Going from 2.5 to 3.75 Mounjaro - did you tell your provider? How did you decide to move up or not?

[YoshiIsCute]

Hi all, I'm 5 weeks into my Mounjaro journey and have a few questions about moving up dosages.

So I have completed my first 2.5mg pen (including the bonus dose, which was about 0.65ml instead of 0.6ml) and am debating whether I should move up to 5mg or not.

So far on the 2.5mg, I have decent suppression for 5 days post-jab. My weigh-ins have been a bit up and down but the overall trend is down. I do seem to still be losing at this dose, though it has slowed down.

I've already got my next 5mg pen (had a discount that I wanted to make sure I used on the more expensive dose!) and am wondering what to do - should I go straight up to 5mg? Or should I order another 2.5mg pen and keep the 5mg in the fridge for the future?

Or do I count clicks and do 3.75mg out of the 5mg pen? And if I go for the counting clicks option, do I tell my provider (Voy)?

One final question for those of you who are doing the 3.75mg doseages from a 5mg pen - are you using the pen for longer than 30 days? It looks like you can get about 6.5 x 3.75mg doses out of a 5mg pen, but to use them all on a weekly schedule would take between 35-42 days...

Am I just massively overthinking all of this 😆

Are you having any side effects? Unless you are, I would say you have two options:

1. order another 2.5 and hope the loss doesn’t slow even further
2. start your 5

If you are having bad side effects that make you not want to increase to 5mg but feel the 2.5 isn’t working for you any more, then click counting is an option but no, I wouldn’t tell Voy. Prescribers are unlikely to endorse usage against the guidelines (although some of the smaller, more creative pharmacists may!).

Using a pen past the 30 days is a very personal risk and only you can decide if you are comfortable with it tbh.

Thanks @IReallyNeedThisToWork , I thought as much about telling Voy (that they would be unlikely to endorse counting clicks to get to a 3.75 dose!).

I definitely had side effects after my first 2.5mg dose - crazy suppression, nausea, and some diarrhoea. The side effects have reduced a lot and are now manageable (as long as I don't eat large portions and stay hydrated).

Based on that I am guessing I will get side effects when I initially jump to 5mg that will (hopefully) settle down. Perhaps I'll try one dose at 3.75 and see how I get on. I think I'd be comfortable going to 35 days on an open pen but not beyond that.

The pen would be used up in 36 days if you do 4 doses at 3.75mg and the last 2 (including bonus) at 5mg. It would help you stay on the recommended 4 weeks at a dose before moving up too. Just keep the pen in the fridge - top shelf not the door - the whole time and wipe before and after each dose.

Alternatively if you get another 2.5mg, use only 2 doses at the 2.5 and the last 2 at 3.75mg gives you a couple of weeks buffer before going up to 5mg and uses the full pen in 22 days. That would be my suggestion.

Ohh that's really helpful, thank you so much @9ToGoal ! I hadn't thought about it that way - to do 4 x 3.75 and 2 x 5mg to use up the 5mg pen.

Even if I didn't use the bonus dose and just did 4 x 3.75mg and 1 x 5mg, that would mean I could use the whole pen within 30 days and then move up to 5mg. Perfect! Thanks so much :)

It’s entirely up to you! I went to day 42 with my 2nd pen and it was fine. I did a mix of 2.5, 3.75 and finished with 5. I didn’t tell my provider, you have to be aware some pharmacies have strict policies on time between orders.

@YoshiIsCute this is what I did/do currently -

After my 5 x 2.5mg, I had a 5mg as I had bought two pens as a starter pack.

In hindsight I was getting enough suppression at 2.5mg and should probably have stuck with 2.5mg for longer, "everyone" seemed to move up (this was over 6 months ago) so I thought I should/had to. If you are getting a good balance of suppression with a bit of will power stick with 2.5mg until that changes. The price between a 2.5mg and 5mg pen for most providers is very similar. Having the 5mg in use allows you to increase your dose mid month if needed.

I was, like many, concerned about side effects kicking in at 5mg so, thinking I had to move up I tried 3.75mg as an interim and have stuck with that for over 5 months now.

