4 ms·

> Even at the lowest 2.5mg starter dose which you're only allowed to stay on for 1 month... So they are going to force you onto a higher dose?!

by saurik 2y ago

willis936 2y ago
Yes, up to 15 mg. Maintenance levels at 5, 10, and 15. If you cannot tolerate a maintenance level you can still get it, but insurance will not cover it ($1000/mo rather than $15/mo.) This is not an unreasonable situation. https://www.goodrx.com/zepbound/dosage https://www.goodrx.com/zepbound/dosage
- cj 2y ago
  Luckily during the “shortage” you can currently get GLP-1’s in vials rather than injection pens. The brand name GLP’s you can’t control the dose. But when you get it in a vial from a compounding pharmacy you can inject however much or little you want. Not looking forward to ever using the brand name version specifically for this reason
  - dghlsakjg 2y ago
    The injection pen I have see has two marked dosages, but there is nothing stopping you from injecting more or less. Basically it is a ratcheting mechanism where after ~10 clicks you get .25 mg dosage and 20 clicks gets you .50. Basically, no doctor is going to endorse it, but you can dial a dose to whatever amount you want.
  - blackeyeblitzar 2y ago
    Aren’t any states like California trying to ban compounding pharmacies? It’s an unfortunate attack on individual freedom, but I am not sure if we will still have them 20 years from now.
    - dragonwriter 2y ago
      > Aren’t any states like California trying to ban compounding pharmacies? No. California has not banned compounding pharmacies, nor is there a significant movement to do so in the legislature, among the people (who could do so by ballot measure), or a proposal by the governor to do so. California does require additional licensure for sterile compounding, but that is very much not a ban on sterile compounding or compounding more generally. Relevant to GLP-1s, though, several state pharmacy boards (not California’s, as far as I know) have raised issues that compounded GLP-1 drugs that they have seen appear to be illegal, because they use a form other than the FDA-approved base form of semaglutide (which is only available from Novo Nordisk), and th3 form used is not itself approved for human use, and have taken steps to crack down on that. But that's also not banning compounding, but enforcing existing rules on compounding.
    - gedy 2y ago
      I think the issue is more the FDA has hit compounding by announcing semaglutide and tirzepatide are no longer in shortage - so compounding pharmacies aren't legally able to sell the cheaper compounded versions. Since most insurances don't cover GLP-1 for weight loss, this is a huge issue given they cost almost $2000/month in the US out of pocket. I was approved for semaglutide but now compounding pharmacies like Hims are stating their cheaper (<$200/month) compounded versions are out of stock.
    - pkaye 2y ago
      Last week the FDA said the shortages are over so compounding will probably decline as they get sued by the companies. https://www.barrons.com/articles/eli-lilly-zepbound-higher-dose-lower-price-35511af5 https://www.barrons.com/articles/eli-lilly-zepbound-higher-d...
    - IG_Semmelweiss 2y ago
      what is happening is more complicated. First, there's no legislation. What is happening is that the branded drug was in shortage so compounding pharmacies were legally allowed to step in under existing regulations. The shortage status was first updated in the summer, and Novo went on a lawsuit spree. Suing everyone mentioning GLP on a website. But, there have been more back and forths since, very recent. TLDR what is restricted now is not the sale of the compound, but the manufacture of it. Therefore, you can keep selling inventory past the restriction, but of course that will either run out, expire, or be restricted as well. As of now, if everything stays the same, expect the last few compound pharmacies to run out of product at the end of Q3/25 . However, I understand there's groundbreaking legislation being worked on that will dramatically change the status quo for the better, meaning more choice for end consumers and less profits for Novo.
  - loeg 2y ago
    I get vials direct from Lilly and can choose what dose I take. Ask your PCP to check out LillyDirect.
- cm2187 2y ago
  Hum, I don't know, here in the UK, no one is forcing you to do anything. I am free to chose if I want to step up, down or stay on the current dosage every month. And I took the cautious approach to only step up when I stopped feeling the effects at the current dosage, so 8 months in, I am only starting on 10mg (range is 2.5 to 15mg in 2.5 increments).
- blackeyeblitzar 2y ago
  Is that really true? I remember reading that people with side effects often were given lower doses.
- cyberax 2y ago
  If you want lower dosage, then there's a simple trick: just use less frequent injections. For example, try one in 10 days instead of 1 every week. It will result in lower steady-state GLP-1 levels.
matt_heimer 2y ago
It depends. The 5mg, 10mg, and 15mg were the doses tested and recommended as maintence doses. The 2.5mg is meant as a starter to reduce side effects but since most people don't see results with it the recommendation is that you only take it for 4 weeks. The 7.5mg and 12.5mg doses are meant as transitional doses but you can stay on them longer than 4 weeks. Some doctors will go by the Lilly recommendations but I think more are allowing people to stay on the lowest dose providing benefits. That leaves your health insurance as the only other obstacle. There is a chart at https://zepbound.lilly.com/hcp/dosage https://zepbound.lilly.com/hcp/dosage I was one of the rare people that saw results with 2.5mg but by the end of that first month I had plateaued. After 3 months at 5.0mg I've plateaued again and will probably move up to 7.5mg in the near future and stay on it as long as I can. Some people like to go back to 2.5mg as their maintence dose after reaching their weight loss goals.
op00to 2y ago
The inbetween doses are just used for titration. They were not studied as long term doses like the maintenance doses. It’s stupid, and you can get exceptions if you are persistent. I preferred 7.5 mg over 10 mg for example.

