From Tirz to Reta...cross titrating question

[jackie.d.]

Hi everyone! Having been on tirz through a telehealth co. and getting the money gouge accelerated titrating plan has me at 15mg weekly already in 4 months. That is a pretty costly dose and not sustainable, especially as i want to try some other p e ps being a 39 year old woman thinking about longevity and fat targeting. I have lurked on forums, disc, TG long enough to know i can cross titrate lower on Tirz while adding Reta. I'm just wondering if anyone out there did the same thing, how fast did you decrease T and where did you start on R? A nutritionist suggested I start at 6 on R and cut T to make the switch but that doesn't seem like a good plan and is also such a high R dose. Anyone have success in this area to share? Also for the ladies, any peps I should think about stacking? Thanks GLP GENIUSES!

 

[Calm Logic]

A nutritionist suggested I start at 6 on R and cut T to make the switch but that doesn't seem like a good plan and is also such a high R dose.

Yeah, 6 mg is too high for starting with reta, regardless of tirz history. Better safe than sorry, especially for the glucagon component of reta. I would not start at any higher than 2 mg for the initial reta dose since you can do twice weekly dosing (or even every other day at microdoses). So you could give a 1 mg boost of reta later in the week, if the 2 mg didn't seem to do anything after a few days. OTOH, some GI sides may not hit for up to 5 days or so.

Worse come to worse, it's better to plan for maintaining weight rather than weight loss during the initial transition at least, like focusing on body comp instead (to distract from the scale).

Biggest reasons for issues during a switch seems to be either: lowering tirz too much (in a hurry to switch to reta), or raising reta too much (since it can hit different). So low and slow may be best, as is usually the case. But with dosing 2+ times a week, you have more time for adjustments.

You can always increase the reta dose later, after a few days or the next week, and slowly adjust week after week. Rarely, some people get crazy sides with reta like projectile vomiting or ongoing hiccups, even after slowly adjusting to eventually 8+ mg.

For tirz, I would decrease the dose more than you are increasing reta, since reta can be stronger per mg. So just guessing (since everyone is different and at different starting points), maybe 11 mg of tirz (total for first week) with 2 mg of reta (total for first week). Or even go lower that that for one or the other, since you can always give a boost/dose later in the week.

Personally, I could probably dose myself completely by feelz at this point with split dosing. But it's delayed symptoms that can still trip me up (from GLPs or their effects building up). So I still have to be conservative or pay with GI sides.

 

[anhydrous]

I agree with Calm Logic, I would play it safe and start with 2mg. It only costs you a little time and the reward is the ability to wait and see. Very worthwhile tradeoff imo.

 

[joseblo]

I can say that I did that transition about 9 months ago and did a pretty fast titration. I cold turkeyed the Tirz and ramped Reta. The key for me was that I spaced my initial doses at 3days each which is enough to build up the baseline blood concentration, keep the peaks (and hopefully sides) low, and give you a few days to decide whether the sides are too much. Definitely use a level tracker like the one below. I started with 2mg (2 days after last Tirz) then on a 3 day cadence 1, 1, 1.5, 1.5, 2, 2 and I was about to go to 3 when I got really strange gastro symptoms. Even with lots (30g daily) of fiber and water (80oz) things stopped moving so I waited things out and took lots of Mg and PEG 3350 (Miralax). Things cleared up in 48 hours, but it was strange. I titrated a bit more slowly after that, but still got to 5mg every 6 days in 5 weeks. That's where appetite suppression started to kick in. Then I started spacing things out to weekly so I'd have higher peaks and eventually ended at 7mg weekly at 10 weeks. No further bad sides, although I did notice a touch of allodynia.

YMMV!

When I talked to a friend in medicine the one comment they had was that they use a Glucagon agonist in MRI patients to stop gut/bladder motility during scans. That is much shorter acting, but still causes intestinal distress.

 

[Calm Logic]

At 15 mg of tirz, I assume you are not prone to sides as much as most people. But whatever sides you have had in the past, may be similar with reta. At least, that was the case for me for all the GLPs -- more similar than different with sides.

To make things even more complicated, haha, you could eventually throw in 250 mcg of cagri per week if you get a long stall later.

