Mounjaro at lower BMI

[roundrobyns]

Has anyone tried Mounjaro who is a lower BMI ie 26/27? I’ve seen that prescribing criteria has changed with some providers so I am now eligible to order it. I’m a small frame and an apple shape so I carry all my weight on my tummy and look bigger than my weight suggests, and I worry about the impact on my health. I would like to lose about 15kg. I struggle to lose weight and stick to a diet so I’m hoping this would give me the extra help I need. But I am scared a bit of the side effects. If anyone has any experience would be great to hear it.

I'm the same, want to lose about a stone. My manager lost 1.5 stone over about 5 months, Put 0.5 back on but is keeping the rest off.

That’s interesting, which providers have changed their prescribing criteria?

The lowest BMI eligible before was 27 if you had a weight related health condition or from some ethnic backgrounds. What is it now?

I’ve seen Voy will prescribe for bmi of 25+

Is that not for patients who have already been on it?

No I don’t think so, they are advertising on social media as now available for 25+. I filled out the questionnaire and it will allow me to order.

It allows you to order Mounjaro or Wegovy? When I filled out their online form giving a BMI under 27 it only offered me Glucomman (sp?) tablets, rather than prescription medication.

If you are worried about side effects you can take a lower dose. E.g with the kwickpen 60 clicks is a full dose so 30 clicks is a half dose. That would give you 1.25 instead of 2.5 from a 2.5 pen for example. When it is time to increase your dose you can also go up slowly in a similar way.

The medicine builds in your body so it is stronger in week 2 and week 3 at the same dose- so don't raise your dose straight away thinking that you have been fine as it will increase in your blood levels each week.

Your prescriber is not able to discuss taking less medicine as they must prescribe at the levels in the clinical trials.

Yes, I think it must have changed. I have BMI 26, no health conditions. I can order Mounjaro or Wegovy

I got mounjaro approved last night.Hight 5’7” weight 12 stone.

The annoying thing about Voy is they let you order even if they are going to reject you, really stupid way round of doing it. I’d be really interested to hear how you get on op if your prescription is accepted. I got accepted by Voy with a BMI of 28 with no medical conditions which is also against most guidelines (was outright rejected by Juniper).

🤣 I just tried it too and it offered me Wegovy or Mounjaro. Height 174, 12st (BMI 25.2j, hadn’t been on WLI before, femaile, white, no conditions. Wonder what questions we differed on….

I did wonder if Voy, being Dr led and not being constrained only by GPhC, is now prescribing outside licensed eligibility (the same as they have recently allowing click counting and using pens over 30 days). Perhaps they would reject at review.

Opens up a bigger customer base for them, but not sure I agree with the ethics - I hope they clearly outline the balance of risks to these patients and the potential long term financial impact to maintain so they can make a well informed choice.

I started at a lower BMI and lost weight quickly but didn’t feel great on 2.5mg. Would definitely recommend half dose or less to start and see how you get on. I’m maintaining on 0.83mg.

@roundrobyns I filled the form out just now, so I wonder what I am doing that means a different answer.

I feel discriminated against @WeAllHaveWings! I answered very similarly. My understanding is that when you prescribe against criteria in this way that you are supposed to be very very clear that it is off label and what the risks are. And there’s supposed to be a medical reason in each case, rather than it being cosmetic or just choice.

I have the same issues regarding the ethics of this. Just approving people via the online form without any additional explanation of the off label use seems inappropriate to me.

I have worked out why I was getting a different response, which was due to having a cached version of their online form in my browser. Using an incognito tab means I can now see the new version of their form. At the end of the consultation form it now says:

"Lastly, do you agree and consent to the following?

We may prescribe GLP-1's (e.g. Wegovy and Mounjaro) off-label, for example if your BMI is less than 30 or initiation on a higher starting dose. Learn more

I consent to being offered GLP-1 treatment off-label if my clinician recommends it"

And then indeed I was offered Wegovy or Mounjaro.

I anticipate they are about to be run off their feet with people BMI 25 to 27 ordering from them.

I haven’t actually placed the order but you’re right perhaps they would reject it at review. I’m not sure yet if I will order or not, I will need to weigh up the risks (side effects) vs benefits (healthwise and to my confidence).

I know people will have used them at this starting bmi before (either by fudging the numbers or being prescribed off label privately) so curious as to any experiences anyone could share.

I started MJ at a lower BMI. I began on 1.25mg but quickly moved up to 2.5mg. The worst SE for me was nausea, which was tolerable most of the time but quite bad some days. Then after about four months my hair started shedding quite badly (definitely a direct SE of the drug, not the weight loss) so I stopped the drug. I was at my goal weight by then anyway. Everyone’s SEs differ, regardless of BMI, but they won’t be any worse just because your BMI is lower.

They will absolutely let you order it, whether they approve it or not will be the question.

Maybe Voy are starting off-label prescriptions. The weight loss market is huge and given the expense of the product companies will now chase those people with only a stone or two to lose.

i think @SilenceInside is right

In case it is useful, I will share my experience. I started MJ with a BMI of 27, weight 72 kg. I stayed in 2.5 mg for three months and didn’t have any side effects at all. I increased to 5 mg because I started to get hungrier and have food noises after a holiday. Did 3 pens of 5 mg, still no side effects except lately being very tired and sort of low mood, so will go back to 2.5 mg with the approval of the prescribing team. I have lost 15 kg and feel very happy with it. I will start maintenance with the lower 2.5 mg dose and see how it goes. I have increased protein intake and already feel more energetic. I think my problem was too low calories due to excess dose of 5 mg.
so for me it has been successful so far and no physical side effects at all. Good luck!

Just to add: I decided to take it because I had a couple of health issues which would benefit from weight loss.

Thank you for sharing, this is helpful! I’m glad you’ve had a positive experience

How can you know that hair shedding was as a result of the drug and not as a result of weight loss/calorie restriction if you did lose weight?

If you are on HRT (and can prove it) some pharmacies will prescribe at BMI 27 and no underlying health issues.

Voy looks to be one of the more expensive pharmacies, but once people have had their first prescription approved from there off label, they can easily move to cheaper pharmacies for future pens.

I went with MedExpress with a BMI of just over 27 and an associated health condition. I have tried swapping to a couple of other cheaper providers who rejected me at review I guess as my BMI is now under 27. I went for Wegovey as cheaper and have lost 3 kg in 3 weeks with the only side effect being increased tiredness but due to eating less calories that might be the reason I have felt tired at times so happy with this so far. I took the view I could always swap to Montjaro if Wegovey wasn’t giving me results.