> Even at the lowest 2.5mg starter dose which you're only allowed to stay on for 1 month... So they are going to force you onto a higher dose?!

by saurik 2y ago

> Even at the lowest 2.5mg starter dose which you're only allowed to stay on for 1 month... So they are going to force you onto a higher dose?!

willis936 2y ago

Yes, up to 15 mg. Maintenance levels at 5, 10, and 15. If you cannot tolerate a maintenance level you can still get it, but insurance will not cover it ($1000/mo rather than $15/mo.) This is not an unreasonable situation. https://www.goodrx.com/zepbound/dosage https://www.goodrx.com/zepbound/dosage

cj 2y ago
Luckily during the “shortage” you can currently get GLP-1’s in vials rather than injection pens. The brand name GLP’s you can’t control the dose. But when you get it in a vial from a compounding pharmacy you can inject however much or little you want. Not looking forward to ever using the brand name version specifically for this reason
- dghlsakjg 2y ago
  The injection pen I have see has two marked dosages, but there is nothing stopping you from injecting more or less. Basically it is a ratcheting mechanism where after ~10 clicks you get .25 mg dosage and 20 clicks gets you .50. Basically, no doctor is going to endorse it, but you can dial a dose to whatever amount you want.
- blackeyeblitzar 2y ago
  Aren’t any states like California trying to ban compounding pharmacies? It’s an unfortunate attack on individual freedom, but I am not sure if we will still have them 20 years from now.
  - dragonwriter 2y ago
    > Aren’t any states like California trying to ban compounding pharmacies? No. California has not banned compounding pharmacies, nor is there a significant movement to do so in the legislature, among the people (who could do so by ballot measure), or a proposal by the governor to do so. California does require additional licensure for sterile compounding, but that is very much not a ban on sterile compounding or compounding more generally. Relevant to GLP-1s, though, several state pharmacy boards (not California’s, as far as I know) have raised issues that compounded GLP-1 drugs that they have seen appear to be illegal, because they use a form other than the FDA-approved base form of semaglutide (which is only available from Novo Nordisk), and th3 form used is not itself approved for human use, and have taken steps to crack down on that. But that's also not banning compounding, but enforcing existing rules on compounding.
  - gedy 2y ago
    I think the issue is more the FDA has hit compounding by announcing semaglutide and tirzepatide are no longer in shortage - so compounding pharmacies aren't legally able to sell the cheaper compounded versions. Since most insurances don't cover GLP-1 for weight loss, this is a huge issue given they cost almost $2000/month in the US out of pocket. I was approved for semaglutide but now compounding pharmacies like Hims are stating their cheaper (<$200/month) compounded versions are out of stock.
  - pkaye 2y ago
    Last week the FDA said the shortages are over so compounding will probably decline as they get sued by the companies. https://www.barrons.com/articles/eli-lilly-zepbound-higher-dose-lower-price-35511af5 https://www.barrons.com/articles/eli-lilly-zepbound-higher-d...
  - IG_Semmelweiss 2y ago
    what is happening is more complicated. First, there's no legislation. What is happening is that the branded drug was in shortage so compounding pharmacies were legally allowed to step in under existing regulations. The shortage status was first updated in the summer, and Novo went on a lawsuit spree. Suing everyone mentioning GLP on a website. But, there have been more back and forths since, very recent. TLDR what is restricted now is not the sale of the compound, but the manufacture of it. Therefore, you can keep selling inventory past the restriction, but of course that will either run out, expire, or be restricted as well. As of now, if everything stays the same, expect the last few compound pharmacies to run out of product at the end of Q3/25 . However, I understand there's groundbreaking legislation being worked on that will dramatically change the status quo for the better, meaning more choice for end consumers and less profits for Novo.
- loeg 2y ago
  I get vials direct from Lilly and can choose what dose I take. Ask your PCP to check out LillyDirect.
cm2187 2y ago
Hum, I don't know, here in the UK, no one is forcing you to do anything. I am free to chose if I want to step up, down or stay on the current dosage every month. And I took the cautious approach to only step up when I stopped feeling the effects at the current dosage, so 8 months in, I am only starting on 10mg (range is 2.5 to 15mg in 2.5 increments).
blackeyeblitzar 2y ago
Is that really true? I remember reading that people with side effects often were given lower doses.
cyberax 2y ago
If you want lower dosage, then there's a simple trick: just use less frequent injections. For example, try one in 10 days instead of 1 every week. It will result in lower steady-state GLP-1 levels.

matt_heimer 2y ago

It depends. The 5mg, 10mg, and 15mg were the doses tested and recommended as maintence doses. The 2.5mg is meant as a starter to reduce side effects but since most people don't see results with it the recommendation is that you only take it for 4 weeks. The 7.5mg and 12.5mg doses are meant as transitional doses but you can stay on them longer than 4 weeks. Some doctors will go by the Lilly recommendations but I think more are allowing people to stay on the lowest dose providing benefits. That leaves your health insurance as the only other obstacle. There is a chart at https://zepbound.lilly.com/hcp/dosage https://zepbound.lilly.com/hcp/dosage I was one of the rare people that saw results with 2.5mg but by the end of that first month I had plateaued. After 3 months at 5.0mg I've plateaued again and will probably move up to 7.5mg in the near future and stay on it as long as I can. Some people like to go back to 2.5mg as their maintence dose after reaching their weight loss goals.

op00to 2y ago

The inbetween doses are just used for titration. They were not studied as long term doses like the maintenance doses. It’s stupid, and you can get exceptions if you are persistent. I preferred 7.5 mg over 10 mg for example.