You mentioned tesa in a previous post, and that is another popular addon (if no family history of cancer). Like other GH peptides, tesa can help maintain muscle while helping (to some degree, slowly over time) with visceral/belly fat loss, despite possible, temporary water weight. Women generally will need to go to 2 mg eventually for tesa since they respond less than men do, starting at 1 mg to prevent carpal tunnel symptoms. But ideally, one should test IGF-1 levels before starting tesa for a baseline. Fasting a little before tesa at bedtime (or fasting after taking tesa after waking up) can also help with efficacy and weight loss.

I started with 2mg (2 days after last Tirz) then on a 3 day cadence 1, 1, 1.5, 1.5, 2, 2 and I was about to go to 3 when I got really strange gastro symptoms.

So like this?:

Initial Dose: 2mg (as a baseline).

Day 3: 1mg

Day 6: 1mg

Day 9: 1.5mg

Day 12: 1.5mg

Day 15: 2mg

Day 18: 2mg

 

[joseblo]

At 15 mg of tirz, I assume you are not prone to sides as much as most people. But whatever sides you have had in the past, may be similar with reta. At least, that was the case for me for all the GLPs -- more similar than different with sides.

To make things even more complicated, haha, you could eventually throw in 250 mcg of cagri per week if you get a long stall later.

You mentioned tesa in a previous post, and that is another popular addon (if no family history of cancer). Like other GH peptides, tesa can help maintain muscle while helping (to some degree, slowly over time) with visceral/belly fat loss, despite possible, temporary water weight. Women generally will need to go to 2 mg eventually for tesa since they respond less than men do, starting at 1 mg to prevent carpal tunnel symptoms. But ideally, one should test IGF-1 levels before starting tesa for a baseline. Fasting a little before tesa at bedtime (or fasting after taking tesa after waking up) can also help with efficacy and weight loss.

So like this?:

Yep, and started really quick after last Tirz dose, because I knew I didn't have sides for that, while blood level was dropping fast. At day 21 instead of dosing I waited until 23 to do 2 again after (5) days, and then 2.5(3), 2.5(3), 2.7(3), 3.6(4), 4.5(5), 5.4(6), 6.3(7) -new vial- 6.3 (7), 7(7), 7(7), 7(7), 7(7)-new vial-

My rules of thumb is no more than a 50% increase per week even at low levels, and no more than a 10% / week increase once there are effects/sides and 0% change when switching vials.

 

[jackie.d.]

Yeah, 6 mg is too high for starting with reta, regardless of tirz history. Better safe than sorry, especially for the glucagon component of reta. I would not start at any higher than 2 mg for the initial reta dose since you can do twice weekly dosing (or even every other day at microdoses). So you could give a 1 mg boost of reta later in the week, if the 2 mg didn't seem to do anything after a few days. OTOH, some GI sides may not hit for up to 5 days or so.

Worse come to worse, it's better to plan for maintaining weight rather than weight loss during the initial transition at least, like focusing on body comp instead (to distract from the scale).

Biggest reasons for issues during a switch seems to be either: lowering tirz too much (in a hurry to switch to reta), or raising reta too much (since it can hit different). So low and slow may be best, as is usually the case. But with dosing 2+ times a week, you have more time for adjustments.

You can always increase the reta dose later, after a few days or the next week, and slowly adjust week after week. Rarely, some people get crazy sides with reta like projectile vomiting or ongoing hiccups, even after slowly adjusting to eventually 8+ mg.

For tirz, I would decrease the dose more than you are increasing reta, since reta can be stronger per mg. So just guessing (since everyone is different and at different starting points), maybe 11 mg of tirz (total for first week) with 2 mg of reta (total for first week). Or even go lower that that for one or the other, since you can always give a boost/dose later in the week.

Personally, I could probably dose myself completely by feelz at this point with split dosing. But it's delayed symptoms that can still trip me up (from GLPs or their effects building up). So I still have to be conservative or pay with GI sides.

That was a great, thoughtful answer! I was considering adding NAT or Tesa but decided to do this reta/tirz switcheroo instead first to see how that goes. I think your logic is pretty sound and as I boosted turz 1mg/wk with no sides I think that sounds pretty reasonable. I'll let you know how it goes!

 

[jackie.d.]

