Bariatric history + Tirz mg: thinking adding 0.5 mg reta

[Mara_aa]

I’m thinking about trying retatrutide and would really appreciate some thoughts before I do anything potentially stupid.

Right now I’m on 2.25 mg of tirzepatide. I wasn’t able to titrate much higher because I had stomach pain related to my cardia after a bariatric gastroplasty.

Thankfully over time my body seems to have adapted and I don’t really have significant side effects anymore.

Instead of titrating tirzepatide higher, I’m wondering about introducing a very low dose of retatrutide (around 0.5 mg) as a sort of micro-titration.

My metabolism has basically been asleep since the gastroplasty at this point I’m not sure if it’s sleeping, hibernating, or just refusing to get out of bed.

A few questions for those with experience:

1) Is this a terrible idea?

2) Could 0.5 mg of reta be too much to start with considering the GI sensitivity I had when starting tirzepatide?

3) Would spacing it about 3 days after the tirzepatide shot make sense?

For context: my diet is generally healthy, but I don’t always reach my protein target, and my activity level is light daily movement, nothing intense, because I’m not very strong right now.

If anyone has tried something similar or has experience with both compounds, I’d really appreciate hearing how it went for you.

 

[lessthanhalf]

Effects of GLP drugs on the stomach , or at least gastric emptying are one thing that is definitely known to have tolerance develop over time. So having issues increasing the dose a while ago does not necessarily mean you will have the same issues a while later - like months rather than weeks. Generally gi side effects like nausea also tend to fade over months, but not always.

I know very little about bariatric surgery.

But in general increased doses of tirz or adding reta may be tolerated better now than they were initially, but in your case going super low dose and increasing super slow is definitely the right approach. Most gi side effects are worst at peak blood levels 24 -48 hours after a dose. If this is the case, then splitting doses or smaller doses more often will often allow a higher total weekly dose with less side effects. Not sure if there is any major advantage of adding low dose reta instead of increasing tirz dose. ( I am assuming you last tried increasing it a fair while ago )

I am currently on both tirz at 15mg plus reta 5mg and do not have any major issues but had to play around a lot last year on ozempic as it made me very nauseous at low doses and had to use second daily doses of 0.2mg to try to get around that.

 

[Mara_aa]

Effects of GLP drugs on the stomach , or at least gastric emptying are one thing that is definitely known to have tolerance develop over time. So having issues increasing the dose a while ago does not necessarily mean you will have the same issues a while later - like months rather than weeks. Generally gi side effects like nausea also tend to fade over months, but not always.

I know very little about bariatric surgery.

But in general increased doses of tirz or adding reta may be tolerated better now than they were initially, but in your case going super low dose and increasing super slow is definitely the right approach. Most gi side effects are worst at peak blood levels 24 -48 hours after a dose. If this is the case, then splitting doses or smaller doses more often will often allow a higher total weekly dose with less side effects. Not sure if there is any major advantage of adding low dose reta instead of increasing tirz dose. ( I am assuming you last tried increasing it a fair while ago )

I am currently on both tirz at 15mg plus reta 5mg and do not have any major issues but had to play around a lot last year on ozempic as it made me very nauseous at low doses and had to use second daily doses of 0.2mg to try to get around that.

Thank you, that’s really helpful. The point about tolerance developing over time makes a lot of sense

You’re right that it has actually been quite a while since I last tried increasing tirz, so it’s possible my body might tolerate it differently now.

My hesitation is mostly because the pain I had near the cardia after the gastroplasty was quite unpleasant, so I’ve been very cautious about pushing the tirz dose again.

The idea of adding a very small amount of reta came from thinking about a sort of micro-titration rather than making a larger jump with tirz.

From your experience running both together, do you feel reta tends to be more or less GI-intense than tirz at low doses, or fairly similar?

Also I’m not sure I fully understood the Ozempic part — when you mentioned using second daily doses of 0.2 mg, do you mean you were splitting the dose into multiple small injections across the week?

 

[lessthanhalf]

Yes , with Ozempic as I was using the prescribed version, any time I tried increasing the dose above 0.5mg/w, and I already knew it might be a problem based on some side effects at that dose, even increasing to 0.6mg/w was a problem with worse nausea and feeling a bit ill. At that stage I did not know everybody had already worked this out and there were sites like glp-plotter, so I read up and tried to graph out drug levels on paper to see what was going on. As most gi side effects are at peak levels, and peak blood levels are 24 to 48 hours after a dose, I decided on very small 0.22mg doses every 2 days ( 0.22x7/2 ) , which adds up to about 0.77mg/week, and I found that caused less nausea than 0.5mg once a week. I had already lost about 50% of my body weight and was permanently hungry so even a bit more appetite suppression was helpful even if I had to put up with nausea to go with it.

I kept going on second daily doses with reta and tirz mainly out of habit as I had gotten used to it over the year on ozempic.

