What do to for last 20lbs on Tirz @ max dose

[Grogu]

Long story short, I'm about 15 months on tirzepatide and pinned 18mg this morning. I've lost 107lbs and weighed 228 this morning. I'd really like to get to 205, which would put me just into the "normal" weight category for my height. I started a small stack of sema at the end of November, and that seems to have continued my weight loss, but I stopped sometime in March when my sleep got all messed up. I'm thinking now it wasn't the sema.

I pinned 5mg of tirz mid-week this past Monday and it felt really good, but I think that that was kind of a crazy dose given that I've been pinning 17mg weekly.

I'm going to double down on the protein and up my exercise, but I'm wondering if anyone has advice on what I might try on these last 20-23lbs. All I have in the stockpile right now is tirz, sema, reta, and cagri. I was thinking I could get some maz or survo and do ghetto reta or would it be better to just transition to reta at this point? The only thing that scares me about reta is when people say there less food noise dampening. Should I go back to the sema stack and keep increasing the sema until I'm get to the max dose of sema? I was doing 1mg, but maybe pull back on the tirzepatide and go full steam ahead with the sema? I can order some max or survo, but that's going to take awhile. I'm just confused on the best path forward.

 

[Sasquatch]

I been doing 19.5mg total for two or three weeks. ( must be three, according to the vial count) 12.5 or 13mg on wed./Thurs. Then the remainder on Sat.
Initially I started losing a couple pounds a week, but went on vaca and everything went to hell. Gained back 5lbs. But I think if I behaved, ida been OK.
Similarly, imat 270, trying to get to 250. I'm giving myself 6 more months. If I make it OK. If I don't, I still lost 60/70lbs. Now, what I'll do in 6 months, I don't know?

 

[Grogu]

I been doing 19.5mg total for two or three weeks. ( must be three, according to the vial count) 12.5 or 13mg on wed./Thurs. Then the remainder on Sat.
Initially I started losing a couple pounds a week, but went on vaca and everything went to hell. Gained back 5lbs. But I think if I behaved, ida been OK.
Similarly, imat 270, trying to get to 250. I'm giving myself 6 more months. If I make it OK. If I don't, I still lost 60/70lbs. Now, what I'll do in 6 months, I don't know?

I could definitely do another 5mg next Monday and that would put me at 23mg weekly. My only side effect this past week on Monday, Tuesday or Wednesday was really no interest in food 🤣, but I was able to eat with no problem.

Based on the clincial trials for tirzepatide, I'm probably right at the point where weight loss on this medication is done. So, I'm not so sure if more tirzepatide is really the answer. I feel like I need to shake things up.

 

[Sasquatch]

Indeed, I like to refer to the studies/trials, as I don't have much else as far as real guidance. (No offense to our forum brethren) That's why I'm using a year and a half as a milestone.
Losing over 100lbs.! You've already won! It's all in the point of view. Reading this proactive/positivity based forum, you'd think everyone simply takes the stuff and simply drives to the desired weight. Bob's yer Uncle. Well, according to the "study" there's a large percentage of success, but it's still a percentage.
Honestly, I'm fucking old and getting older. I've lost quite a bit. It's not making me better looking. The last coat was pretty dry long before I started this shit. 20 more pounds would be nice, but percentage wise especially, won't amount to much. I wish I could say 15lbs. is just 3 healthy shits, but those were the days.🤣

 

[Summer48]

Just done my 61th shot of tirz. Still got 14 lbs to go and I’ve lost 1/2 lb in 5 weeks. Just feels like I’m not taking it anymore food cravings coming back. But the last shot I’ve taken is 20mg instead of 15mg and definitely feel a difference no food cravings at all. I have tried 17.5mg before but didn’t feel any different from 15mg. Hope this doesn’t mean I have to keep going up and up and up. Who knows where it might lead

 

[staffn1]

Unless you have actually plateaus why not keep going with what you were doing? Try increasing exercise intensity (with intermittent high intensity training). Focus on muscle building and less on weight loss. The last lbs can be slow.

 

[woundcarping]

Halfway to your next tirz 17mg dose take 6mg of Reta. Drop your tirz to 12-15mg. Give it ~24-48 hours and decide how your food noise is before adding more tirz before your next Reta.

