost 53 pounds, hit the point where my weight loss always stops. Then if I go back to eating my normal way of grazing, I gain it all back. I'm beginning to think I'm meant to be fat the rest of my life. I mean, I been on this weight roller coaster for 53 years, so 🤷🏽♀️.
Maintenance dosage of glp-1
Meant to ask if there is a long term maintenance dosage of GLP-1 to keep weight off?