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!

Another dull update from me!

Pen 1 (2.5 mg) - 2.5, 2.5, 2.5, 2.5, 3.2 (5)(5)
Pen 2 (5.0 mg) - 4.2, 4.2, 4.6, 2.5, 4.2 (5)(10)
Pen 3 (5.0 mg) - 4.2, 4.4, 3.3, 3.75, 3.75 (5)(15)
Pen 4 (5.0 mg) - 3.75, 4.2, 4.2, 4.2, 4.2 (5)(20)
Pen 5 (5.0 mg) - 4.2, 4.5, 4.6, 4.6, 4.6 (5)(25)
Pen 6 (5.0 mg) - 4.6, 5.0, 5.0, 5.0, 5.0 (5)(30)
Pen 7 (5.0 mg) - 5.8, 5.8, 6.3, 6.7 (4)(34)
Pen 8 (7.5 mg) - 6.9, 7.5, 7.5, 8.1, 8.8 (5)(39)
Pen 9 (7.5 mg) - 9.5, 10.0, 10.0, 10.0 (4)(43)
Pen 10 (10.0 mg) - 10.0, 10.0, 10.0, 11.2, 10.7 (5)(48)
Pen 11 (12.5 mg) - 12.5, 12.5, 12.5, 12.5, 13.75 (5)(52)
Pen 12 (15.0 mg) -
Pen 13 (15.0 mg) -

Went up to 13.75 mg on Thursday and all is well. Losing weight again - slowly but it was always going to be slow. Now I'm entering my second year I've got a strong sense of this is a new chapter and at higher level. More effort with food, ditching alcohol and more exercise - pulling it all together now I've got the 'worst' of the weight off.

Looking back at the year, I didn't get the dosing right - went up too fast (should've gone up to 3.75 mg and stuck there with the second pen) to start with then too slow. But it doesn't really matter. I'm glad I started a year ago and I'm looking forward to the second year. I'll almost certainly stick with 13.75 mg for at least 4 doses now and then go up to 15 mg when the time feels right. Then my slow titrating and sub dosing journey will be over!

I've been on 5mg for a few weeks now, so I feel like a bit of an imposter still posting on a sub-dosing thread, but I had to do some slow and careful titration to increase from 2.5mg while keeping side effects manageable.

I'm currently using a 7.5mg pen to take the 5mg (40 clicks), and if it stops working then I'll consider increasing to 5.5mg (44 clicks) but I'm not that far from goal now and hope to take 5mg for maintenance.

Sorry @JunoRoma - only just noticed your post!

Glad things are still working out so well for you on 5 mg!

I've just taken my fourth dose of 13.75 mg. I would say that is working for me in terms of food noise/appetite but not for weight loss! That bit needs to come from me, MJ has taken me as far as it can. At 52 and in late perimenopause it is just hard, I'm really not eating much at all. I'm going to have to get on MFP and do a strict 40% protein, 30% fat, 30% carbs (that naturally curbs the calories) and no alcohol. I've made quite a few positive changes but I'm going to have to go super-strict to shift the rest of this weight. Meal plan. Meal prep. Really focus. I'm very happy to eat like that it is just the mental load that gets me - the planning! Changing lifelong habits.

Pen 1 (2.5 mg) - 2.5, 2.5, 2.5, 2.5, 3.2 (5)(5)
Pen 2 (5.0 mg) - 4.2, 4.2, 4.6, 2.5, 4.2 (5)(10)
Pen 3 (5.0 mg) - 4.2, 4.4, 3.3, 3.75, 3.75 (5)(15)
Pen 4 (5.0 mg) - 3.75, 4.2, 4.2, 4.2, 4.2 (5)(20)
Pen 5 (5.0 mg) - 4.2, 4.5, 4.6, 4.6, 4.6 (5)(25)
Pen 6 (5.0 mg) - 4.6, 5.0, 5.0, 5.0, 5.0 (5)(30)
Pen 7 (5.0 mg) - 5.8, 5.8, 6.3, 6.7 (4)(34)
Pen 8 (7.5 mg) - 6.9, 7.5, 7.5, 8.1, 8.8 (5)(39)
Pen 9 (7.5 mg) - 9.5, 10.0, 10.0, 10.0 (4)(43)
Pen 10 (10.0 mg) - 10.0, 10.0, 10.0, 11.2, 10.7 (5)(48)
Pen 11 (12.5 mg) - 12.5, 12.5, 12.5, 12.5, 13.75 (5)(52)
Pen 12 (15.0 mg) - 13.75, 13.75 13.75 (2) (55)
Pen 13 (15.0 mg) -
Pen 14 (15.0 mg) -

I don't think it is going to make much difference now whether I am on 13.75 mg or 15 mg. I may just start taking 15 mg from next week to be done with it!