 

[Grogu]

Just done my 61th shot of tirz. Still got 14 lbs to go and I’ve lost 1/2 lb in 5 weeks. Just feels like I’m not taking it anymore food cravings coming back. But the last shot I’ve taken is 20mg instead of 15mg and definitely feel a difference no food cravings at all. I have tried 17.5mg before but didn’t feel any different from 15mg. Hope this doesn’t mean I have to keep going up and up and up. Who knows where it might lead

Lilly is currently testing higher doses of tirzepatide in a clinical trial and they haven't cancelled the trial for safety reasons, and we've both survived higher doses 🤣, so clearly 15mg is not the highest dose. I told myself I'd be fine going up to 25mg 🤷🏻‍♂️, but not sure if that that is the best approach.

 

[Devilseye]

I mean if you were doing good with a sema stack I would just keep doing that. They compliment each other affinity wise. Tirz for GIP and sema for GLP1. I would just keep doing that until you reach your goal and then drop the sema and maintain on tirz alone.

Good luck! Those last few pounds can be the hardest.

 

[Grogu]

I mean if you were doing good with a sema stack I would just keep doing that. They compliment each other affinity wise. Tirz for GIP and sema for GLP1. I would just keep doing that until you reach your goal and then drop the sema and maintain on tirz alone.

Good luck! Those last few pounds can be the hardest.

There is definitely a point about going back to the sema. I felt pretty good on that and I now know that my sleep issue wasn't because of the sema. That could be a possible solution.

 

[Grogu]

Halfway to your next tirz 17mg dose take 6mg of Reta. Drop your tirz to 12-15mg. Give it ~24-48 hours and decide how your food noise is before adding more tirz before your next Reta.

tbh, the whole reason that I even stocked up on reta was I felt that at some point the tirz would stop working and I would need something else to get me to the finish line. So, I can definitely give reta a try, what am I stockpiling it for if not to use. Nothing is written in stone. I can also go back to stacking with sema if I don't like the reta. Do you think that the 6mg is too much for the first pin?

 

[cldfront]

Cagri? That's my next plan once I go from 15 to 20mg Tirz. Reta doesn't agree with me and the Survo stack was meh with sides.

 

[Grogu]

Cagri? That's my next plan once I go from 15 to 20mg Tirz. Reta doesn't agree with me and the Survo stack was meh with sides.

Looking back now, I think that's why I must have cagri in the toolbox. I ruled out Survo for some reason, but don't remember why. Then I read about the pH issue and fibrils issue with cagri and that kind of spooked me a little, but I'm going to look at cagri again.

 

[cldfront]

Looking back now, I think that's why I must have cagri in the toolbox. I ruled out Survo for some reason, but don't remember why. Then I read about the pH issue and fibrils issue with cagri and that kind of spooked me a little, but I'm going to look at cagri again.

Same/same. So I did some research and I copied this info from a post here because it appears to be "best practices", ordered some 0.6% acetic acid and pH strips on Amazon, and I'm about to give it a whirl (apologies I don't have the OP):
For those who truly love precision and want to perfectly mimic Novo Nordisk’s formulation, here’s a straightforward method:

• Take your 10 mg vial or 5mg vial of cagrilintide and mix with 2 ml of standard BAC water. Gently swirl until fully dissolved—never shake vigorously.
• Now, slowly add about 0.2 ml of 0.6% acetic acid solution (pharmaceutically sterile). This is a mild acid solution safe for injection.
• Gently mix again and check pH with narrow-range pH strips (ideal is around pH 4.0–4.5).
• If your pH isn’t quite low enough, add additional 0.05 ml increments of 0.6% acetic acid, checking pH each time. You’ll likely find the sweet spot around a total of .25-40 ml added.
• This method is super easy once you’ve done it a few times. It ensures your peptide stays chemically stable and mimics the precise conditions Novo would use if they sold a standalone vial.

