Start dose Reta

[skaylife]

Hi friends,

A good friend of mine weighs 146kg (322lbs) and have been using Ozempic couple of years at highest dosage. He could ever lose 20kgs. But gained back and at the moment it doesn't help anymore. He wants to try Reta and asked me advice about dosage. But I am not a Reta user. Sometime ago tried Reta for a few weeks. But did not work for me. Stopped after getting 3 days long heavy diarrhea.

I know how Reta protocol is. But I didn't ever reach such a high weight and don't have any idea what should be his start dose? Good advice will be much appreciated.
Almost forgotten! He has also diabetes II.

 

[eidos]

It should be noted that the effect of retatrutide on the glucagon receptor is really felt from 8mg/week in clinical studies (7.5 significantly lowered my blood sugar). This is what is really important for diabetes.

I started at 2.5mg to test my reaction and then gradually increased the dose up to 10mg/week. My blood sugar level is below 100 mg/dl, even though it's after dinner. I have a CGM and it projects an HbA1c of 6.5% whereas I was at 10.5 in February, under Tirz and before switching to Reta. BMI from 31-32 to 27-28.

 

[skaylife]

It should be noted that the effect of retatrutide on the glucagon receptor is really felt from 8mg/week in clinical studies (7.5 significantly lowered my blood sugar). This is what is really important for diabetes.

I started at 2.5mg to test my reaction and then gradually increased the dose up to 10mg/week. My blood sugar level is below 100 mg/dl, even though it's after dinner. I have a CGM and it projects an HbA1c of 6.5% whereas I was at 10.5 in February, under Tirz and before switching to Reta. BMI from 31-32 to 27-28.

Thanks for your advice. I was also thinking that start doses like 0.5~1mg like most people do, should be too low for him. Thought may be start at 2mg and after a month titrate to 4 and so on unltil we find the good response dosage. But could not dare to give any advice without asking opinion of researchers with Reta experience.

At first he was also sceptisch about Reta and had concerns about long term unexpexted consequences which are not known yet. Asked, what if he after 10 years get some other health issues because of Reta use. He is already 61 years old and has a passive office job. Walking 2 steps takes 2 seconds. I had to ask him if he was expecting to live 10 more years at that weight, age and condition? It was not easy to say that to him. But as a friend I had to confront him with truth. I hope he can live healthier and longer thanks to Reta. In Belgium insurance pays only semaglutide. He has to pay full price for Mounjaro and 10mg costs €400/month which he can't afford. Grey market is the only good solution for him at the moment. I can even pay it for him, if he accepts. But I don't think he will.

 

[eidos]

He has to pay full price for Mounjaro and 10mg costs €400/month which he can't afford.

Same thing in France, just a little cheaper at my pharmacy, which doesn't take a margin. I switched to Grey, and I have no regrets.

How many psychologists does it take to change a light bulb?
Just one. But the light bulb has to want to change.

 

[BBA1969]

I helped my sister get started on Retatrutide. She had a history on Ribelsus (oral Semaglutide). We started off on 1mg for 4 weeks for adaptation. She really responded right away so she stayed on 1mg for 6 weeks before going to 1.5mg. Now after 4 months she's still on 2mg per week and will likely stay there until she reaches her goal weight (8kg to go).
After that I will probably advise her to swith to Tirzepatide or cagrisema at a minimal dose for maintenance.

My advice is to start really low like 1 to 2mg max for a couple of weeks and then go up 1mg at a time.

Or you can get grey Tirzepatide and follow the Mounjaro route > 2.5 - 5 - 7.5 -10 and so on. If pure weightloss is the main driver, nothing beats Tirzepatide in my opinion.

Feel free to DM me 😉

 

[Mochizuki0124]

My recommendation is start at .5 regardless of his experience with GLP's. Do .5 1 week then titrate by .5 weekly until he finds a sweet spot or 4mg whichever comes first. I would stay at 4mg for a few weeks before going up again.

 

[Don]

It should be noted that the effect of retatrutide on the glucagon receptor is really felt from 8mg/week in clinical studies (7.5 significantly lowered my blood sugar). This is what is really important for diabetes.

I started at 2.5mg to test my reaction and then gradually increased the dose up to 10mg/week. My blood sugar level is below 100 mg/dl, even though it's after dinner. I have a CGM and it projects an HbA1c of 6.5% whereas I was at 10.5 in February, under Tirz and before switching to Reta. BMI from 31-32 to 27-28.

Not sure I agree that the glucagon effect only starts being relevant at 8 mg.

The liver fat data already showed around 51% reduction at 1 mg and 59% at 4 mg after 48 weeks. The biggest jump was between 4 mg and 8 mg 82%, but there was clearly a substantial effect before 8 mg as well and on 12mg it didn't increase much to 86%
To me, the data suggest that the glucagon component may become more noticeable at higher doses, but not that it suddenly switches on at 8 mg.

Also, I wouldn't use improved glucose control as evidence of a glucagon effect. Glucagon on its own tends to increase blood glucose. The HbA1c improvement is more likely the result of the overall effects of retatrutide: GLP-1, GIP, weight loss, reduced food intake, and improved insulin sensitivity

 

[Don]

At 146 kg I still wouldn't start higher just because of body weight. I would start low and up the dose normally every 2-4 weeks. With Reta, tolerance is usually the limiting factor, not weight

Also if Ozempic stopped working, I wouldn't read too much into that. Plenty of people plateau on Sema and still respond very well to Tirz or Reta

The biggest mistake I see is people rushing the escalation because they want to get to the "effective" doses as fast as possible. I would rather take an extra few weeks and stay on the drug than push too hard and end up dealing with side effects. Most people who run into trouble do so because they increase too fast, not because they started too low