Hello, just wondering how people are doing now?

This thread has been useful for me, I am about to do my first injection (very small dose) as I have a crippling fear of vomiting. It’s taken a year of reading, researching and fretting to get to the point of actually starting Mounjaro but I’ve decided to go for it. Starting with 0.8mg and plan to go up with tiny increments. Not at all cost effective but it’s the only way I can manage my anxiety.

I’ve now successfully been able to remain on Mounjaro for 4 months and have lost over 2 stone which I’m delighted with. I took my first dose of 2.5mg thinking it was a “low” starting dose and I’d be okay. Well 24 hours later my glands swelled, my shoulders, back and clavicle ached like I had a very serious case of flu. I was exhausted, nauseous and couldn’t face food. I ended up off work. I thought it had been expensive waste of time. But by the 6th day I felt great - I wasn’t hungry, I was able to eat a reasonable amount of food at each meal and could control my intake.
I decided to drop right down to 0.5mg, which I tolerated well. From there, I gradually stepped up: 1mg, 1.25mg, then into 3mg and 3.75mg where I hit a wall with awful diarrhoea. I stuck it out for four weeks, but with Le Mans coming up, I knew I couldn’t risk that level of disruption. So I skipped a dose. Once I was back home, I restarted at 2.5mg and doubled up that week. Then I made the leap to 5mg where I’ve been for 5 weeks and it’s been brilliant. I remain baffled that 3mg and 3.75mg rendered my bowels liquid and yet after the week break (even the skipped dose week I had diarrhoea?) I was able to tolerate 2 doses, and then straight up to 5mg. Just makes no sense. My only explanation is that I bought and took some Pepto Bismol before my 2.5mg starting dose and took it a couple of times on jab day. But that’s it. I’ve not been taking it regularly.

I’ve been losing around 2lb a week and plan to taper down again in a few weeks. I almost don’t recognise my own body in the mirror. I’ve not started resistance training yet as wanted to focus on food, daily movement (12 - 20k steps) and looking after my mental health. Trying to add everything and fix everything is where I’ve gone wrong all these years.

I’ve also discovered the existence of a condition called Lipoedema which explains the extremely dimply legs I’ve had since I was 13 but always thought was cellulite. However cellulite doesn’t hurt, swell, bruise easily or feel heavy so both discovering this condition and realising Mounjaro has eased it as been quite a revelation. Especially as it appears to be cutting through the uneven skin and revealing a tone on my legs I’ve never had. It real is a wonder drug and I will be continuing on it long term 🙌🏻

I've lost just over 7 stone in the last year, happily now at 8st 12lb.

I started at 2.5mg then crept up slowly in 0.5 - 1mg increases to a max dose of 10mg (taken every 5 or 6 days for my preference of more stable levels).

I'm now working my way back down, dropping just a few clicks each shot. My rate of loss is very slow now, so by gradually increasing calories I'm hoping to maintain within 5lb of where I am now.

I still have a stock of pens to last me for about 12 months, but if I need to stay on longer term, I accept this. I'm with a maintenance friendly pharmacy, so should be able to reorder again within 12 months of my previous order. I've set a calendar reminder, just in case!

Good luck to all.

I’m on week 11. I started at 1.25 and have crept up. I did do 5mg the week before last after 3 weeks at 3.75 but felt awful so did 3.75 again last week. I think I’ll do 5mg as I’m maintaining on 3.75 but not losing. I found the side effects difficult though.

I’ve just seen 4.2 so I might try that. Even 3.75 this week saw me really lethargic for 2-3 days. Wiped me out!

@Iamnewaroundhere
I get achy shoulders too. I do regular resistance training and have been wondering if it’s muscle soreness or mounjaro but think it’s must be mounjaro. It sort of goes into my neck.

I started on 2.5mg but the nausea was unteal so i jabbed every 10 days. After my first pe, instarted doing 1.25mg every four days and this has suited me well. There has been a few hicknups like last week my pen jammed and im not sure how much went in sonive put my dose at higher on shiotsy.
im hoping to stay as low as poss but winter is always more difficult for me in terms of eating so i may up my dose. My third pen is a 2.5mg but i will go up the dose and make them last longer. Also might share the pen with DP (obviously not the needle)

Here is my shotsy you can se how much more balance it is to do 2x 1.25mg than once 2.5mg. I wish i had started like this

So do you change your jab days each week @babylone ? I’m quite tempted to try two half doses a week but would prefer to stick to the same jab days, if that makes sense? Jabbing every 4th day sounds good in terms of avoiding peaks and troughs.

I’ve found this thread really helpful, thanks to everyone who’s posted and to @SubDoser for starting it. Lots of food for thought (pardon the pun) and good to hear from people who want to keep low and slow as much as possible.

