Not exactly the same but there are some similarities. Currently on 16mg tirz plus 5 of reta plus 0.25-0.5 of cagri, only started after weight loss to try to make it a bit easier to tolerate being hungry all the time. Started at 145kg , started ozempic at 75kg 18m ago and swapped to tirz 9 months ago and added the others in , now at 54% down at 66kg.
Unfortunately trying to achieve and maintain losses above 30% or so are out of the scope of the available research. Yet there are a lot of people out there who started with more severe obesity. From what I have read of the research, the combo of reta and cagri is pretty much state of the art in terms of receptor targeting although the combo will not get studied due to being owned by different drug companies. The drug companies are aggressively pursuing research into combination and add on therapies to GLP drugs, so they think the solution for those who respond less well to GLP's or have more severe obesity will lie in combinations.
I find I am limited in terms of doses, even very small increases of 1 mg a week of reta or tirz causes worse skin sensitivity and generally feeling erk, despite not having much in the way of side effects at the doses I am on, other than intermittent mildly annoying skin sensitivity.
So in terms of increasing doses it mainly comes down to adverse effects, if they are not a problem then gradual dose increases are probably reasonable. It is likely a good idea to keep an eye on basic health issues like blood pressure , blood glucose and lipids, for everyone, but especially in the context of severe obesity, and even more so if using experimental higher doses. Even if obesity is dramatically improved, damage could have already been done, and considering cardiovascular risk or assessing if existing damage is present is worth considering. I found out I had very early heart failure and significant coronary artery disease, despite not having symptoms after I lost the weight, even if these cannot be reversed progression can be dramatically slowed by the correct treatment. Anyone with that degree of obesity should be assessed to see if statins and low dose aspirin are needed, and at least an ECG and urine protein checked.
Without being disrespectful to some of the comments above, I think trying to manage severe obesity with BMI's above 40 or 45 is a very different issue to using GLP therapy for BMI's of 30 or 35. The idea of GLP's being a crutch is really the wrong type of thinking. They are a literally lifesaving tool to help manage a very serious illness, that untreated has horrible and almost inevitable long term health consequences. That degree of obesity increases cardiovascular risk by around 40 times, worse than smoking or diabetes. In that context I think using combination therapies or doses above standard ones is likely to be a reasonable risk. Yes it could have serious long term side effects, but not using them almost certainly has worse and much more likely severe long term consequences.
Obviously staying on them long term is critical to maintain the weight loss, and in that context they are justified solely for cardiovascular risk reduction . You might be able to reduce doses a bit once you get to a weight you are happy with, but even if you cannot quite get there, the weight loss already achieved is enough to reduce health risks towards normal levels, after that fitness probably matters more than exact weight.