I can say that I did that transition about 9 months ago and did a pretty fast titration. I cold turkeyed the Tirz and ramped Reta. The key for me was that I spaced my initial doses at 3days each which is enough to build up the baseline blood concentration, keep the peaks (and hopefully sides) low, and give you a few days to decide whether the sides are too much. Definitely use a level tracker like the one below. I started with 2mg (2 days after last Tirz) then on a 3 day cadence 1, 1, 1.5, 1.5, 2, 2 and I was about to go to 3 when I got really strange gastro symptoms. Even with lots (30g daily) of fiber and water (80oz) things stopped moving so I waited things out and took lots of Mg and PEG 3350 (Miralax). Things cleared up in 48 hours, but it was strange. I titrated a bit more slowly after that, but still got to 5mg every 6 days in 5 weeks. That's where appetite suppression started to kick in. Then I started spacing things out to weekly so I'd have higher peaks and eventually ended at 7mg weekly at 10 weeks. No further bad sides, although I did notice a touch of allodynia.

YMMV!

When I talked to a friend in medicine the one comment they had was that they use a Glucagon agonist in MRI patients to stop gut/bladder motility during scans. That is much shorter acting, but still causes intestinal distress.

Very interesting way to go about it! Did you get similar sides with tirz or were those specific to reta?

 

[jackie.d.]

At 15 mg of tirz, I assume you are not prone to sides as much as most people. But whatever sides you have had in the past, may be similar with reta. At least, that was the case for me for all the GLPs -- more similar than different with sides.

To make things even more complicated, haha, you could eventually throw in 250 mcg of cagri per week if you get a long stall later.

You mentioned tesa in a previous post, and that is another popular addon (if no family history of cancer). Like other GH peptides, tesa can help maintain muscle while helping (to some degree, slowly over time) with visceral/belly fat loss, despite possible, temporary water weight. Women generally will need to go to 2 mg eventually for tesa since they respond less than men do, starting at 1 mg to prevent carpal tunnel symptoms. But ideally, one should test IGF-1 levels before starting tesa for a baseline. Fasting a little before tesa at bedtime (or fasting after taking tesa after waking up) can also help with efficacy and weight loss.

So like this?:

Yes, I was trying to decide between a few add ons and Tesa and NAD and a few others were in the running but I figured I might want to do get R/T cross over to see how that does for me. I had ZERO sides in my tirz journey so hopefully I'll have a good experience with reta.

 

[Omxxl]

Don't expect that much suppression with Reta, and wait several weeks before increasing your intake. It's not related to the fact that Reta's magic lies in its glucagon pathway, where you'll see your heart rate, energy expenditure, and therefore fat utilization increase week by week.

 

[lessthanhalf]

I would respectfully disagree that swapping to 6mg of reta is likely to be an issue. If you tolerate 15mg of tirzepatide, then 6 or even 8 mg of reta should have less gastrointestinal side effects than the tirz you are on. There is a small risk of increased heart rate, so if you have cardiac disease, maybe stick with tirz, or get anxious easily , then go slower with reta. There is also a small chance of skin sensory symptoms that seem to be more common with reta than tirz. And there is a small chance you will get worse gastrointestinal symptoms like nausea, as sometimes reactions to different GLP drugs are a bit idiosyncratic.

No dose increase schedule is zero risk, but in most respects 6 or 8 mg of reta should have less side effects than 15mg of tirz. One way to reduce this risk is half the dose twice a week, until you get to a dose that either works fine in terms of hunger control or rate of weight loss or causes side effects, then you stop increasing doses or slow down a lot, and you can swap to weekly doses instead. How high a dose you go up to depends mainly on how overweight you started at, if obesity is severe and long term, then I would recommend 12mg, and staying on it long term for prevention of serious obesity related health problems, assuming side effects are not a problem. Most people on here would recommend lowest dose possible, which I think is fine for not severe obesity.

Use GLP plotter to look at what different doses do in your body, and how long it takes for doses to be absorbed and decline, it makes it easier to make sense of effects and side effects with different doses and schedules.

 

[Thee Oohwee]

I was up to 10mg Tirz when I got my first 20mg "tester" of Reta, about three weeks ago. I wanted to see how my body would react to the new new. I decided that I would start at 2mg Reta on my pinning day for Tirz, while titrating Tirz down to 8mg. I did them both on the same day. Probably not the best idea, in hindsight, and I read many other experiences of folks separating their pinning day for Tirz and Reta, with either titrating Tirz completely out or taking a smaller dose just for the food noise control. After two days, I pinned another 2mg of Reta. And boom! It definitely kicked in for me.