Congratulations on your amazing weight loss @Swissrollover

Can I ask, you mentioned going up in small increments - did you increase a little every jab, or did you stick to the same amount for a couple of weeks before increasing?

@Thistleton yes i do. Change jab day but it is fine. If im not sure i can check shotsy and it teminds me. I weight myself before i jab so i dont want to miss that either!
As you can see i went from 10 days for a full dose to 4 days to a split dose. The SE have gone! My suppression is stable. I did try to leave 5 days once but i didnt like the fact that again i would have a big difference between my levels. Every 4 days work for me.
i still have a 2.5ml pen though. I was wondering about a 5mg pen and keep the same pattern. Obviously that would be a lot of “holes” in the seal (10 injections for a 2.5 pen but 20! For a 5 ml pen!) i dont know if the seal will be resistant enough. I am going to try it out and see.

Thank you! It's incredible to think of where I was this time last year and where I am now, just over 100lb lighter. Now is the really hard part, keeping it off without losing more. (Although, another 5lb loss and I'd be at my wedding weight - eek!)

I did the standard 2.5mg x 4, then increased weekly by about 0.5mg on my way to 5mg, after that I played it by ear.

Some doses I stayed on for 8-10 weeks, but when my weight loss or suppression reduced, I usually increased my next dose a little. Or I reduced the gap between shots to 6 days, then 5.

I use Shotsy to help me visualise my levels. I also prefer the steadier levels from a lower dose taken every 5 days to the peaks and troughs on the standard dosing schedule.

@babylone Thanks that's really helpful. I've downloaded the Shotsy app, I think it will help me keep track of what I'm doing. Can you help me understand this though:

I was wondering about a 5mg pen and keep the same pattern. Obviously that would be a lot of “holes” in the seal (10 injections for a 2.5 pen but 20! For a 5 ml pen!)

Sorry if I'm being a bit thick but why would there be 20 holes? Is it because you continue to use the medication for longer than the 30 days? No judgment if you do, just trying to understand.

If i split my dose, i have to inject twice as much and i am also using the 5th dose so for a 2.5ml pen i would have 10 1.25ml doses. For a 5ml pen i would get 20 of 1.25 ml doses and yes that would last for about 60days
But i am not so concerned about the 60 days, i am more concerned about whether this is possible or not. Will the seal be strong enough to take 20 jabs/holes? Or will it get damaged and the medication will be spoilt (colour change/cloudy). So i will try it out. I do keep the pen in the fridge at all times though

Having been on 5mg for several months, I've now reached my goal weight and I'm planning to decrease the dose slightly and see how I get on.
Titrating up very gradually worked really well for me, so I want to do similar for this stage.

This week I took 4.6mg (the amount that was left in the pen).
I'm hoping to split the next 5mg pen into six doses: five doses of 4.2mg then one dose of 4mg.

Can I ask, how do you manage this with your prescribers? Are you ordering less often, or allowing pens to stockpile? I’m considering microdosing for maintenance (when I get there!) but not sure that prescribers will support this.

Thanks for any advice!

@SpiralSister I had a call with the pharmacist. He said that in maintenance many patients increase the gap between doses i.e. taking them up to 10 days apart (this is 4 doses within 30 days) and confirmed that he is happy to re-prescribe with a slightly longer gap between pens (e.g. up to 6 weeks).

Thank you so much!

This might also help with the dose and click calculations. It works out ur dose and even the golden dose amounts if ur pulling 2.5 from say a 10 mg pen

https://www.vrgrowth.co.uk/mounjaro-clicks

I did build up a stockpile a long time ago from a combination of sub-dosing, ordering every 3-4 weeks, plus placing some adhoc orders with other pharmacies. I had 12 pens at one stage! I had a break from ordering for a few months then ordered one pen every 4 or 5 weeks from my usual pharmacy to keep on their books and am down to about 8 pens currently, which I am very thankful for with the recent price hike.

I have lost over 7 stone, am now in maintenance (BMI 20.5) and have stopped ordering, but still titrating down using my stockpile. I'm reducing the dose each week by a click or two, which is usually about 0.2mg, depending on the pen dose. My highest dose was 10.5mg , and I am currently down to about 8mg.

I told the pharmacy that I am going it alone for now and they have agreed that I can restart within 12 months of my last order, as they have a record of my ordering history and weightloss journey. I realise that they may restart my orders on 2.5mg, but I'm OK with that.

I have a diary reminder for 12 months so that I don't forget. I am hopeful that I really can go it alone after stabilising my weight set point for about a year, but want to keep my options open.

Thank you so much, @Swissrollover - so helpful. I’ve got about 7lbs to go so will chat to my prescriber soon!