What is the purpose of increasing dosage?

[FireWyrm]

Bear with me here.
I have been overweight since my early teens and never managed to lose any significant weight no matter how diligently I ate and exercised. I never understood why as I am not a snacker (I know, I know, only guilty man in Shawshank) and OMAD for most of that. At one point, I was cycling 16 miles to work five days a week and still only managed to keep my weight to 15 stone!

Strangely, I seem to be a super responder in that 2.5mg has a profound effect on me. I am losing weight and I have almost no appetite at all for most of the week (Im a Sunday injector and by Thursday Im beginning to feel hunger more often again but still only "mmm..could use a sandwich about now" rather than revenously hungry). Unfortunately, I also feel nausea and unpredictable stomach behaviour which makes me wonder whether it is necessary to go up to 5mg as suggested by the dosage documentation.

So, my question is, what is the purpose of the increased dose other than the obvious increased revenue for the supplier? Does increasing the dose increase the weight loss effect? Will the effects of 2.5mg become diminished as I become tolerant of the increased hormone in my body? Or will 2.5mg do me forever? What are the expected results as described by the manufacturer? Are they expecting your metabolism to increase as well as your appetite to decrease?

What I am trying to guage is whether the increased metabolism and consequent accellerated weight loss (if it works like that) worth the potentially more profound side effects that I am expecting from an increased dose?

Everyone responds differently. Some people don’t feel any effects till they get to the higher doses. Other people respond well on the lower dose. Some people feel the effects wear off and have to move up. Other people don’t. The effects might change in time for you.

I never got beyond 5 and lost the bulk of my weight on 3.75. If current dose is working for you then there’s no rush to increase. But for some people the 2.5 dose has basically no effect, so they would want to move up asap.

I responded very well to 2.5, until I didn't. I have moved very slowly through the doses, as I've had quite a lot of side effects, but when a dose has stopped being effective, you know. It may not in your case, but if it does, order the next dose up rather than waiting to see how it goes.

Your body becomes accustomed to the medication so the desired effects wear off. It's that simple.

I spent 20 weeks on 5mg before food noise came back and have just done 16 weeks on 10.

If the dose is working, stay on it. The weight loss will not be any quicker on higher doses. Only move when you need to!

I'm a strong believer in staying on a dose as long as it works for you. Why put more of this strong substance into your body than you need?
Tolerance does build over time but not everyone needs to move up.
I've been taking it for nearly a year and have been on 7.5 the last couple of months, will move up only if I need to

If my body becomes accustomed to a dose and I am consistently no longer getting the desired effects then I will move up.

11 months in I am on 3.75mg and lost 7st. I only moved up from 2.5mg because I thought I had to back them. It is working so well I am too scared I will break it if I experiment and try to move back down to 2.5mg 🤣

Another part of the decision is each persons individual expectations. I was heavily suppressed in the first couple of months of Mounjaro - I didn't particularly enjoy that. Now it keeps the food noise volume dialed down, mostly removes obsessive cravings/snacking and helps with portion control and that has been perfect for me to keep on track.

I am starting to feel cravings again (not every day) now for the last month or so, but knowing I need to come off/taper down at some point I am currently trying to see if I can overcome them while sticking to 3.75mg. I am comfortable I can increase when I want to so it doesn't concern me if during this I stall or put a couple of lbs back on - I know this will be a long journey for me - years, and want to see how much I can do myself with Mounjaro there to help me at whatever dose I need it.

For others the expectation is to continue to feel appetite suppression so they increase dose for that effect once it starts to wear off.

You can look at the manufacturer research trials, eg SURMOUNT-4 which show that the most weight was lost at the 15mg dose, with 10mg and 5 mg also producing meaningful weight loss. In the trials the participants were moved up the doses each 4 weeks until they reached their maximum tolerated dose. Outcomes at 5, 10 and 15mg for the remaining duration of the trial were studied. So for weight loss, reaching the highest tolerated dose should produce the most weight loss, hence the suggesting dosing schedule to move up to 15mg in 4 week steps. Of course in each person’s individual circumstances they might find that one of the doses does the trick for them and stick at that dose.

I have lost weight on every dose, but have had pretty much no side effects the whole way through so I don't think I'm v sensitive to the medication. The lower doses didn't give me much suppression and all the doses wore off a bit in week 4. I'm 5 months in now and on 12.5mg. I've lost 25% of my body weight. 12.5mg has been the best for me.

I think we just all respond differently. Some people seem v sensitive to the medication and others need a big dose! I did stuck at 7.5mg for 2 months, but should have gone up as the last 3 weeks didn't really give much suppression.

I've also found that I really really really like the feel of full suppression, so I am chasing that a lot and the lower doses just don't give it to me!

I'm about to start going back down the doses as I'm now at maintenance. Not looking forward to the food noise coming back really!

I stayed on 2.5mg whilst it was still working, went as high as 7.5mg but the nausea was more than I cared for. So I’ve gone back down to 5mg which whilst working slowly is working, but I’ve lost almost 4 stone so the weight loss is bound to slow for me at this point. Oh and a friend recommended rennie’s for helping with the nausea so might be worth a try!

@FireWyrm I think I'm also a super responder. So much so that I'm now only having 1.25ml and still having good suppression and can barely eat. The downside is the terrible diarrhoea that I had.

Just jabbed now and today (ie day 7) is the first day that I felt that I wanted to eat something.

I am so surprised to have such a huge effect on a low dose, and to be honest, I don't particularly enjoy being so suppressed for 6 days. Was supposed to be meeting my daughter for lunch tomorrow but I know i wouldn't enjoy it (and am very busy) so cancelled it.

I don't intend to move up til I start feeling hungry. I still sometimes "want" something, but it often seems to be boredom or when it's in front of me, I no longer want it. It's a new sensation for me.

My understanding is that 2.5 weekly is sub-therapeutic for most people (although obviously not everyone). Titrating up the doses is a safe way of getting people to a higher dose whilst minimising side effects.

MJ has a very long half life so you never go back to zero level of the drug in your system at the end of the 7 days - there is always an amount remaining. So over weeks/months you will build the level of MJ in your system and have the maximum effect -again, for most people.

But I’d echo what others have said / if a lower dose is working for you, stay on it. I’ve had no side effects but only minimal loss on 2.5 (w3d1today) so I’m keen to move up to 5mgs in two weeks.