The next week, I did Reta 4mg on Friday (my original pinning day) and 7.5mg Tirz on Monday. I did get some gastro issues that week, but not too major. It resolved after a few days. I found having electrolytes every single day helps a ton. I got the weirdest skin sensitivity stuff that week - feeling like I had a light sunburn. Since then, it has abated some, but its present a little around my neck and shoulders. Its not horrible and it feels like its lessening.

This week, today, I did 5mg of Reta and I am going to do 7.5 Tirz on Monday. I am losing about 0.5-1lb/wk right now. I'm hitting the gym, weightlifting 4x week and upping my protein intake. No processed foods, fast food, junk food, etc. Lots of water and electrolytes.

Next week, I will do 6mg Reta on Friday, and then 5 Tirz on Monday. Afterwards, for the next titration up for Reta, I am going for 8mg. I want to try that for a month with no Tirz and see if the Reta alone can kick in with its food noise suppression. If its not going great, I will add 5mg Tirz back on Mondays.

 

[jackie.d.]

I was up to 10mg Tirz when I got my first 20mg "tester" of Reta, about three weeks ago. I wanted to see how my body would react to the new new. I decided that I would start at 2mg Reta on my pinning day for Tirz, while titrating Tirz down to 8mg. I did them both on the same day. Probably not the best idea, in hindsight, and I read many other experiences of folks separating their pinning day for Tirz and Reta, with either titrating Tirz completely out or taking a smaller dose just for the food noise control. After two days, I pinned another 2mg of Reta. And boom! It definitely kicked in for me.

The next week, I did Reta 4mg on Friday (my original pinning day) and 7.5mg Tirz on Monday. I did get some gastro issues that week, but not too major. It resolved after a few days. I found having electrolytes every single day helps a ton. I got the weirdest skin sensitivity stuff that week - feeling like I had a light sunburn. Since then, it has abated some, but its present a little around my neck and shoulders. Its not horrible and it feels like its lessening.

This week, today, I did 5mg of Reta and I am going to do 7.5 Tirz on Monday. I am losing about 0.5-1lb/wk right now. I'm hitting the gym, weightlifting 4x week and upping my protein intake. No processed foods, fast food, junk food, etc. Lots of water and electrolytes.

Next week, I will do 6mg Reta on Friday, and then 5 Tirz on Monday. Afterwards, for the next titration up for Reta, I am going for 8mg. I want to try that for a month with no Tirz and see if the Reta alone can kick in with its food noise suppression. If its not going great, I will add 5mg Tirz back on Mondays.

Sounds like you have a good plan in place. I definitely want to drown the food noise while I figure this reta thing out!

 

[Calm Logic]

I would respectfully disagree that swapping to 6mg of reta is likely to be an issue. If you tolerate 15mg of tirzepatide, then 6 or even 8 mg of reta should have less gastrointestinal side effects than the tirz you are on. There is a small risk of increased heart rate, so if you have cardiac disease, maybe stick with tirz, or get anxious easily , then go slower with reta. There is also a small chance of skin sensory symptoms that seem to be more common with reta than tirz. And there is a small chance you will get worse gastrointestinal symptoms like nausea, as sometimes reactions to different GLP drugs are a bit idiosyncratic.

No dose increase schedule is zero risk, but in most respects 6 or 8 mg of reta should have less side effects than 15mg of tirz.

There are people on 20 mg of tirz who wouldn't start with 6 mg of reta, let alone 8 mg. Those doses would be week nine on a reta trial. Eight weeks is a long time for glucagon adjustments compared to zero adjustment.

And this thread is about (less conservative) transitioning (with "cross-titrating" in the title, essentially stacking), not swapping (stopping tirz completely and starting reta). The old-school swapping approach (when all of this was new), was to titrate down with tirz, then stop completely, before starting reta at a low starting dose. Obviously, some people did not like the conservative approach since it was almost ideal for them gaining weight.

Someone with previous high tolerance to tirz may or may not be fine with 6 mg of reta as a starting dose. We don't have the data to make any generalizations. But we do know that no one in the phase 3 reta trials hit at least 6 mg until the third month (4 mg, 6 mg, or 8 mg for the third month). Phase 2 for reta tried up to 4 mg as a starting dose, but they settled on 2 mg with phase 3 due to GI sides. But even if doing 4 mg, I wouldn't do it as a single dose, splitting instead.

Also, it's always safer for the first dose of any new kit to be a baby dose, especially if not third-party tested already.

