Should I stay or go up

[Thismorning83]

I’ve been on mounjaro since the start of December. I did one month on 2.5, one month on 5 and am on my second month of 7.5. I’ve lost 1 stone 4 lb in total. But I have suddenly stalled on week two of 7.5 and gained 1lb, having consistently lost between 1-3 lb each week up until now. I’m wondering whether to go up to 10 or stay another month on 7.5 (that would be my third month). I don’t want to go up too quickly if this is just a normal hiatus. Does anyone have any similar experience/advice?

Give it another month and up
your protein and water

How much weight have you got left to lose?

When are you going to do your next order? Could you wait to see how you are after the of next dose?

Im always in a quandary about whether to go up or not; each month.

Are you still feeling the other mounjaro affects apart from the weight bit, like lack of food noise and satiety.

I was wondering about going up to 10mg last order too. This is my second 7.5mg pen and did my first dose from it last Tuesday evening and it’s going better than I thought.

Also could it be a time of the month related thing?

Plus I think it’s too early to call it a stall.

I don’t really have a target. I just want to lose to a point I feel confident and good again. I’m six months post partum

I have more food noise than last month but I’ve increased my exercise an awful lot so assume it may be due to that too. We are off on holiday for two weeks next weekend so I need to order in the next couple of days annoyingly rather than wait until my next dose

It could well be this/ lack of sleep due to the baby!

A pound is within normal fluctuations and as a one off not what I’d call a stall. You haven’t mentioned whether you’re finding the suppression and other effects to be lessening? If it’s working as usual then I’d give it a bit longer before deciding to move up a dose.

Thanks. The suppression has gone a bit but that could be time of the month/ increased exercise, lack of sleep. Thanks all I’ll give it another month I think

I always put water weight on when I start or increase exercise so it could be that

Poor sleep and stress also increase cortisol levels which lead to water retention and bloating and fat gain over time. Could be that.

go up, then if you find you dont need to you can just take less and make the pen last longer that way! least then you have the option to go up if you need too..

I think there’s a danger in not having an actual target weight with this medication. Didnt you need to enter a goal weight to get the prescription?

For me, the decision about going up or not would depend on why I thought I wasn't losing weight. It's not the medication itself that causes weight loss, it's the effect it has on what and how much you eat. So if you are finding that you are still getting food noise which you can't control and you aren't getting appetite suppression to help you eat less, then yes, go up. But if you are feeling those effects and still aren't losing then I would take a closer look at your diet and exercise - are you eating in a calorie deficit for instance.

Hi @Thismorning83 I have been taking Mounjaro (MJ) since October last year, but I am lucky enough to get it on prescription, as I - obviously - qualify for it. In fact, I hadn't even mentioned it to my Diabetes team, they were the ones who advised me to start taking it.

{NB My Diabetes team are not attached to my GP's surgery, except that I have to get my prescription as normal, through my GP practice. The DT runs as a community, and specialist nurse, led, project, that is still funded through the NHS. They do, of course, keep my GP practice up to date with how I am doing.}

For my first month I was just taking the 2.5 that everyone is advised to start off with, but my next telephone appointment with the Diabetes team (DT) wasn't scheduled until after I was due to get my second pen. Before starting my first dose, the DT had sent me a booklet explaining a little about MJ, and the technique on how to administer it, and in that booklet, it said that MJ is given in monthly stages, adding an extra 2.5mg every month, until the maximum amount of 15mg per week, is reached.

So, I didn't realise during that first month that I was supposed to leave it up to my DT to decide if, and when, I should go up to the next dose, and, therefore, I just requested that my next prescription be for 5mg, which my GP practice agreed to without any extra questioning!

When I had my next - and the first - telephone appointment with the DT team since starting taking MJ, I told them how I had been during the first month of taking 2.5mg, and how I was now that I was taking the 5mg dose. The nurse I was talking to sounded a bit puzzled that I had increased my dosage to the 5mg dose of MJ. She told me that they are supposed to let me know when I should have the dose increased! However, as I was tolerating the second level well, she said I could stay on that dose for now, rather than having to go back to the 2.5 dose. So I asked her when she thought I should have my dose increased, she replied that most of their patients stay on that dose for at least 8 to 9 months, but that it, of course, depended on the individual patient.

Wanting to understand the whole process better, I delved into the whys, and why nots, a bit more. Apparently the slow start, and slow progression, are for safety reasons, and that when we read about 'celebrities' having quite strong adverse reactions to any of the WLpens, it is usually because they have increased their doses far to quickly! I have since then, read that hospitals have recently been seeing many more patients with severe kidney, bowel, and pancreas problems, amongst a range of other potentially dangerous symptoms, and that a large proportion of those nasty symptoms were due to them taking WL drugs, and especially to upping the doses far too quickly.

Therefore, it is very important to up one's doses very gradually, in order to let your different organs get slowly 'acclimatised' to the changes happening to them. I don't know if those of you who are funding your own MJ, have any chance to get advice from the people who you receive your MJ from? If not, I hope that your GP practice would agree to monitor, and advise you on when you should be changing the amount of MJ that you take? After all, if anyine in the UK takes too much of any of the WL drugs, it is almost certainly our NHS hospitals that are going to have to deal with the fallout.
Good luck OP, and please take care with your doses. 💐

@PlayingDevilsAdvocateisinteresting every who accesses WLI privately (legitimately) has a prescription for it and meets the prescribing criteria, just as you do via the NHS.

The recommended titration schedule is to step up doses each month until you reach 15mg, due to that being the dose that people in the clinical trials lost the most weight on. However, the titration instructions also say that you can move down or stay on a dose dependant on how you tolerate each dose level. So it's flexible and depends on personal response to the medication. Whereas you as a T2 diabetic would have your dose level changed based on how well your blood sugars are being controlled, not how much weight you are losing. Your diabetes team perhaps should have explained that more clearly to you. Any advice from your diabetes team will be based on that, not on what people using the same medication for weight loss should be doing with their dose level.

And of course people who get a private prescription get plenty of information about the dose schedule and when to increase or decrease their dose. Of course, the injection pen itself comes with patient leaflets that explain it, as well as information sent via email, in apps, and on the websites of the online pharmacies. Any pharmacy that didn't make that information available would be sanctioned by the GPhC at their next inspection.

No NHS GP will agree to monitor and advise on a private prescription, as it's not appropriate for them to do so. They have not made the prescribing decision, and will/should refer you back to the private provider for advice. The private providers will provide that advice if asked.

No one here is advising the OP to take too high a dose or overdose. There will be no "NHS fallout" if the OP chooses to move up a dose, or stay on the same dose level. Everyone is entitled to NHS emergency treatment, if necessary, regardless of how the medical situation might have occurred, and you don't need to point out that specifically for those of us who have dared to seek private treatment as if it's something we need to be told off for.

I know I want to lose at least another stone so put that.

You need a target.
How much do you need to lose to get to a healthy BMI?
What's your BMI now?

It’s very normal to have plateaus on any diet where nothing much changes for a couple of weeks and then you might have a sudden drop of 3lbs or more in the 3rd or 4th week.

If you have been doing more exercise recently, it could be that your muscles are retaining more water and that will account for the 1lb increase.

If you’re not struggling with food noise, then maybe think about staying on 7.5mg for now? I’m still only on 3mg after 6 months on MJ as it’s still working for me and I’m happy to lose slowly at an average rate of 1lb a week.