Appetite suppression getting too strong

[LimeChateau]

I took my 4th dose of 2.5 on Thursday. First three weeks amazing, losing weight but eating healthy and balanced diet. Was happy with how things were going so ordered 2.5 again.

However, this week my appetite suppression has really ramped up. It didn’t wane at all during the week, and I’m only managing very small amount of calories a day now - and that is really forcing myself.

Obviously I’m not happy about this. Health wise not great at all, and not sustainable. I’ve contacted MedExpress to see if I should skip a week, and do my next jab in a fortnight.

Anyone else’s appetite suppression become unmanageable? Has anything helped? I am loving Mounjaro, it’s been life changing, but it’s just the current level of suppression is way too high for me to carry on in a healthy way.

Sounds like you’re not suitable for the drug when you’ve such an extreme reaction to a non therapeutic dose, I’d consider coming off it and trying something else. Poor you, what a shame.

I felt that my suppression and fullness was too strong after the first two weeks, so I dropped down to 1.25 for week 3, then up to 2 for week 4 and things were much better. I was starting to get hungrier back at the middle/end of week 4 so week 5 I went back to 2.5 and it's been great - able to eat 3 times a day but smaller meals. Meeting my calorie and protein goals. I find that eating bread especially makes me too full to eat my next meal, so I'm avoiding that.

I've just taken 2.5 again for week 6.

Obviously this is going against the prescribed regime, but I think I'm quite sensitive to it so I'm staying low and going slow.
I'm losing roughly 2lb a week, getting less hunger noise, feeling full and my blood sugar feels more stable, so the drug is working as it should, even at this 'non therapeutic level' for me.

Why is 2.5 not a "therapeutic dose" when so many people report weight loss on it?

Thanks @Cocoaone - it does feel that a lower dose would work better for me. I will see what MedExpress say.

I was like that for the first two months then it stopped being so effective. I'm on 7.5 now and it's working well.

@GinForBreakfast I think Eli Lily must have either tested and found that most people didn't respond until reaching 5mg, or they based it on calculations of the drug and decided that nothing much would happen until blood concentrations were at 5mg and above, so started their testing regime at that level. Not sure. I might have to see if I can find it mentioned in any of the trial papers.

But clearly lots of people find the effects strong at 2.5. Lots find nothing happens until 5mg or even 7.5mg. It's fascinating!

Thanks @Cocoaone it's interesting. So many people come across as didactic on the WLJ threads, denying people's actual experience "your weight loss isn't down to the jab, 2.5 isn't a therapeutic dose". Suddenly everyone is a medic/scientist!

I would stay on the 2.5 for another plan and see how you go. I was exactly the same and did go up to 5 but I don't think I needed to. I am now on 7.5 and have been there for a few months and have absolutely no side-effects but very comfortable suppression.

Looking at the surmount trial (specifically for obesity weight loss rather than diabetes) -they tested starting on 2.5mg for 4 weeks then either staying on 5 or working up to 10 or working up to 15.

Specifically the study was designed to only look at results for 5, 10 or 15mg. This dose decision was based based on efficacy, weight loss and gastrointestinal side effects from the phase 1 and 2 trials (conducted on diabetic patients)

I wonder if they are or will look at lower dose regimes going forward?

As they are now looking at this for kidney disease and cardiovascular disease as well as sleep apnea I suspect they will. I’d also assume likely it was already looked at a long time ago, before deciding 5mg was the lowest therapeutic dose.

Looking at the original trials for diabetes, they did look at lower doses - 1mg and 2mg, but they produced lower weight loss and HbA1c reductions compared to 5mg and 10mg

As the clinical expectation is 5% body weight loss to use a drug for weight loss purposes, they therefore have picked 5mg as the therapeutic dose as 50% of people lost at least 5% body weight at that dose, compared to only 14% of people on 1mg.

clinicaltrials.gov/study/NCT03131687?tab=results

I have seen a couple of people taking it at a lower dose than 2.5, perhaps half a dose of that? Maybe that could be worth a try?

Ridiculous comment.

Op you can reduce your dose or go longer between doses.

There's two ways of approaching this.

The official guidance is that prescribed medication should be used in accordance with the testing, licensing and prescribing of the medication which is 2.5mg weekly as the minimum dose.

The other is to follow the advice of people on the internet who, presumably, are not medically qualified. That does not make their advice automatically wrong but it can often mean using the medication outside its licensed terms which, in turn, means that the manufacturer is not legally liable for any adverse events.

If I was prescribing a medication for you outside its licensed indications, doses, etc I would have to explain the implications to you, obtain informed consent and document that in your patient record.

It concerns me that people who are not qualified to prescribe or medically advise throw out advice with no thought as to the legal implications. I would advise you speak to your prescriber and follow their advice

OP I feel the same. I have only had 2 doses but had a 9 days between them. Days 6-9 I was managing about 1400-1600 calories a day. My BMR is around 1400 so that’s about right.

I took my second yesterday and I don’t want to eat at all, I only ate yesterday at 5pm because my DH was home and I cooked for the kids so I was trying to be discreet. By day 9 I wish I hadn’t had my second jab I’m not enjoying this at all!

I do know someone who is a healthy BMI who still uses wegovy for maintenance (under supervision from a private GP) and she injects every 10-14 days depending on what’s going on socially etc for her.

It is parroted bollocks usually from those of limited understanding who read the 'rules' but do not actually comprehend them.

7.5mg and 12.5mg are also non-therapeutic doses according to the same recommendations and you are not meant to stay on them either!

Quite - whether or not it is therapeutic depends on your bodies reaction to it, which is pretty unique.

@LimeChateau I had / have very strong appetite suppression too on 2.5. I injected every 8 days, which meant that I was able to eat more normally on days 4, 5, 6, 7 and 8. After two months of injecting every 8 days, I felt the supression subside a bit and now I inject once a week, but I'm still on 2.5 (started on MJ in the middle of August).

We are all different, so the reactions to the medication are too. I'm on the threads for August starters and we are all on different doses with a very wide variety of different reactions too.

I'm not medically qualified so relay this only as my experience and not as any kind of guidance or suggestion of what you should do.

I'm a high ender

On 10 and sometimes notice full and leave half a meal

But never have the full or the suppression so many say about

Or have a cuppa and stuffed for the day

I wish lol

I was also super responsive to 2.5. I would personally count clicks and do a bit less and see how you get on. I would also suggest drinking calories where you can (protein shake etc) and don't do low fat anything

Terrible advice. Reactions to Mounjaro are fluctuation and variable. Your post came across as rather nasty to me at least.

OP - keep going. Things will change.

Thanks all for the messages, appreciate the advice/ support. Ironically just after I wrote my first post appetite came right back 😆

I still have some suppression, but am able to eat again - so balanced meals and a reasonable level of calories for the last few days. Feel so much better! I think there will just be fluctuations, as many of you have said. Glad that I have been able to carry on.

The advice from MedExpress for anyone interested was to have a break and give my body a rest as the calories I was having at that point were too low. However things seem back on track, so I’m happy to carry on for now.

Thanks @LimeChateau how many calories were you having for them to say that? I am thinking about having a fortnights break and maybe doing a half doze. The only problem is that is then a new pen id need and that’s a risky strategy.