In any case, there is no need to redline the glucagon engine in week one. And the half life of reta is slightly longer (6 days) than tirz (5 days). If were were talking about shorter-acting lira or orfo, then there would be less concern.

There are other effects as well unique to reta/glucagon on the liver, blood pressure, etc. Some reta-specific threads on sides:

Reta and Low Carb equals Some Dizzy Spell?

So, after Reddit was mentioned in another thread, I popped over. YIKES! Anyways, one had mentioned getting light headed and passing out, along with a few others. This got me thinking, as I've had like 2 of slight light headed deals in the last week, nothing major and goes away quick. Now, we've...

glp1forum.com

Anyone on Reta experience panic attacks?

My first 4 weeks were completely fine. Then during the last 2–2.5 weeks I’ve had two panic-attack–type episodes within a few days after my injection — racing heart, sudden anxiety, heavy “WTF is happening” feeling. The last one hit hard enough that I went to the VA and they had to give me Ativan...

glp1forum.com

At least at this forum, we don't see complaints about 22-day hiccups or projectile vomiting with tirz as we have seen with reta. Those who have been through it learned the hard way that reta can hit differently.

For @BamaCrazy, professional medical intervention was of limited benefit for ongoing reta hiccups (after going from 8 mg to almost 12 mg of reta; titrating up while not taking test mg into account):

22 days straight hiccups. Multiple doctors appointments. 3 changes in medications. CT and Ultrasound scans of my brain, chest, and abdomen. ER visit. Gastroenterologist and neurologist appointments. Then on day 23 when the Gastroenterologist went to do my endoscopy my hiccups stopped completely. The endoscopy did find a hiatal hernia but he said it was too small to be the cause of the hiccups. He blamed the GLP and later said the hiccups stopped because the medication finally left my system completely.

It was a nightmare that finally ended.

With @bluefootedboobie, another case of reta hiccups, on 7 mg:

Severe hiccups / diaphragm spasms on Reta

Tldr; Has anyone else experienced hiccup problems on reta? Does anyone have any advice? Long version: Beginning September 1st, I've had off-and-on severe hiccup problems. The first time it happened (9/1), I had moved from 5 mg to 7 mg of Reta weekly two weeks prior and was doing extremely...

glp1forum.com

I dialed back my 7 mg weekly dosage to 5 mg, which was the dosage I'd been taking before when I'd had zero issues whatsoever.

Projectile vomiting with 1.5 mg of reta:

How to transition

I was on 2mg tirz but it worked phenomenally. And then I found out about grey market and retatrutide. Decided to buy a reta kit from nexaph but not feeling the reta at all yet which I understand is normal. Should I stay on tirz 2mg while I titrate up?

glp1forum.com

When I went from 1 mg to 1.5 mg of Reta, I wound up projectile shitting across the bathroom and into the hallway when I went to puke. lol. It never hurts to be cautious.

Personally, I have ridden out some pretty bad GI sides while stacking or titrating up too aggressively. But, as before, I try to avoid anything that seems crazy as a way to avoid going to the ER, which I have avoided so far. I am only on 6 mg of tirz right now as a base for stacking, but all the GLP drugs hit strong for me at some mg when starting out, even the ones just affecting GLP-1 receptors (sema, lira, and orfo).

Some people on TG wanted to argue with me that starting with 12 mg of orfo (with a dose range of 1 mg to 36 mg) was fine for GLP veterans, even though the clinical trials settled on 1 mg. They were adamant since for theoretical reasons they didn't want to split the tablet into smaller pieces. But with reta (and the other injectables where you pick your dose), there is no such pressure to "go big or go home" when starting out.

 

[lessthanhalf]

I accept that you have done more solid research than me on reta specific side effects, and I might have regarded those effects as not likely enough to be a significant concern.

Unfortunately accurate data about adverse effects on starting and increasing doses is not really available from the studies for any of the GLP's, just rates of nausea and vomiting diarrhea and constipation as the only common issues, and that most of these are described as minor, without out a lot of detail as to what qualifies as minor.

By far the most common drug induced serious adverse effect on starting and dose escalation with GLP's is persistent vomiting, with dehydration and potential renal injury as a result, that causes hospital admission in 0.5-2% of cases ( chatgpt estimate ). This is a real and not at all rare problem, and I am not sure any of the GLP's are definitely safer than the others with respect to causing this. If I had to order them in terms of risk I would go from highest to lowest semaglutide - retatrutide - tirzepatide.