 

[Grogu]

Same/same. So I did some research and I copied this info from a post here because it appears to be "best practices", ordered some 0.6% acetic acid and pH strips on Amazon, and I'm about to give it a whirl (apologies I don't have the OP):
For those who truly love precision and want to perfectly mimic Novo Nordisk’s formulation, here’s a straightforward method:

• Take your 10 mg vial or 5mg vial of cagrilintide and mix with 2 ml of standard BAC water. Gently swirl until fully dissolved—never shake vigorously.
• Now, slowly add about 0.2 ml of 0.6% acetic acid solution (pharmaceutically sterile). This is a mild acid solution safe for injection.
• Gently mix again and check pH with narrow-range pH strips (ideal is around pH 4.0–4.5).
• If your pH isn’t quite low enough, add additional 0.05 ml increments of 0.6% acetic acid, checking pH each time. You’ll likely find the sweet spot around a total of .25-40 ml added.
• This method is super easy once you’ve done it a few times. It ensures your peptide stays chemically stable and mimics the precise conditions Novo would use if they sold a standalone vial.

Wow! Thanks so much for this. This sounds like really good advice about how to properly adjust the pH, which I think is a pretty good idea. That would definitely make me more comfortable.

 

[swimmer]

The last 10 lbs was a bitch for me too. When I stalled on 15 mg tirz, I went up to 20 mg. When I stalled on 20 I went to 20 every 6 days. Then 20 every 5 days for the last month. I had no negative side effects. For maintenance I am on 10 mg tirz and I sprinkle in 2.5 Mazdutide every once in a while. I have Cagri and Reta in the freezer if I ever need them.

 

[RadicalCrimson]

Same/same. So I did some research and I copied this info from a post here because it appears to be "best practices", ordered some 0.6% acetic acid and pH strips on Amazon, and I'm about to give it a whirl (apologies I don't have the OP):
For those who truly love precision and want to perfectly mimic Novo Nordisk’s formulation, here’s a straightforward method:

• Take your 10 mg vial or 5mg vial of cagrilintide and mix with 2 ml of standard BAC water. Gently swirl until fully dissolved—never shake vigorously.
• Now, slowly add about 0.2 ml of 0.6% acetic acid solution (pharmaceutically sterile). This is a mild acid solution safe for injection.
• Gently mix again and check pH with narrow-range pH strips (ideal is around pH 4.0–4.5).
• If your pH isn’t quite low enough, add additional 0.05 ml increments of 0.6% acetic acid, checking pH each time. You’ll likely find the sweet spot around a total of .25-40 ml added.
• This method is super easy once you’ve done it a few times. It ensures your peptide stays chemically stable and mimics the precise conditions Novo would use if they sold a standalone vial.

When I did my first cagri I mixed 2mL BAC water and 1ml AA and pH was around 5, so I decided to do 50/50 next time. I’ve seen some people also recommend it.
I suppose it depends on your AA’s concentration, that’s why measuring is important.

This made me realize that this was 5 weeks ago, so time for a new vial next week, even though I only used 2mg out of the 5.

 

[lessthanhalf]

Starting at very different positions given I only started GLP's to control hunger after losing weight, but my logic was that reta was surprisingly good at low doses at causing weight loss, 9% at 1mg over a year, so I added a smallish dose of it to 15mg of tirz. Did not want to swap as I had very few side effects from it and had horrible side effects from ozempic. Ended at 15mg of tirz and 5mg of reta, and lost a further 13 kg from 79 to 66 kg over 9 months, but had only been on tirz for 1 month before adding in the reta. So I cannot say a lot about the difference between just tirz and tirz plus reta, other than I felt less hungry on both.
I figure you get a little more GIP and GLP-1 , plus the extra effect from glucagon with adding reta, plus possibly less side effects than higher doses of reta alone. Not very different to just higher tirz doses but with the added glucagon agonism.
Adding in low doses of cagri is the other option, probably slightly higher chances of nausea and fatigue, so might depend on how sensitive to those side effects from tirz you were, although I am not sure how well they correlate given it acts on different receptors in different parts of the brain.
My logic is the risks of higher than standard doses or combination therapies are probably lower than the risks of severe obesity, and if you have lost 107 lbs and want to lose another 20, then you likely started in that category. I would class the theoretical risks of cagri and fibrils in the same area, it might be significant , but losing and maintaining large amounts of weight loss has an enormous effect on long term health risks. The relative risks are likely different orders of magnitude.