Few of my thoughts -

If you decide you want to try 3.75mg (45 clicks) with your 5mg pen you will get 5 doses out of it before the pen locks. For the 6th dose on day 35 you will need to hard twist or use a syringe (hard twist worked for me every time except the last pen, so worth getting some syringes on standby).

I personally accept the risk of using a 6th dose on day 35 - I wouldn't go any further. You need to do your own research and make your own decision. If you are going to try hard twist for a 6th dose, mark the 45 click point with a biro on your first dose so you can find it easily.

Change your mindset to not think binning even a drip of liquid in a pen is "wasting" it. If you got 6 weeks of what you wanted you are already way ahead on getting more than your moneys worth.

My suppression comes and goes, so I don't plan to move up until I get 2-3 weeks where MJ + a touch of willpower isn't working for me anymore. I prefer a stay as low as possible/if it's not broken why fix it approach.

If you can't be honest with Voy, I believe their pens are more expensive because of the added value of coaching, what is the point of the coaching? As a subscription service type provider sending you pens every 4 weeks it could get difficult.

I have done 4 weeks on 2.5mg and am due to start my 5mg pen this week but I am a bit scared of side effects. Can I do 2 weeks at 3.75 and then 5 or do i have to do 4 weeks of the same dose (3.75) before moving up to 5

I've done smaller doses before 3.75mg one time after 5 weeks incl bonus on 2.5mg. 4 days after 3.75 I topped up with 1.25mg as i only had two days suppression, the extra top up helped! I had a bad 3 weeks of anxiety and poor mental health starting mj, but I was going through difficult times so it was probs a coincidence. I didn't want to risk worse side effects. Needn't have worried as was fine on 5 and 7.5mg. The step up from 5 to 7.5 I did bonus at 6.83mg 0.7ml and two on 7mg before 7.5mg weekly, that pen lasted 34 days and effectiveness was fine as I keep in fridge.

Do your bonus dose, it may be slightly bigger volume than 0.6ml so you can see how you react to it before deciding dose week after. No you don't have to do all weeks on 3.75mg. 5mg was great for me, full suppression for 2 months and no side effects

Thanks so much for sharing your experiences and tips @IHateMozzies and @WeAllHaveWings ! It’s so helpful to hear from others how you’ve handled these things.

@WeAllHaveWings you make a very good point about mindset too - I think if I even get 5 doses out of pen I’ll be happy!

BTW with Voy, yes they are a subscription service that comes with access to a clinician and separately, a health coach. The health coach isn’t involved with discussions about the medication itself, they are there to help you with modifying your nutrition, exercise, overall lifestyle and mindset so that hopefully maintenance will be easier when it comes time to come off the meds.

I haven’t tried it, but I suspect that Voy would be happy for me to say I want to stay on 2.5mg and they would adjust my order accordingly, but I doubt that they will formally ok a 3.75mg dose given that’s bordering into off label use territory / against the manufacturer guidelines. I’m personally comfortable with that risk, as well as the risk of going slightly over the 30 days use by date, I just don’t think Voy can really formally ok either of those things without exposing themselves to lawsuits. I might be wrong! I’d be interested to hear from any Voy users whether they’ve had these chats with them or not…

I think I’ll try one more week on 2.5mg (from the 5mg pen) and go from there

That’s helpful to know @Mysticmaiden2024! May I ask which provider you’re using and if you told them that you were adjusting your dose ages?

Providers should not advise, recommend or condone adjusting doses, but you should be able to discuss any issues you have and "own up" to what dose you are actually taking honestly without consequences so they can advise appropriately.

I would recommend going to 3.75 mg for 4+ weeks if you've had decent suppression on 2.5 mg and losing weight. Only go up when you feel your suppression isn't ideal.

I decided to spend a month 'slowly' titrating from 2.5 mg up to 5 mg but I had to stop and drop back down twice as I couldn't tolerate anything above 4.2 mg for a long time (so glad I didn't go straight to 5 mg!). If I could go back and advise myself I would do 3.75 mg for 4+ weeks and only go up when suppression wasn't adequate. Not go up a little bit like I did each week.

No, I didn't tell my provider I was doing this (but asda not voy).

