Ride out the plateau or increase dose?

[teees]

I have been on 2.5mg for around a year, weight loss has been steady, about 2lb a week for the first 4/5 months then roughly 1lb a week after that. I have definitely reached a plateau and while I am able to eat more then I was at the start I am usually quite happy with the amount and level of control I have when it comes to not over eating. This past few weeks though I seem to be able to eat more, and the weight isn’t shifting. I’m reluctant to increase dose so if this is something I can just ‘wait’ to pass I would rather, but could I just be wasting these weeks plateauing and would be better upping the dose asap?

Are you talking about Mounjaro?
If yes, I’d deffo go up. I’m amazed at how long 2.5mg has worked for you!

I was on 2.5mg and lost a couple of stone between March and June, but have then hovered annoyingly just a few pounds in the overweight category since July. I was also reluctant to increase.

I switched to a higher just over a week ago and the weight is starting to fall again. I thought 3 months was long enough a plateau and concluded that I was getting less suppression. I have only moved up to 4mg/week (48 clicks from a 5mg pen) so it's not much more expensive and not such a dramatic dose increase.

Yes sorry, I don’t realise I hadn’t named it!!

It’s worked amazingly and I was hopeful that by this point it would be ok for slower weight loss and then maintenance. That said I don’t like appetite suppression so my ‘it works’ probably doesn’t match those who chase the suppressive aspect of it.

I don’t really have suppression on 2.5mg but I don’t like it anyway so have been happy with that for months now. I do wonder if maybe a jump to 3.75/4 might be the answer but if I see the plateau through a bit longer the weight might start to shift again!

You've done very well indeed to get away with only 2.5mg so far. I understand that people have their reasons to be reluctant to increase the dose but it is how the drug is intended to be used.

Is It though? There is no need to move up if it works?

Blindly taking higher doses ‘just because’ seems a bit odd to me and you wouldn’t do it with any other medication. If a prescriber is suggesting you move dose becsue that’s what intended rather then clinical need I would probably steer clear of them tbh.

That's categorically not what I said. I'm not advocating blindly taking higher doses 'just because' and I'm highly critical of unethical prescribers who push their patients up through the doses without a clinical need.

The drug is manufactured at multiple strengths because most users will develop a degree of tolerance after prolonged use. Based on what you have said, 2.5mg is no longer working because your weight loss has plateaued and you are not experiencing any appetite support, so you meet two clinical criteria to increase your dose based on the manufacturer's prescribing guidelines.

2.5mg is a starting dose to get your body accustomed to the drug. According to the manufacturer, patients should move to 5mg after the first 2.5mg pen is finished. Moving up from 5mg is then at the advice of your clinician. So yes, the intended use is to move up to 5mg after a month.
Of course, many people find they successfully lose weight on 2.5mg and therefore choose not to increase the dose, which is fine. It does sound like it may be the time for you to think about increasing your dose though.

Fair enough, I misread you there.

I haven’t had suppression for months on 2.5mg but neither do I want it. I’m happy being able to eat a proper amount of food just healthy food and balanced. I’m not sure the plateau means I need to increase just yet, it’s normal during weight loss to experience them so I’m debating whether to just wait a bit longer or increase

I was led to believe you were supposed to use the smallest effective dose. I guess that’s incorrect. I’m not too sure what to do at this stage tbh

You are supposed to use the smallest effective dose. That's the guiding principle of all prescribing in all medicine. My point is that, based on what you've described, 2.5mg does not sound effective for you any more. You obviously have your reasons to be reluctant to move up and I'm certainly not here to talk you into anything. I hope you find a way forward that works for you.

I think what I’m debating is whether it is effective still or not. It’s usual to get plateaus when losing a lot of weight so perhaps it’s just part and parcel rather than the dose not working. I’m so conflicted over it. It’s done me well for around a year and 7 stone loss so maybe my body is needing a bit of a boost with a slightly higher dose. I really wish this stuff was easy!

Why don't you ask your prescriber?

It would be a no-brainer for me to move up, but not necessarily to 5mg though.

How much more are you hoping to lose? Are you close to goal or still a long way away?

2.5mg is just a starting titration dose to get you used to the medicine. The instructions say to increase to 5mg after 4 weeks regardless.
Once you're on 5mg then you only go up if it becomes ineffective.
That's the Lilly instructions, they consider 5mg to be the smallest effective dose. But as I say, plenty of people find 2.5mg works for them, which is fine. All I'm saying is that that isn't what the manufacturer says to do.
For example -
"The recommended starting dosage of MOUNJARO is 2.5 mg injected subcutaneously once weekly. Follow the dosage escalation below to reduce the risk of gastrointestinal adverse reactions...
The 2.5 mg dosage is for treatment initiation and is not intended for glycemic control.
After 4 weeks, increase the dosage to 5 mg injected subcutaneously once weekly.
If additional glycemic control is needed, increase the dosage in 2.5 mg increments after at least 4 weeks on the current dose."
And -
"The starting dose is 2.5 mg once a week for four weeks. After four weeks your doctor will increase your dose to 5 mg once a week.
Your doctor may increase your dose by 2.5 mg increments to 7.5 mg, 10 mg, 12.5 mg or 15 mg once a week if you need it."
(my highlight)

I think we have slightly different definitions of suppression. To me, suppression just means I can eat a healthy amount, I feel pleasantly satisfied after a meal and I don't feel like I'm constantly starving like I felt pre-Mounjaro. It suppresses my insatiable appetite. I have always ate about 1500-2000 cal on this.

Basically, I found that I was getting hungrier after a number of months and returning to snacking more. It was OK for maintaining, but moving up slightly has got me back to losing again. You could wait it out and see if it's just a temporary plateau, but I do recommend moving up if you're not seeing any movement at all and still want to lose more. 4mg is doing it for me at the moment. I may be able to reduce a bit to maintain but we'll see.

I would add though, if you're reluctant to increase, you may want to continue on your current dose for a bit. As mentioned, I spent 3 months fluctuating between about 10st and 10st3 before increasing dose. I wouldn't mind if it had continued to go down slowly (eg 1lb/month) but it just stopped altogether in my case.

I think I spent nearly 40 years yo-yoing, and although I'm looking forward to maintaining at goal weight, I'm not in a massive rush to get through the weight loss phase. It will be a relatively short period of my life in the grand scheme of things.