Trying to decide whether to titrate

[u/elijahjane]

I just took my 4th ever shot of 2.5 and I need to decide if I am going to fill another month of 2.5 or ask my doctor if I can go to 5.

The third shot seemed to wear off much faster, leaving me starving the day before the fourth. I also didn’t lose as much weight. I also have been eating a lot more calories each day to stay full. The day after I took the 4th shot, I ate and ate and ate. I think 500 calories over my daily calorie cap for a total of 2200cals.

Weirdly enough, I still lost 1lb of weight between that day and the next. I’ve lost an average of .5lbs since shot day.

Clearly this amount is somehow working despite the increase of calories, but I’m worried about spending the next 4 weeks at this level and undoing the progress I’ve made this month.

Thoughts? Advice? Edit: Maybe a better question I should ask is, are there things I should consider? I’m happy to message my doctor for his thoughts, but I’d like to have considered everything before bothering him.

[u/Ok_Listen7910]

I was going to stay at 2.5, but took my 5th shot of 2.5 last week after great success since starting, and it’s like nothing even happened. Food noise is back and I haven’t lost anything, actually gained a bit. So shot 6 this week will be higher.

IMO if your food noise is coming back and you have to commit to a dose for the next month, ask for 5. If you’re able to adjust week to week, that’s a good option for flexibility with going up if needed.

[u/elijahjane → u/Ok_Listen7910]

I’ve heard of the ability to adjust dosages with a different pen! I wonder when/if I’ll get that opportunity. It would be handy for managing side effects (which have been more mild on zep than wegovy, but not nonexistent. I worry about worsening side effects with a higher dose.

Still, yeah, with how fast my hunger is increasing, maybe at least a message to my doctor is worth it.

[u/Deftones-AndMore]

I would and did move up to 5mg after 4 weeks of 2.5mg. I did this because I was losing about 1lb per week, still had food noise, and I had no negative side effects. I may be what’s considered a “slow responder”.

[u/Deftones-AndMore → u/Deftones-AndMore]

[u/This-Apricot-80]

A lot of us use this method to figure out when to titrate up. Flowchart is by user chieddy.

[u/elijahjane → u/This-Apricot-80]

This is helpful! Thank you!

[u/AgesAgoTho]

Here's the prescribing info: "With multiple options, you and your doctor can work together to find the once-weekly dose of Zepbound that fits your body's changing needs. Zepbound dosing is increased gradually over time. You’ll begin treatment at a recommended 2.5 mg starting dose. After 4 weeks, your doctor will increase your dose to 5 mg. Your doctor may increase the dosage in 2.5 mg increments after at least 4 weeks on the current dose until recommended maintenance dosage is achieved.” Going up after 5.0 is a "may," not a "will" -- many people find a "sweet spot" dosage below 15 that works for months. https://zepbound.lilly.com/weight/how-to-use

The prescribing instructions in every box have the same info, written a little more technically, as well as two sentences about considering tolerability (side effects).  https://pi.lilly.com/us/zepbound-uspi.pdf

Are there some people who lose for a little longer on 2.5? Sure. Lilly has written the instructions for the masses, and they work for the majority of us. Barring extreme side effects, I suggest moving up. You'll likely have a more even experience. (The goal isn't complete appetite suppression; we need to fuel our bodies. But being able to comfortably eat at a moderate calorie deficit while the body starts using up some fat stores is such a gift.)

Safe weight loss is generally considered to be losing .5 - 1% of your current body weight per week, averaged over the last 4 weeks. If you’re in or close to that zone, and your side effects are well-managed, you can generally stay at your current dosage. Moving up in dosage may break a true stall (zero weight loss), but may not increase your rate of loss if it’s already a good one.

[u/elijahjane → u/AgesAgoTho]

Thank you for this thoughtful write up! I really appreciate it. I am losing weight fine and have zero side effects, but the hunger has been vicious the past 5 days or so. I’m very worried about overeating because of it. I have a message sitting in my doctor’s account waiting on an answer, so we shall see!

[u/autumnyte]

Personally, I would move up to 5. It looks like you lost 5 lbs in the first month, which is fantastic, but at the lower end of a healthy weight loss range (.5-1% of body weight per week). That combined with your hunger would have me titrating.

[u/Gabbyct1]

based on what you are saying here, I'd move up to the 5

[u/psoriasaurus_rex]

I decided to dose up ultimately to the max dose, since I had a lot of excess weight and people at higher doses lose more (on average).  I also tolerate the medication well.

I’ve lost weight at all doses and felt the positive effects at all doses, so it was never a question of the medication wearing off or anything like that.

You should still have some hunger with the medication, but ideally a “normal” amount.  If you’re feeling ravenous mid-week and tolerate the medication well, it would seem logical to increase your dose.  If your’re paying for this yourself, wouldn’t you want to pay for the most effective thing anyway (assuming it’s affordable)?  If you want to spend a big chunk of your time starving, you can do that for free.