tirzepatide — 9 things I got wrong before I got it right
tirzepatide — 9 things I got wrong before I got it right. Change my mind, genuinely — I have no stake in being right about this.
Switching from semaglutide, since three people asked in this thread alone.
There is no published dose equivalence between the two. The conversion tables that circulate are somebody’s arithmetic, not data. What people report here is that the first month after a switch is often flat, that the appetite effect feels differently shaped rather than simply stronger, and that starting at the bottom of the ladder again is the common approach.
None of that is a recommendation. It is what the threads say, and the threads are not a clinic.
Week 29 was the first time the scale moved after a five-week stall. I changed nothing in that window.
SURMOUNT-1 ran 72 weeks with the top arm around 21% mean body weight change. SURPASS is the diabetes programme and reports glycaemic endpoints, so quoting the two interchangeably is a category error.
Corrections welcome, especially the pedantic ones. Pedantry is how this board earns its reputation.
best — the order this archive was captured in
The distribution matters more than the mean. In the trial population the interquartile spread was wide enough that two honest people can have completely different runs on the same arm.
Are you comparing yourself with the trial mean or with the people who post the most?
Held 7.5 for five months. Everyone kept asking when I was going to 10. The answer was never, because 7.5 was working.
Left up, flair changed to Discussion. It is an opinion post and that is fine as long as it is labelled.
Pen or vial? The step sizes available differ and it changes this answer.
Small fix: SURMOUNT is the obesity programme, SURPASS is the type-2 programme. They are different endpoints and the numbers do not transfer.
The step schedule question, answered properly, because it comes up weekly.
The label sets a minimum interval of four weeks between increases. That is a floor on how fast you may go, and it exists because tolerability, not efficacy, is what limits most people. There is nothing in the pharmacology that says you must increase at four weeks, or at eight, or ever.
What decides it in practice is whether the effect you want is still there. If appetite is quiet and the trend is going the right way, the dose is doing its job. If both have genuinely gone flat for six weeks or more, that is a conversation worth having with someone who knows your history.
Cosigning the four-week thing. It is a minimum interval, and treating it as a schedule to keep up with is how people end up miserable at 12.5.
Appetite effect for me is flat across seven days. On sema it was a wave. Same person, different molecule.
The four-week interval in the label is a minimum. Nothing about the pharmacology requires you to step on schedule, and the trials stepped on a calendar because trials have to.
2.5mg is a four-week starting dose, not a maintenance dose. Worth being precise since people search these threads.
The thing nobody warned me about was how much of this is logistics — storing it, remembering it, the same day every week.
Went 10 to 12.5 on the calendar and had the worst fortnight of the whole run. Dropped back to 10 and everything settled.
Right. And the sema-to-tirz "conversion" people post is invented. There is no published equivalence.
It is a dual GIP and GLP-1 receptor agonist, and the GIP arm is the part that has no equivalent in the semaglutide threads. That is why the side-effect profile reads differently rather than just milder.
That percentage is body weight change, not body fat. Different measurement, and the distinction gets lost every time.
It is a dual GIP and GLP-1 receptor agonist, and the GIP arm is the part that has no equivalent in the semaglutide threads.
Agreed, with one qualifier: that is the mean of the top arm and the spread around it was enormous.