Slow titrating & sub dosing chat/support

[SubDoser]

Thought it would be good to have a specific thread for those of us who are using sub doses to titrate more slowly than average due to managing side effects (or simply preference). If there is already a thread going though please point me in the right direction!

Attached photo of what I've done so far.

I went up too quickly to start with. In hindsight I should've stuck with 4.2 mg for at least four weeks the first time round as I was very suppressed on that rather than going up. Had side effects that I wouldn't tolerate in week 7 on a higher dose so dropped back down. Similar story on week 11 (although different side effects), so then went back up much more slowly.

Now finally made it to 5 mg but under suppressed due to spending longer than planned on the two sub doses before that (didn't want to risk it due to what was going on socially/at work at the time!). Might just do three weeks on this before going up again...

I'm about to jab on week 10. Still on 2.5mg which is working for me. I'm happy losing a pound a week though, as I feel it will be easier to come off at the end.

I'm still on 2.5mg but if/when I decide to increase the dose I will be doing so gradually.

PS I like your spreadsheet

Mounjaro is prescribed in certain doses, with a dosing schedule which includes a minimum of 4 weeks at each dose to allow it to build in concentration and your body to get used to it at that dose.

I am all for adjusting doses and do it myself, but knee jerk reactions - chasing suppression, avoiding side effects - resulting in altering doses up and down faster than a yoyo is not going to give your body enough time to tell you how it feels about a dose.

I would suggest if anyone has unpleasant side effects, yes try going back down, but then stick with that dose as it builds up again for 4 weeks, even if you feel it is not suppressing you yet.

My suppression, on the same dose for several weeks, varies from week to week. Patience is needed.

I've attached some columns of my spreadsheet. Each pen was originally in a different colour, but greyed out when that pen was finished. (I was running out of colours as I'm a bit of a stockpiler.)

I tend to dose every 6 days, as this is what works for me to keep my suppression levels more stable.

I think my approach has worked for me in terms of reducing side effects too. Generally, I am particularly susceptible to gastro symptoms and vomiting (motion sickness and extreme morning sickness), but these haven't troubled me on MJ.

At a point in the middle, I started rushing up the dose, and I can't remember why - possibly as I had a high dose pen to use up before the expiry date and within 30 days. But I slowed down again and was comfortable on 8.3mg for a number of weeks.

Thanks @JunoRoma !

Now I am going up a sub dose every 4+ weeks I think that I am getting the increments wrong. I'll see how I feel after another two weeks om 5 mg but thinking it may be an idea to try going up 1 mg rather than just 0.4 mg. I've stopped losing weight so something needs to be done. Maybe it is follow a diet too...

I used glp1plotter to guide my doses when I dropped down after getting the dose wrong at the start - may have appeared to be 'going up and down like a yo yo' but due to the 5 day half life it was more like going down very slightly to what I was the week before. I also had no idea I would end up titrating this slowly and taking 26 weeks to get to 5 mg!

Interesting to see what has worked for you @Swissrollover !

Sounds like a good plan @ThatSchoolOfficeLady & @JunoRoma ! I was ready to go up after 4 weeks on 2.5 mg so wasn't expecting my journey to take this route.

I'm in this boat! It's a bit trial and error to find a dose which doesn't cause massive suppression and/or drastic delayed gastric emptying (ie a few bits of chicken and a bit of veg filling me up uncomfortably for a whole day).

On the weeks where I've gone back down, it's because the week before I've struggled to manage 700-800 cals a day for the whole week. Luckily the other side effects are minimal, and I watch my levels on the shotsy app to avoid massive peaks and troughs. I'm still averaging 2lb loss a week and don't want to increase this, ideally it will reduce a bit as I want to eat more in order to exercise more in the new year.

Here's my shotsy levels graph. So you can see that after I dropped down from 3.75, I went 2.5 then 3 and 3, but that kept my levels fairly stable

If you're on Ozempic and have been taking 1mg, but have now been prescribed a 1.7mg pen, but due to side effects and chrustmas, you want to stay on 1mg, does anyone know how many clicks you'd use to achieve a 1mg dose from a 1.7mg pen?
My SIL has asked me this because I'm a nurse, but I have no idea! I've advised her to contact her prescribing company, Newman, I think, but thought I'd ask here.
Thank you

@Oneearringlost I take MJ but I looked up Ozempic pen sizes and number of clicks per max dose with a view to calculating it for you. It looks like you have some misinformation? Ozempic doesn't come in a 1.7 mg pen - Wegovy does though?

To calculate for a different dose the formula is:

(desired dose/pen dose) x clicks for full pen dose

MJ is 60 clicks for a full dose, Ozempic is 72 and Wegovy is 74. Please check again with your SIL exactly what she is on though!

If it is wegovy then it is (1.0/1.7) x 74 = 43.52 = 44 clicks (43 clicks = 0.99 mg and 44 is 1.01 mg).

Your weight loss is great @Cocoaone ! Think I might try shotsy - with GLp1a plotter it doesn't store your data so it is a right pain to keep entering it. Haven't used it for ten weeks or so now but I'm interested to see what it looks like.

Here is my graph from when I was using it to plan my dose down - looks very similar! I went down to a dose that was effectively between my previous and the one before (where I was a bit over suppressed). Things move on so fast - when I was sub-dosing then it wasn't talked about at all and hadn't heard of shotsy.