I've had these pens so far:

2.5 mg - used standard doses + 3.2 mg bonus dose
5 mg x 4 - using lower doses than 5 mg (5 doses and discarded surplus)
5 mg x 1 - using standard 5 mg dose (5 doses)
5 mg x 1 - using dose above standard dose (could only get 4 doses out of it as a result)
Just about to start first 7.5 mg pen - I will almost certainly take 5 x doses less than 7.5 mg out of this and discard the rest.

No, I do not use a pen for longer than 30 days.

I had exactly this dilemma. Good suppression and loss at 2.5mg. For my second pen I got the 5mg and decided to ease up to 3.75. It was way too much for me and the side effects were overwhelming so dropped straight back to 2.5. For my 3rd pen I again ordered 5mg and am slowly edging up (35 clicks instead of 60) which seems to be right for me.

I use 5 doses my pen to keep me under the 30 days. So far my provider (medexpress) hasn't noticed or commented.

In the whole it's going well. Lost 1st 10 since 18th November so not dramatic but nice and steady and still really good suppression most days (in fact some I really struggle with food at all!)

Happy to answer any other questions

Thanks so much for sharing your experiences @SubDoser and @RedorBlack !

It sounds to me as though my response to MJ has been similar to both of yours (and that's why I am hesitant to jump straight to 5mg as it will almost certainly be too much for me, and I am still losing on 2.5mg).

It's jab today for me so I've decided to try 3.75mg from my 5mg pen and see how I get on. If that suits me, I'll stick at 3.75mg for at least 4 weeks. If that is too much, I'll drop back to 2.5mg (or possibly slightly above, eg 35 clicks as you do @RedorBlack).

I'll update the thread next week and let you all know how it goes! It's been so useful to have real life feedback :)

I've had 4 providers now! Not told any of them, at end of day its my body and I put in it what I feel is right for me. The way I see it I used logic and gut instinct for stepping up to avoid potential side effects. It didn't harm me and worked as they should have. I've been lucky to be on it 4 months and not had a single side effect. People smoke and drink knowing it can cause cancer and take risks with drugs all time but there is so much negativity over taking a part dose, crazy really.

I’ve been on 2.5mg for 5 weeks I had 2x 2.5mg pens..I’m going to do a 3.75mg tonight see how I go off it am starting to feel quiet hungry now off the 2.5 so hopefully no side effects seen a lot of people saying moving straight to 5mg causes a lot of side effects

I've been on my for 5 months I've been on 10mg the last 2 months but this last week feel my food suppression is less , I'm thinking of moving up to 12mg but not sure any advice please

I am in a similar situation had 2 months of 2.5 but last 2 or so weeks less suppression. Bit nervous to go straight to 5 as had a few side affects in first month of 2.5. How do you do 3.75 dose is it so many clicks of the 5mg pen? Thank you

Hi @beck73 probably best to start a new thread with this question so you can get specific advice

An update, for anyone who is interested! I decided to go with 3.75mg (45 clicks on the 5mg pen). I did one week on that bdose ut found I didn't have very good suppression. The next week I did 5mg and found that way too much, so this past week I've gone with 4.25 (51 clicks on the 5mg pen) and that seems to be the sweet spot for the moment.

I have not told my provider (Voy)

And @Lozzypeanutbeet hopefully this answers your question too :)

That's great to know. Glad you found your sweet spot. Thanks for sharing update. I have ordered 5mg and will try the 3.75 first and go from there. Thanks again

I did 4x 2.5mg, then as I was worried about doubling the dose and side effects, I’ve done 3.75mg (45 clicks) for two weeks, and no I didn’t tell the provider, as they’ll say not to. I did my first 5mg on Sunday and my side effects (feeling tired and cold) are no worse.

Really interesting thank you. I have done 4 at 2.5, bonus dose of about 3ish and due to do my next on Thursday. I responded quite well for the first 3 weeks with minor side effects, easing off in wk 4 and only light suppression this week. Lost weight each week but not heaps.

I was planning to move up to 3.75 this week and see how I go - I have been responding reasonably but need a bit more.

help needed pls my mounjaro peoples . I have a 5mg pen . I took a two week break after 2.5 mg. I read online if you take a break you need to start on a low dose again such as 2.5 . I did 2.5 mg on my 5mg pen today but I was thinking of switching to 3.75 . How do I do this and how many doses will I be able to get out of this one