In practical terms this is by far the most likely major thing that can go wrong on starting and increasing doses of GLP's, and a 0.5-2% chance of needing hospital is not even a bit rare, and needs to be considered. It is especially important if the person is older or diabetic or has significant medical issues, and dose escalation must be more careful then.

Next most common serious problem is gallstones, but this is a risk with any weight loss, not just from GLP's at about 1-2% over a couple of years.

The estimates of reta starting dose I made are based on what I believe is the relative effects on gastrointestinal symptoms of the different drugs, plus a bit of a safety factor, but given the examples above of significant problems at lower doses of reta, maybe it needs to be lower like 4mg and twice weekly 2mg doses being safer again. No swapover dose or titration schedule has zero risk, I know from experience how different GLP drug side effects can be compared to what is expected , not being able to tolerate ozempic at doses above 0.6-0.7mg/week versus hardly any side effects on tirzepatide 15mg/w.

As far as I am concerned one of the biggest titration risks is the official semaglutide one of 0.25 - 0.5 - 1 - 1.7 - 2.4mg, any of the increases above 0.5mg are large and have a high risk of causing significant nausea and vomiting.

 

[jackie.d.]

I would respectfully disagree that swapping to 6mg of reta is likely to be an issue. If you tolerate 15mg of tirzepatide, then 6 or even 8 mg of reta should have less gastrointestinal side effects than the tirz you are on. There is a small risk of increased heart rate, so if you have cardiac disease, maybe stick with tirz, or get anxious easily , then go slower with reta. There is also a small chance of skin sensory symptoms that seem to be more common with reta than tirz. And there is a small chance you will get worse gastrointestinal symptoms like nausea, as sometimes reactions to different GLP drugs are a bit idiosyncratic.

No dose increase schedule is zero risk, but in most respects 6 or 8 mg of reta should have less side effects than 15mg of tirz. One way to reduce this risk is half the dose twice a week, until you get to a dose that either works fine in terms of hunger control or rate of weight loss or causes side effects, then you stop increasing doses or slow down a lot, and you can swap to weekly doses instead. How high a dose you go up to depends mainly on how overweight you started at, if obesity is severe and long term, then I would recommend 12mg, and staying on it long term for prevention of serious obesity related health problems, assuming side effects are not a problem. Most people on here would recommend lowest dose possible, which I think is fine for not severe obesity.

Use GLP plotter to look at what different doses do in your body, and how long it takes for doses to be absorbed and decline, it makes it easier to make sense of effects and side effects with different doses and schedules.

I appreciate your comment and perspective. I suppose in this scenario I just quit tirz altogether so I'm not overdoing it? I started at 208 lbs and I'm 179 more, 5'4" so maybe current bmi 32 started around 34

There are people on 20 mg of tirz who wouldn't start with 6 mg of reta, let alone 8 mg. Those doses would be week nine on a reta trial. Eight weeks is a long time for glucagon adjustments compared to zero adjustment.

And this thread is about (less conservative) transitioning (with "cross-titrating" in the title, essentially stacking), not swapping (stopping tirz completely and starting reta). The old-school swapping approach (when all of this was new), was to titrate down with tirz, then stop completely, before starting reta at a low starting dose. Obviously, some people did not like the conservative approach since it was almost ideal for them gaining weight.

Someone with previous high tolerance to tirz may or may not be fine with 6 mg of reta as a starting dose. We don't have the data to make any generalizations. But we do know that no one in the phase 3 reta trials hit at least 6 mg until the third month (4 mg, 6 mg, or 8 mg for the third month). Phase 2 for reta tried up to 4 mg as a starting dose, but they settled on 2 mg with phase 3 due to GI sides. But even if doing 4 mg, I wouldn't do it as a single dose, splitting instead.

Also, it's always safer for the first dose of any new kit to be a baby dose, especially if not third-party tested already.

In any case, there is no need to redline the glucagon engine in week one. And the half life of reta is slightly longer (6 days) than tirz (5 days). If were were talking about shorter-acting lira or orfo, then there would be less concern.

There are other effects as well unique to reta/glucagon on the liver, blood pressure, etc. Some reta-specific threads on sides:

Reta and Low Carb equals Some Dizzy Spell?

