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Semaglutide and Tirzepatide: Dose Plateau, Medication Plateau, Titration Plans

Tirzepatide FAQ's
Semaglutide Plateau In Weight Loss

Semaglutide is a medication used to treat obesity and type 2 diabetes. It works by mimicking the effects of a hormone called glucagon-like peptide-1 (GLP-1), which helps to lower blood sugar levels. Semaglutide slows down the speed of your stomach, making you feel full longer. This, combined with decreased insulin resistance, leads to weight loss for patients. However, there may come a time when you can no longer lose weight with semaglutide. Advancing weight loss when a patient plateaus on semaglutide requires an experienced weight loss provider. Once you have reached your weight loss goal, patients may titrate off or start maintenance dosing. Titrating off semaglutide can be a gradual and safe process if done under the supervision of a healthcare professional.

For weight loss, Semaglutide is typically started at a low dose of 0.25 mg once a week for four weeks, then increased to 0.5 mg once a week. After 4 weeks at the 0.5 mg dose, the dose can be increased up to 2.4 mg once a week if needed. Each patient responds differently to semaglutide, some patients will experience brisk weight loss, while others will require a larger dose to start losing weight.

Semaglutide Plateau

Most patients will experience a plateau in weight loss using semaglutide. Usually, this means we need to increase the dose. In some patients, despite an increased dose, weight loss stops. In this case, patients require a careful evaluation of their dose, diet, and exercise. Often patients will switch from semaglutide to tirzepatide for improved weight loss. Tirzepatide works on two separate receptors, helping patients control cravings more efficiently. Patients who switch may break through a plateau to continue on their weight loss journey.

Poor diet control while taking either semaglutide or tirzepatide will lead to a stall in weight loss. Health coaching can provide a mechanism for breaking through this plateau if a dose adjustment is not an option.

Finally, exercise is critical for any weight loss plan. Women are often directed to cardio-only exercises, a misstep in any weight loss plan. Lifting weights builds lean muscle mass, burning more calories. Weight-based exercises serve to decrease osteoporosis development, especially in women.

7 Changes To Make When Semaglutide Stops Working

  1. Ask your provider to increase your dose. Scheduled dose increases are not the best practice in medicine for tirzepatide or semaglutide. Weekly check-ins allow the patient to increase as they tolerate the medication while safely losing weight.
  2. You may need to switch to another medication like Tirzepatide. Tirzepatide works on GLP-1 and GIP receptor sites providing better control of cravings for many patients.
  3. Weight loss medications require a sensible diet. If your diet includes fried foods, heavy carbohydrates and sweets, it will be difficult for you to lose weight.
  4. Exercise is a must! Patients should work out with weights and cardio a minimum of 4 times per week for 1 hour a day.
  5. Add lipotropic injections. Lipotropic injections boost your B vitamins, combined with carnitine, methionine choline, and inositol. This helps you perform in the gym, shedding more weight.
  6. Women should consider adding AOD-9604. AOD-9604 is a human growth hormone (HGH) fragment instructing your body to burn more fat, increase metabolism, and release fat cells. It works especially well in women, compared to Tesamorelin. Tesamorelin stimulates HGH secretion, reduces abdominal body fat, increases lean muscle mass, reduces recovery time, and helps build muscle. In men, it reduces abdominal body fat over 6-9 months.
  7. If you struggle with motivation or energy at the gym, adding Alpha GPC or NAD+ will help. Alpha GPC works by increasing choline levels in the brain, which increases acetylcholine production. Acetylcholine is a neurotransmitter involved in many vital functions in the brain, including memory, attention, and learning. NAD stands for nicotinamide adenine dinucleotide and naturally exists in all living cells in our bodies. Our levels decline as we age, causing our energy levels to drop.
Titrating Off Semaglutide

Titrating or slowly decreasing the dose of semaglutide requires supervision by your provider. When patients approach their weight loss goal, diet and exercise habits should drastically differ from the start of semagolutide. Patients who fail to change their diet, exercise, and or do not remain on the medication for at least six months are likely to have weight gain after stopping.

The dose reduction of semaglutide should be over a minimum of 6 weeks. A typical plan is to reduce the dose by 25% every 2 weeks for 6 weeks while monitoring the patient.

Weight Loss

In conclusion, tapering off semaglutide is a gradual and safe process that should be done under the supervision of a healthcare professional. Talk to your healthcare provider, monitor your blood sugar levels, and be aware of potential side effects. With the right approach, you can titrate off semaglutide and transition to an alternative treatment plan that meets your needs.

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Clayton Evans

Clayton Evans is an IFA Certified Personal Trainer and IFA Certified Sports Nutritionist with over 5 years of experience in the health and fitness Industry. After years of struggling with his own health and fitness, Clayton lost over 30 lbs and started a career helping others achieve the best version of themselves. Clayton spent several years working with large corporate gyms developing fitness programs and working with Nutrition and Wellness Companies to improve a client’s overall health. His approach with clients is simple – small changes in fitness and diet that will have the largest impact and will fit into a client’s busy lifestyle.

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Brooke is a skilled and compassionate Adult Nurse Practitioner with over 10 years of experience in healthcare and a passion for helping patients achieve optimal health and wellness. Brooke holds a Master of Science in Nursing with a specialization in adult health and gerontology from Maryville University of St. Louis. She completed post-graduate training in functional medicine through the Institute for Functional Medicine and obtained her NP board certification through the American Academy of Nurse Practitioners Credentialing Board in 2019. As a Nurse Practitioner, Brooke seeks to address the root causes of disease and treat the whole person, rather than just the symptoms. She believes in taking a personalized and holistic approach to each patient. She has special interests in helping patients heal from metabolic syndrome, achieve their weight loss goals, optimize fertility, and recover from complex chronic illness. In her free time, Brooke enjoys hiking, reading, rollerblading, cooking healthy meals, and spending time with her fun-loving husband and spirited toddlers. She is excited to partner with you on your health journey and support you in achieving your goals.

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Jacqueline Carbone is a highly experienced nurse practitioner that specializes in providing her clients with holistic, evidenced based, compassionate care. She specializes in Mental health, ketamine assisted therapy and Migraines. She is board certified from the American Nurses Credentialing Center. Jacque has her post Masters certificate from University of Colorado in Psychiatric Mental Health and two master’s degrees—one in acute care/geriatric nursing and one as a clinical specialist in geriatrics—from Georgetown University. She has also completed a fellowship with Dr Arnaldo DeSilva a headache specialist. She is passionate about providing a holistic treatment plan for her clients.

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Dr Michael McGurren was born and raised in Denver, Colorado. He graduated from Creighton University Medical School, and was the Chief Resident followed at Barnes-Jewish in St. Louis. He is board certified in Emergency Medicine and provides medical direction, as well as urgent care services for Mobile Care Health. In his free time he can be found sailing around the world, with a captains license and over 2500 nautical miles sailed. On shore he enjoys traveling with wife and pup Kylo in custom campervan.