coming off semaglutide, is there a conversion or do i restart at 2.5
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#tirzepatide 2026-05-02
Saturday46 messages11 participantstimes are UTC
Highlights from this day
- osier_orders — switched from 2.4 semaglutide and started at 2.5, took the slow route, never regretted it 17:37
- escalation_anxiety — @tail_factor doing the thing where he agrees with you and you feel worse 18:51
- vial_ledger — here is the rough map so you stop having to ask 19:58
- vial_ledger — the single most common mistake in here after purity vs content 23:23
the switch felt like a step down at first and then caught up around week 3
✅2👀18
changed my mind about needing 15, i was chasing a number rather than an outcome
same plateau here
[edited]at 12 my appetite went completely and i dropped back a step, eating nothing isnt a win
anyone got a 10 recon they like for the 2 vials
i argued the sweet spot was nonsense and then spent 3 months at 7.5 not needing more
i sat at 7.5 for 15 months and never needed more, which is where the folklore comes from
10 was enough
if youre coming off semaglutide the honest answer is start low and find out, theres no table
the 2.5 to 5 step was the roughest one for me and everything after was easier
switched from 2.4 semaglutide and started at 2.5, took the slow route, never regretted it
🔥8🧪16
7.5 gang
how many weeks at 7.5 before you knew it was enough
right so i log everything and my appetite curve looks flatter across the week than my semaglutide log did
🧪3🤝3
no clean conversion
18:16new_here_nat joined the room
joined a couple of days ago. is the 20% figure for tirz a real trial number or a marketing number
real number, SURMOUNT-1
72 weeks. roughly 15% at 5mg, high teens at 10mg, and about 20 to 21% at 15mg
and it is the first obesity trial where a chunk of the top dose arm cleared 25%
so tirz just wins
on that endpoint in that trial, at those doses, against placebo. yes
which is a much narrower sentence than the one you just typed
@tail_factor doing the thing where he agrees with you and you feel worse
😂8
fair enough. whats SURMOUNT 3 and 4 then
same shape as the semaglutide withdrawal trial. everyone titrates, then half get placebo, and the placebo group goes back up
the continuers kept losing a bit more over the second stretch
SURMOUNT-3 is the other direction, an intensive lifestyle lead-in first and then the drug on top. Nature Medicine 2023
the interesting bit there is people who had already lost weight the hard way still lost a lot more
so it isnt just picking off the easy weight
🤔4
thats the reasonable read, yes
here is the rough map so you stop having to ask
| Trial | Design | Weeks | Rough headline |
|---|---|---|---|
| SURMOUNT-1 (NEJM 2022) | tirz vs placebo, obesity | 72 | about -20% at 15 mg |
| SURMOUNT-3 (Nat Med 2023) | lifestyle lead-in then tirz | 84 total | large further loss on top |
| SURMOUNT-4 (JAMA 2024) | continue vs withdraw | 88 total | withdrawal group regains |
| SURPASS-2 (NEJM 2021) | tirz vs semaglutide 1 mg, T2D | 40 | tirz better on A1c and weight |
adding that table to the channel pins, its the fourth time this month
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one thing that gets lost. SURMOUNT-1 was non diabetic. the SURPASS programme is diabetic
weight loss in people with type 2 is consistently smaller across every one of these drugs. dont compare across the two programmes
the single most common mistake in here after purity vs content
✅10
why is it smaller in diabetes
several reasons argued about. background medication, longer disease duration, different insulin dynamics
no clean answer and anyone giving you one confidently is guessing
one sec, kettle
coming back up the log — when you said tirz wins on that endpoint, is there a trial where sema wins
not at matched top doses on weight, no. against sema 1mg in SURPASS-2 tirz won, but 1mg is a diabetes dose, not the 2.4 obesity dose
the head to head at proper obesity doses is a separate programme and people misquote it constantly
back. and yeah thats the fight in the next conversation down