Can't we learn something about smaller dosage from the weight loss or not of the millions of D2 patients who use Ozempic for glucose control. Max dosage is 2mgs weekly.
Perhaps there should be more studies or conversations regarding this medicine for women in the age group 20-35. I’ve heard of some young women saying the med can negatively affect their mood and sense of daily motivation and when they’ve gone off the med for a break for whatever reason they feel better mood and sense of purpose at work (like studying, doing job, chores, hobbies etc, exercise routine..productivity, connection), so maybe more research in younger adults is needed regarding broader personal daily outcomes and impact around medication management and weekly, monthly dosing. Maybe there should be a questionnaire developed for patient, personal use for discussion points with care providers regarding other kinds of impacts (like being tired or less motivation or less joy, or feeling flatter affect mood, feeling less creativity for example) or other personal impacts of the med effects since it’s a med seemingly used over a longer period of time for different age groups and people at different parts of their personal and work lives.
You're correct that subgroup analyses are warranted and might be very helpful. We do have some of that already. In terms of mental health, I've heard the opposite as well; some people feel their mood improving because the food noise is gone, etc. And it's also nice that there are several options out there. Some might carry different side effects for different groups. It's still early in this story, and we have much to learn!
Great question. I asked the experts on the MedPage Today interview a version of this one last week (will share soon). My q was whether maybe maintenance could be achieved with oral options. It's an open area where we need research. I doubt microdosing will work, but maybe lower dosing, or a combo of oral and injections to make it easier.
I commonly find that I can increase the dose of ozempic slowly and still get good diabetic control, but not below the standard .25 or .5 mg. As we don't have an "off ramp" I understand the desire to try and lower the dose, but thanks for the evidence based review.
Thanks. I am most interested in what a previous commenter said about getting a little creative with maintenance dosing. Maybe switching to orals or drug holidays will become standard some day. But we just don't know what works. We certainly know that many patients who stop taking the medications regain some weight. The question is, how much is okay and can we then do "rescue periods" where they go back on the meds for a little while. This is something I'm eager to see develop.
I've been on MJ for 1.5 years. Never went above 5mg and have been on a "maintenance" dose of 5mg every 2 weeks for almost 1 year (after losing 50lbs). This minimizes my side effects (and costs). I'm in agreement with you "that one-size-fits-all approach to dosing is not optimal."
My doctor and I have been discussing Mounjaro for the last year. I've been a type 2 diabetic on oral meds for over 20 years, age 71, overweight, with chronic diverticulitis ( 1-2 moderate attacks a year) I just got a prescription last week for the 2.5mg and will be picking it up today. I'd like to try a half dose to start to see what my response is. I would like to titrate the dose gradually until I am sure I can tolerate it without having significant side effects. I'm a retired RN and I'm concerned about the options to divide the doses, still on the fence. I've waited long enough for these drugs, do we really need additional studies for lower doses? Mounjaro is approved, people are already doing it, why not allow docs to decide with their patients to choose lower doses rather than patients doing it on their own?
To some extent, the side effects of these medications are a "feature" not a bug, as long as they are mild. A sense of no appetite and even a touch of nausea is how many patients describe the early phase--which is what breaks the chain of overeating. But the side effects wane. What I'd say in response to your comment on letting docs decide is this: yes, I think that it's reasonable to allow that (and we can with any FDA approved drug; off label use, so to speak). But we know that the standard doses work. We don't know if lower ones might for a few. So, I'd recommend starting with what we know. And if that fails, then it'd be reasonable to discuss some nuance/flexible/innovative approaches with your doctor.
My main concern, other than discomfort due to nausea, is that due to my history of chronic diverticulitis I'm concerned that I have a higher potential for Gastroparesis:( This has kept me from trying any of the GLP-1 medications. Also I've been following a Keto diet for many years which has helped my BS control. Still researching how this would work with MJ. It's a lot to think about.