Other end of the scale - Voy advised my friend to just take a week off 5 mg (due to possible anxiety side effect not physical) and then just start straight back on 5 mg the week after. She did with zero side effects! Unfortunately she ended up with much less suppression then before and then went up to 7.5 mg and is still barely suppressed and not losing weight.

Official WI day for me and predictably another low loss. That really is down to me though. I am definitely suppressed to some extent but not to the point I have been before or can't stand the thought of wine - and all these xmas parties! Looking forward to being the other side of Christmas and making an effort again.

Now to get that data entered in a half life plotter...

This is what it looks like for me now (28 weeks of doses)

Oh, maybe I'm wrong...I thought they were one and the same. I'll check with her.
Thank you SO much for replying, and taking the time to do all those calculations. I'm really appreciative.
Merry Christmas!

It's nice to see how everyone is doing and titrating up in a way that feels right for them. I started on 2.5mg but got some bad side effects where I didn't feel like I could continue. So I've taken it quite slow on a very small dose! Currently holding on 1.66mg but think I'll titrate up after Christmas. Shotsy graph for progress!

@SubDoser knowing what you know now, if you could go back in time and redo the initial dose increase after four weeks on 2.5mg, would you do 3.75mg for four weeks? Or something different?

@JunoRoma yes, four+ weeks at each sub dose!

The problem is knowing that I would need to. I thought I was taking it slow! My initial plan was to take whatever the bonus dose was and then 5 mg. Then decided to take it slower so did 50 clicks (4.2 mg) then next week. If I wasn’t on holiday the week after I would’ve done 55 clicks (4.6 mg) instead of sticking at 4.2 mg which I now know was too much. People didn’t talk about doing this kind of thing then though, it was also new,

I think 3.75 mg would’ve been the perfect dose for me for 4+ weeks after the 2.5 mg dose. Then maybe I would’ve been ok going up to 5 mg when that wasn’t enough? I’m going to stick with 5 mg for another 2+ weeks (so 4+ in total) the problem I have now is that I don’t know where to go from there - 6.25 mg MAX but maybe I should stick with smaller increments. Going up 0.5 mg rather than 1.25 mg each time.

@SubDoser thank you. I've done four weeks of 2.5mg. This week I've found it less effective, so I'd like to increase the dose from next week. I'd prefer to increase to 5mg incrementally, including four weeks on 3.75mg (graphed using GLP-1 plotter).

I’ve done 4x 2.5 and now I’ve done a 3.75 to try and avoid side effects over Christmas.

Hope 3.75 mg works out well for both of you!

Took my third dose of 5 mg, and continue to STS weight-wise. There is no doubt it is working to suppress my appetite to some extent at least but it isn't working to keep me off the wine or other stuff I couldn't face when more suppressed. Definitely doing dry January as a re-set and some kind of effort.

Continue not to be sure about where to go up to 5.5 mg or more next time I increase (two weeks time). So hard! Think I am scared to try going up more than that. Actually, a month of 5.5 mg, no alcohol and more effort to eat healthily is the next plan - hopefully that will get the weight loss going again...

What strength pen will you be using? I did shoot up weekly from 5 to 5.5 to 6 to 6.25, but in hindsight might have slowed down.

I now tend to go up in much smaller increments, by just a few clicks every week or maybe by 0.2mg after 3 or 4 weeks at one dose. However, my weightloss is currently progressing, so I can take it slowly again.

But, if you are week 28 or so and aren't getting the desired weight loss effect, maybe you need to increase your dose a little more towards the next standard dose?

In your position, I would increase to 5.5mg for the next shot and see what happens. If ok, stay there a couple of weeks, or go up a bit to 5.6/5.7/5.8 the following week.

You've been on MJ for a long time now, so should be tolerating the med better than earlier in your journey and should have 7.5mg in your sights, if this would give you the weight loss you desire.

I just don't see what you gain from staying on a low dose for a very long time if it isn't really working for you. I know many people say they never moved up from 2.5mg or 5mg, but not everyone is that lucky. Also, some say very proudly that they "only take 5mg", but later admit that they take it twice a week!

We are all different. MJ isn't magic, so taking only a partial dose doesn't always let it support us effectively in our difficult journeys. As always though, discussing with your prescriber is the best option, as we aren't experts.

Does anyone do 2x doses a week but smaller doses, like 2.5 twice in a week instead of 5 once a week, to help with side effects?

I'm going to buy a 7.5 mg pen next - but I have a new 5 mg pen waiting to be used first so will use that and then the 7.5 mg.

I tried just going up a little each week and that didn't work for me - suddenly got bad symptoms. Although not saying it won't work now! That's the problem isn't it - not actually knowing how your body will react.

Anyway, I've decided to go up to 5.5 mg next week and see how it goes along with a month with no alcohol at all and more effort with diet. It definitely has worked preventing me from gaining in December given all the meals out and drinking I've been doing - which has been great really but time to move on and downwards! I shall do dry January - starting now. Had my last social occasion of the year yesterday.

No, haven't tried that [yet] @missslinkyagain - might be worth using a plotter to see how that looks with the half life?

Yes I do that and have been doing it since 5mg (2.5mg twice a week). It has been working well for me. I'm now on my second 10mg (5mg twice a week) pen and will likely stay on 10mg till maintenance.

This takes care of the peak and troughs and reduces the suppression and side effects. It just stays steady and stable in my system.