 

[Grogu]

Unless you have actually plateaus why not keep going with what you were doing? Try increasing exercise intensity (with intermittent high intensity training). Focus on muscle building and less on weight loss. The last lbs can be slow.

Definitely at a plateau. Just checked and I’ve gone up and down, but I’m basically at the same weight I was at the start of March. That was about the time I stopped the sema stack.

 

[woundcarping]

Could always roll the dice on sleep and add Sema back…

 

[chewonmysac]

For me, what worked is that once I hit my goal at the end of January, 280 to 200. Plateaued the final 60 days. Took forever to lose the final 6lbs. I went from 15mg Tirz to 12.5 one week. 10mg next week and stayed there for 3 weeks. The plan was to go to maintenance( whatever that is). 2 lbs up or down each week. Then I convinced myself I needed to lose 20 more pounds for an even 100lb loss. Titrated back up to 12.5 one week, then back to 15mg, where I remain today. Lost an additional 14lbs in 5 weeks. One Costco chicken away from my final goal. The dreaded 6 lbs. Sometimes you gotta take one step back to take two steps forward.

 

[Grogu]

Could always roll the dice on sleep and add Sema back…

Who needs sleep? 😂

Yeah, trying Sema again is a good idea too. I just checked and the three months I stacked with Sema I lost 23 pounds. Stopped Sema and basically nothing since then.

 

[tubby]

I'll skip the stuff that I don't think you'd be as receptive to, but I'll point out that in a certain sense, losing the last 20 pounds (while on a GLP) in many ways would be very similar to losing the first 20 pounds (had you never discovered the world of GLPs). There isn't really a universal "best" approach, but more a universe of different approaches that will vary from person to person in effectiveness.

Cagrilintide seems to be the obvious choice in terms of aligning with your personal weight loss belief system, as it's pulling an obviously different lever and would help you eat even less than you're currently eating.

Glucagon-agonism (via ghetto reta) would probably come next on the list for you, as the added sema would help you with perceived hunger control, which would align with your weight loss belief system, while continuing to lose weight.

Transitioning to reta itself would probably come after that because although it would be similarly adding in glucagon-agonism, you'd likely perceive greater hunger and appetite for an extended period and psychologically you'd feel like you were forced to tackle those head on, likely torturing yourself chasing calorie goals during that extended transition period.

GHSs (*morelin) would probably come last on the list because although it's likely to be highly effective, you'd face similar challenges to reta and that would be compounded by potential muscle gain (as well as water retention) causing you to feel like you're losing progress on the scale and you'd probably face the same "calories" challenge reta would provide. Also, since GH tinkering ideally includes additional labwork, monitoring, and other unknowns it might not be the most psychologically comfortable or settling approach.

 

[ambot88]

seems like adding sema is going to be your best bet, you know it works and you have it on hand. Stacking with reta is the other option I'd consider. I'm currently stalled out on reta and was gonna add in tirz this week, love the ability to adjust and figure shit out being in the grey world, the doctor definitely isn't going to let us dial in medication this way.

 

[Grogu]

Cagrilintide seems to be the obvious choice in terms of aligning with your personal weight loss belief system, as it's pulling an obviously different lever and would help you eat even less than you're currently eating.

Although we don't always see eye-to-eye on weight loss philosophy, I really appreciate the comment and totally agree that cagrilintide is the most obvious choice for me — not only physiologically, but mentally too 😂. That's probably why I opted to buy cagri over survo/maz a few months back.

I've been hesitant about the pH thing with cagri, but @cldfront provided a solid roadmap that I think will make me more comfortable with it. Now I just have to track down some sterile acetic acid solution. In the meantime, I'm thinking I'll restart sema on Monday while I work on getting the cagrilintide squared away.

GHSs (*morelin) would probably come last on the list because although it's likely to be highly effective, you'd face similar challenges to reta and that would be compounded by potential muscle gain (as well as water retention) causing you to feel like you're losing progress on the scale and you'd probably face the same "calories" challenge reta would provide. Also, since GH tinkering ideally includes additional labwork, monitoring, and other unknowns it might not be the most psychologically comfortable or settling approach.

