Started at 0.25mg with a fairly bad first week, held each step the full four weeks, and I am now at 1mg with no side effects worth naming.
The question I want answered is whether anyone has held at a sub-maximal dose long term and kept the result, or whether the maintenance data only exists at 2.4mg.
I have searched first, so if this is covered somewhere point me at it and I will read it.
This one has a reasonably settled answer, so here it is. Albumin binding above 99% is the whole reason weekly dosing works, and it is also why the trough matters more than the peak. People who dose late are not losing a peak, they are letting the trough fall, and the appetite effect tracks the trough.
Happy to go further on any of that.
BariatricNurseD said:Albumin binding above 99% is the whole reason weekly dosing works, and it is also why the trough matters more than the peak.
That is correct as far as it goes, and here is where it stops going. The dose-response is real but shallow at the top. Across STEP 1 and STEP 4 the gap between 1.7mg and 2.4mg is a couple of percentage points of body weight on average, and the average is carrying a wide spread — plenty of people at 1.7mg sit above the 2.4mg mean. If a dose is working and tolerable, "working" is the relevant variable, not "maximal".
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Browse GL BiochemDerekSJ_a1c said:Started at 0.25mg with a fairly bad first week, held each step the full four weeks, and I am now at 1mg with no side effects worth naming.
Agreed, though "tolerable" needs defining. A dose you tolerate by eating almost nothing is not tolerated, it is being paid for somewhere else — usually in lean mass, sometimes in adherence three months later.
Clinical perspective, offered as context rather than as advice.
DerekSJ_a1c said:...but the FDA says semaglutide...
Interesting point. I want to add some regulatory nuance: the FDA labeling reflects the specific clinical trial data submitted for approval. Real-world clinical practice often extends beyond the FDA label based on emerging evidence and clinical judgment.
Example: semaglutide was first approved for diabetes (Ozempic), then obesity (Wegovy). The molecule didn't change — our understanding of its applications expanded. Similarly, semaglutide may evolve as more data accumulates.