So if the cardia pain you were getting was only occurring in the day or 2 after the dose you might be less likely to get it using smaller more frequent doses, just add up the small doses for 7 days to get the weekly dose or calculate it. And how often does not matter a lot , I chose every second day as it is much easier to remember than every 3rd or 3rd and a half day( twice a week ) even a bit more often smooths out the blood levels a lot. The other advantage of smaller more frequent doses is it is easier to increase doses faster with less risk of side effects that last a whole week, if you did 0.5 of reta every 3 days (weekly dose is 0.5x7/3=1.16mg/w ) , in theory it should only take 3 days or so for levels to drop back to pre dose levels, if you had unpleasant side effects, at least faster than larger weekly doses, but use glp-plotter to double check everything.

One thing I did not think of in the previous post is that if you are going to have trouble tolerating anything but small doses of either GLP, reta might be better, the reta studies showed 9% weight loss at 1mg/week over a year. None of the other GLP's show anywhere near that much weight loss at such low doses. So if you can only get to 2 or 3 or 4 mg of reta it might work better than 3 or 4 or 5 or 6mg of tirz.

There is a lot less data on reta than tirz as it is newer and not yet approved, and the receptor pharmacology is super complicated, but overall reta has slightly more gastrointestinal side effects than tirz at equivalent doses. So tirz would be a better choice from that perspective, but given that you might have a stronger weight loss effect from a lower dose of reta it might have less side effects at that lower dose, assuming you are not likely to tolerate much higher doses given your previous experience. Not a super clear explanation but hopefully that made sense.

 

[Mara_aa]

Yes , with Ozempic as I was using the prescribed version, any time I tried increasing the dose above 0.5mg/w, and I already knew it might be a problem based on some side effects at that dose, even increasing to 0.6mg/w was a problem with worse nausea and feeling a bit ill. At that stage I did not know everybody had already worked this out and there were sites like glp-plotter, so I read up and tried to graph out drug levels on paper to see what was going on. As most gi side effects are at peak levels, and peak blood levels are 24 to 48 hours after a dose, I decided on very small 0.22mg doses every 2 days ( 0.22x7/2 ) , which adds up to about 0.77mg/week, and I found that caused less nausea than 0.5mg once a week. I had already lost about 50% of my body weight and was permanently hungry so even a bit more appetite suppression was helpful even if I had to put up with nausea to go with it.

I kept going on second daily doses with reta and tirz mainly out of habit as I had gotten used to it over the year on ozempic.

So if the cardia pain you were getting was only occurring in the day or 2 after the dose you might be less likely to get it using smaller more frequent doses, just add up the small doses for 7 days to get the weekly dose or calculate it. And how often does not matter a lot , I chose every second day as it is much easier to remember than every 3rd or 3rd and a half day( twice a week ) even a bit more often smooths out the blood levels a lot. The other advantage of smaller more frequent doses is it is easier to increase doses faster with less risk of side effects that last a whole week, if you did 0.5 of reta every 3 days (weekly dose is 0.5x7/3=1.16mg/w ) , in theory it should only take 3 days or so for levels to drop back to pre dose levels, if you had unpleasant side effects, at least faster than larger weekly doses, but use glp-plotter to double check everything.

One thing I did not think of in the previous post is that if you are going to have trouble tolerating anything but small doses of either GLP, reta might be better, the reta studies showed 9% weight loss at 1mg/week over a year. None of the other GLP's show anywhere near that much weight loss at such low doses. So if you can only get to 2 or 3 or 4 mg of reta it might work better than 3 or 4 or 5 or 6mg of tirz.

There is a lot less data on reta than tirz as it is newer and not yet approved, and the receptor pharmacology is super complicated, but overall reta has slightly more gastrointestinal side effects than tirz at equivalent doses. So tirz would be a better choice from that perspective, but given that you might have a stronger weight loss effect from a lower dose of reta it might have less side effects at that lower dose, assuming you are not likely to tolerate much higher doses given your previous experience. Not a super clear explanation but hopefully that made sense.

Thank you so much for taking the time to explain all of that, it was very helpful and clear.

Your explanation about peak levels and splitting the doses makes a lot of sense.

In my case the cardia pain isn't really limited to the first day or two after the

injection, it tends to happen consistently whenever I eat, regardless of the type of food (I've actually tried testing quite a few).

I hadn't really considered smaller, more frequent dosing in that structured way, so

I'Il definitely take a closer look at GLP-plotter and run some numbers before

changing anything.

Also a very interesting point about reta possibly working better at lower doses - that's definitely something I'II keep in mind given that I don't tolerate higher doses very well.

Really interesting explanation, I definitely learned something from!

 

[wulf00777]

The studies showed that most people eventually got over the side effects by halfway through the study. Everything I've heard is reta is more gentle than tirz but may take longer to get started because of the low starting doses.

 

[Mara_aa]

The studies showed that most people eventually got over the side effects by halfway through the study. Everything I've heard is reta is more gentle than tirz but may take longer to get started because of the low starting doses.

That’s really reassuring to hear. I’ve read similar things about reta being a bit easier in terms of side effects compared to tirz, even if it starts slower. I don’t mind taking it slow if it means fewer issues.