Can't we learn something about smaller dosage from the weight loss or not of the millions of D2 patients who use Ozempic for glucose control. Max dosage is 2mgs weekly.
Perhaps there should be more studies or conversations regarding this medicine for women in the age group 20-35. I’ve heard of some young women saying the med can negatively affect their mood and sense of daily motivation and when they’ve gone off the med for a break for whatever reason they feel better mood and sense of purpose at work (like studying, doing job, chores, hobbies etc, exercise routine..productivity, connection), so maybe more research in younger adults is needed regarding broader personal daily outcomes and impact around medication management and weekly, monthly dosing. Maybe there should be a questionnaire developed for patient, personal use for discussion points with care providers regarding other kinds of impacts (like being tired or less motivation or less joy, or feeling flatter affect mood, feeling less creativity for example) or other personal impacts of the med effects since it’s a med seemingly used over a longer period of time for different age groups and people at different parts of their personal and work lives.
You're correct that subgroup analyses are warranted and might be very helpful. We do have some of that already. In terms of mental health, I've heard the opposite as well; some people feel their mood improving because the food noise is gone, etc. And it's also nice that there are several options out there. Some might carry different side effects for different groups. It's still early in this story, and we have much to learn!
What about microdosing for maintenance?
Great question. I asked the experts on the MedPage Today interview a version of this one last week (will share soon). My q was whether maybe maintenance could be achieved with oral options. It's an open area where we need research. I doubt microdosing will work, but maybe lower dosing, or a combo of oral and injections to make it easier.
I commonly find that I can increase the dose of ozempic slowly and still get good diabetic control, but not below the standard .25 or .5 mg. As we don't have an "off ramp" I understand the desire to try and lower the dose, but thanks for the evidence based review.
Thanks. I am most interested in what a previous commenter said about getting a little creative with maintenance dosing. Maybe switching to orals or drug holidays will become standard some day. But we just don't know what works. We certainly know that many patients who stop taking the medications regain some weight. The question is, how much is okay and can we then do "rescue periods" where they go back on the meds for a little while. This is something I'm eager to see develop.
I've been on MJ for 1.5 years. Never went above 5mg and have been on a "maintenance" dose of 5mg every 2 weeks for almost 1 year (after losing 50lbs). This minimizes my side effects (and costs). I'm in agreement with you "that one-size-fits-all approach to dosing is not optimal."
My doctor and I have been discussing Mounjaro for the last year. I've been a type 2 diabetic on oral meds for over 20 years, age 71, overweight, with chronic diverticulitis ( 1-2 moderate attacks a year) I just got a prescription last week for the 2.5mg and will be picking it up today. I'd like to try a half dose to start to see what my response is. I would like to titrate the dose gradually until I am sure I can tolerate it without having significant side effects. I'm a retired RN and I'm concerned about the options to divide the doses, still on the fence. I've waited long enough for these drugs, do we really need additional studies for lower doses? Mounjaro is approved, people are already doing it, why not allow docs to decide with their patients to choose lower doses rather than patients doing it on their own?
I'd love to hear how it goes for you.
To some extent, the side effects of these medications are a "feature" not a bug, as long as they are mild. A sense of no appetite and even a touch of nausea is how many patients describe the early phase--which is what breaks the chain of overeating. But the side effects wane. What I'd say in response to your comment on letting docs decide is this: yes, I think that it's reasonable to allow that (and we can with any FDA approved drug; off label use, so to speak). But we know that the standard doses work. We don't know if lower ones might for a few. So, I'd recommend starting with what we know. And if that fails, then it'd be reasonable to discuss some nuance/flexible/innovative approaches with your doctor.
My main concern, other than discomfort due to nausea, is that due to my history of chronic diverticulitis I'm concerned that I have a higher potential for Gastroparesis:( This has kept me from trying any of the GLP-1 medications. Also I've been following a Keto diet for many years which has helped my BS control. Still researching how this would work with MJ. It's a lot to think about.