So, after Reddit was mentioned in another thread, I popped over. YIKES! Anyways, one had mentioned getting light headed and passing out, along with a few others. This got me thinking, as I've had like 2 of slight light headed deals in the last week, nothing major and goes away quick. Now, we've...

glp1forum.com

Anyone on Reta experience panic attacks?

My first 4 weeks were completely fine. Then during the last 2–2.5 weeks I’ve had two panic-attack–type episodes within a few days after my injection — racing heart, sudden anxiety, heavy “WTF is happening” feeling. The last one hit hard enough that I went to the VA and they had to give me Ativan...

glp1forum.com

At least at this forum, we don't see complaints about 22-day hiccups or projectile vomiting with tirz as we have seen with reta. Those who have been through it learned the hard way that reta can hit differently.

For @BamaCrazy , professional medical intervention was of limited benefit for ongoing reta hiccups (after going from 8 mg to almost 12 mg of reta; titrating up while not taking test mg into account):

With @bluefootedboobie , another case of reta hiccups, on 7 mg:

Severe hiccups / diaphragm spasms on Reta

Tldr; Has anyone else experienced hiccup problems on reta? Does anyone have any advice? Long version: Beginning September 1st, I've had off-and-on severe hiccup problems. The first time it happened (9/1), I had moved from 5 mg to 7 mg of Reta weekly two weeks prior and was doing extremely...

glp1forum.com

Projectile vomiting with 1.5 mg of reta:

How to transition

I was on 2mg tirz but it worked phenomenally. And then I found out about grey market and retatrutide. Decided to buy a reta kit from nexaph but not feeling the reta at all yet which I understand is normal. Should I stay on tirz 2mg while I titrate up?

glp1forum.com

Personally, I have ridden out some pretty bad GI sides while stacking or titrating up too aggressively. But, as before, I try to avoid anything that seems crazy as a way to avoid going to the ER, which I have avoided so far. I am only on 6 mg of tirz right now as a base for stacking, but all the GLP drugs hit strong for me at some mg when starting out, even the ones just affecting GLP-1 receptors (sema, lira, and orfo).

Some people on TG wanted to argue with me that starting with 12 mg of orfo (with a dose range of 1 mg to 36 mg) was fine for GLP veterans, even though the clinical trials settled on 1 mg. They were adamant since for theoretical reasons they didn't want to split the tablet into smaller pieces. But with reta (and the other injectables where you pick your dose), there is no such pressure to "go big or go home" when starting out.

You have given me a lot to think about. I recently watched something with a doctor who mentioned the "reclining your heart rate" issue which i hadn't heard before. I am actually somebody who usually tests with low blood pressure but my family history is tartar all of the men in my family (I am a woman but I try to be thoughtful of every given) has died by age 62 because of heart attacks. They were also historically unhealthy eaters not prone to physical activity who smoked and drank, so i live very differently and do none of those things. It's hard to call something like that genetic.When it can have just as much to do with lifestyle choices. Either way, i think I have decided to start with a small dose and see how things go.

 

[Calm Logic]

For most people, seemingly better cardiovascular health with reta overall, like lower LDL than with tirz:

For most people, the benefit of lower blood pressure and better lipids far outweighs the slight increase in heart rate, but for someone already dealing with a high resting pulse or specific heart rhythm issues, tirzepatide remains the more "conservative" choice for now.

 

[Diamondd817]

I went from 7.5mg of Tirz to 6mg of Reta. No issues. Still losing weight.

 

[JCO79]

I love that people on this forum can discuss a point like this without becoming defensive and making it hostile. Great discussion.

 

[jackie.d.]

I love that people on this forum can discuss a point like this without becoming defensive and making it hostile. Great discussion.

I appreciate this about this forum IMMENSELY! I asked for anecdotal information and got a ton of varieties of input, all respectfully and thoughtfully presented. This is the best!

Since my goal was to lower my costs and the overall volume while obtaining some of the longevity benefits of rera, i decided to titrate down 3mg weekly on tirz and start extremely low and slow on reta. I'm very confident that I won't get many side effects since I rarely do on the high tirz. Sunday night is pin day so I have added .5mg reta on Thursday morning to give enough time to get padt the tirz peak and possibly support the end of week decline. So far it's working out. Every 2 weeks I'll double the reta until 2mg and see how that feels. If I need to I'll do 1mg extra but seems that the weird sides show up for most people between 4 and 8mg and over 8mg sounds like diminishing returns.

I'll report back if I get any progress or problems. May the odds be ever in my (and all of y'alks) favor