Yes, I was thinking at some point I'd like to try tesamorelin, but as you mention (and I agree 100% again) that would come at the end. Because yeah, you've nailed it on the head, any increase on the scale would be unsettling for me 🤣. I guess I'm that easy to figure out.

 

[HereKittyKitty]

I mean if you were doing good with a sema stack I would just keep doing that. They compliment each other affinity wise. Tirz for GIP and sema for GLP1. I would just keep doing that until you reach your goal and then drop the sema and maintain on tirz alone.

Good luck! Those last few pounds can be the hardest.

If you had survo, I'd give it a whirl but you have two good options in your hands: cagri & sema.

If Sema is working - or was - I would titrate up a bit on it and leave my Tz dose where it is. Maybe I would try dosing halfway to next Sema dosing guidelines which would add 0.3-0.4mg to your dose, or go to the full 1.7mg Sema dose.

Sema was just approved in the US above originally approved 2.4mg max dosing so you have some runway.

Did you try changing the dosing timing? Full Tz dose, 3 days later Sema? Or shortening the cycle to 6 days - again with Tz + 3 days then Sema?

I currently pin on a 6 day cycle: Tz dose + 3 days to Survo + 3 days to Tz + 3 days to Survo. Just started this plan and very low dose Survo inline with the protocols I've seen.

If it's any consolation, I hit a huge analysis paralysis wall when I plateaued and wasn't seeing results. Started Tz in January. Down 7#. Not a lot but I don't have far to go.

Good luck!!!!

 

[tubby]

Although we don't always see eye-to-eye on weight loss philosophy, I really appreciate the comment and totally agree that cagrilintide is the most obvious choice for me — not only physiologically, but mentally too 😂. That's probably why I opted to buy cagri over survo/maz a few months back.

I've been hesitant about the pH thing with cagri, but @cldfront provided a solid roadmap that I think will make me more comfortable with it. Now I just have to track down some sterile acetic acid solution. In the meantime, I'm thinking I'll restart sema on Monday while I work on getting the cagrilintide squared away.



Yes, I was thinking at some point I'd like to try tesamorelin, but as you mention (and I agree 100% again) that would come at the end. Because yeah, you've nailed it on the head, any increase on the scale would be unsettling for me 🤣. I guess I'm that easy to figure out.

Realistically, if I laid out a longer list it might be beneficial for others perusing this thread, but it just wouldn't be useful for you. LOL, it's not that I know you per se, just that I've been in the unorthodox "diet" theories space for a while and most people tend to land in certain categories, depending on the path they took to enter and which zigs and zags they've followed.

Weight loss is an area where it's hard to differentiate between ingenious insight and insane nonsense so it's very rational to put up certain barriers to try to protect yourself from the insane nonsense. If one prefers to frame strategies within a CICO model (which I totally respect), it's going to naturally come with certain preferences and biases. It can be fun to give occasional nudges in regards to that, but if I put myself in your shoes it's easy for me to see why certain outcomes would be distressing or undesirable and anticipate what those might be.

My only real pause with cagrilintide is that it's newer, but then the same could be said of glucagon-agonism (reta) so either way that's part of the rub here.

 

[94brian49]

I'm on the opposite end of the spectrum. Reta has been the strongest for me. When I first started dosing at 10mg, I couldn't eat at all, but it mellowed out after some time. I'm now at 12mg and it has been great so far.

I also stacked it with Sema 8mg. I would say Sema 4mg is equivalent to Reta 12mg in my anecdotal experience.

 

[RadicalCrimson]

When I did my first cagri I mixed 2mL BAC water and 1ml AA and pH was around 5, so I decided to do 50/50 next time. I’ve seen some people also recommend it.
I suppose it depends on your AA’s concentration, that’s why measuring is important.

This made me realize that this was 5 weeks ago, so time for a new vial next week, even though I only used 2mg out of the 5.

Sure enough, this time I mixed 50% Hospira BAC with 50% 0.6% AA, and the pH was right around 4.5.

 

[JuneBug1956]

Have reconstituted Cagri with BAC for a year now. I take Tirz (. 12 mg) Sema( 2.4 mg)and Cagri (2.4 mg) . Take them weekly but on different days. Down 110 lbs and at goal. Love them all. Cagri warms me up from the Tirz freeze.