Day 5 top up?

[TopUpHat]

So I'm on 7.5mg and just started my second 4 weeks on this dose. I don't want to move up dose yet because the first 2 to 3 days I'm knackered and days 2, 3 and 4 I have lots of suppression so I think 10mg would have me not eating at all!

But come day 5, 6 and 7 it's like I have nothing in my system and am super hungry. This has been the exact same pattern from day 1 when I started 2.5mg. I am getting really sick of the roller coaster high suppression then zero suppression pattern every single week.

I recently started 'topping up' on day 5 with a half dose, or just a bit less. I'm now wondering if I should just take a smaller dose (say 3.5mg) every 3 or 4 days, rather than a big dose (7.5mg) every week.

Has anyone done this? Anyone know if there's any danger in that?

Or can anyone suggest any other way to stop this yo-yo'ing appetite. It's really reminiscent of yo yo dieting and although I don't binge per se on day 5, 6 and 7 I do get very upset at how hungry I feel all day and the constant food noise and the increased snacking. I can't really cope with it to be honest

Or should I just inject every 5 days? rather than every 7?

Any thoughts?

Having done some digging and read some Reddit threads, I've decided to inject 4mg on a Monday and 4mg on a Thursday every week. I think that will work great for me :) and when I go up to 10mg I will do 5 on a Monday and 5 on a Thursday. Perfect!

In fact, the more I think about it, the more I wonder why everyone doesn't do this! Or the drug companies don't recommend it? Seems like a really good way to keep things even throughout the week and keep side effects to a minimum as you are not taking a huge dose all once, but rather just divided into smaller chunks! :)

I inject twice a week OP and have done from the beginning (20 weeks now) , to try to avoid highs and lows and lower the chance of side effects. I might go to once a week later in the process.

I wouldn't be injecting more than once a week long term without some qualified advice. Reddit or any social media does not count as "digging".

Because the clinical trials were not done in this way, so there is no data about how people respond to a dosing schedule like this. It's normal for the suppression to wear off in the last couple of days of the week, it's something that most people just get accustomed to, or move up a dose if it gets longer.

Thanks! That's reassuring :) the more I think about it, it just seems a no brainer!

Has it been ok for you?

I'm sticking with the recommended doses. I don't recognise feeling tired on he medication - I'd check whether there is something else going on, OP, like low iron.

But as long as I do not exceed the weekly dose (so eg. No more than 10mg per week if on this dose) then I can't see what's wrong with spreading it out rather than taking all at once? And actually seems more sensible to do so?

I read somewhere that the only reason the drug companies suggested weekly was because they thought it would be easier for clients and increase compliance....

I would suggest using a dose diary type app or website to get an idea of the levels of medication in your system, if you are doing your own devised dosing schedule in this way. Dose Diary, or Shotsy are the ones that I know of, there may be others.

Thanks!

I always feel exhausted on day 2 and 3. By day 5 I'm back to my usual self and full of beans. It's too coincidental to be anything other than an mj side effect. If it was anything else I'm pretty sure there wouldn't be a pattern that coincides with the jab days ...

Yes, I’ve had very little in terms of side effects (apart from the darned rash).

I read the reason why the pharmaceutical company chose once a week was because most people would be able to commit to that and it was easy to remember and some people don’t like injecting . I get their reasoning but I am ok with it and can do the maths. As I said later on when my dosage is clear and steady and no side effects, also maintenance if I do that, I would do once a week.

@RelaxRel can I ask where you read that, I'd be interested to read it too, thanks.

Thanks! Yeah that makes sense. I'm going to do Mons and Thurs from now on - 30 clicks each time. I might go to weekly in maintenance too, that makes sense...

I’m sorry @SilenceInside I can’t remember. I’ve read lots on the subject. I’m not saying that’s true by the way - it’s just some reasoning I came across, which makes sense anyway. I’m sure a private doctor would be open to these kinds of adjustments but I suppose they feel they are monitoring it. Most people are happy going up at the recommended dosage but I was very scared of side effects so was very careful ironically (my first week i only took 1.25 mg)

Ah ok. I thought it was more to do with the fact that the half life of Mounjaro is 5 days which makes weekly dosing possible, rather than for example the much shorter half life of liraglutide (Saxenda) which is only 13 hours meaning it needs to be injected daily.

Do you know (from a qualified professional not reddit or MN) if injecting twice a week regularly will put extra stress on your liver, kidneys, overstimulate the pancreas, cause additional GI system distress and risk of longer term GI type ill health?

I don't. It might be fine for most or some, but it also might not and you don't know if it won't be for you.

You could be causing issues that are not immediately apparent until it becomes a real problem. I am happy with 5th (or even a 6th on day 35) doses, adjusting doses etc, but injecting twice a week regularly is not a risk I would personally take without professional advice/support.

Your body, your risk. Just something to consider before you make your decision.

PS. Obviously OP, I use fresh needles for every injection, so I had to buy some extra ones on the Internet, but I am sure you are aware of that necessity already.

As long as you have an in depth knowledge of the pharmacokinetics and pharmacodynamics to know what you’re doing…

I would love to know if anyone has had any medical advice on this because I don't like the highs and lows. I had pregnancy diabetes and was injecting insulin so the injections don't bother me at all, and needles are cheap. I'd happily inject (adjusted doses) daily if it reduced side effects.

The weekly jab seems to have been designed by the drug companies to improve compliance - I was reading how there are hopes that in future they can developer monthly and yearly injections.

Oh yeah! Thanks! I hadn't thought about that and probably wouldn't have realised til I ran out!! So thanks for the heads up! :)

Any ideas where I can get proper info? My GP wouldn't have a clue and I'm not optimistic my provider really understands anymore than what they've been told to tell people.

Who would know? There's nothing in the research I've read that would indicate this would be a problem but I admit I don't know enough, partly why I'm asking others here if they have thoughts or knowledge or experience.

Nobody would know definitively, because it's not been trialled and studied. Your provider isn't going to give you advice on doing a custom dosing schedule and custom dosing because that isn't the published dosing schedule and there's no reason from their point of view to deviate from that advice.

I also would not take advice from random people posting online, for the reasons given above, and also because you have no idea about the level of knowledge and understanding that anyone posting here has, and no way of checking that.

I would repeat that it is totally normal and expected to have lower suppression towards the end of the week, and not something that needs a change in your dosing schedule or dosage to remove. If it starts to be longer than a couple of days then that's an indication to move up to the next dose level.

I think @nocoolnamesleft was being patronising / sarcastic rather than offering genuine advice OP. This is a grown up discussion board - well at least for some 🤷‍♀️ Hope things go well for you going forward whatever you do.

Who would know? - the Eli Lilly scientists I would expect.... Perhaps one of the other big pharma who are looking at similar medications will have a good idea. No-one that MN or joe public has access to.

No one else will know the risks of GLP1 and GIP hormones on a twice weekly off license dosing schedule.

Regardless of what ANYONE else says it all comes down to how much of a risk you are willing to take and how lucky you feel.