Start dose Reta

The glucagon part of retatrutide really shows up at 8 mg per week in the studies, and that matters most for diabetes control. I began at 2.5 mg to check tolerance, then worked up to 10 mg weekly. My blood sugar now stays under 100 mg/dl even after dinner on a CGM, and it projects an HbA1c of 6.5 percent; it was 10.5 percent in February on tirzepatide. My BMI dropped from 31-32 to 27-28.

Same situation here, just slightly lower at the pharmacy that adds no markup. I switched to the unregulated source and have no regrets.

I started my sister on it after she had been on oral semaglutide. We began at 1 mg for four weeks, then stayed there another two because she responded well, and moved to 1.5 mg. After four months she is still at 2 mg and will probably remain there until she reaches her goal. After that I would likely move her to tirzepatide or cagrisema at a low dose for maintenance. Start low, 1 to 2 mg at most for a couple of weeks, then raise by 1 mg at a time. Tirzepatide is still the strongest option for pure weight loss in my view.

Begin at 0.5 mg no matter what prior GLP-1 experience he has. Do that for one week, then add 0.5 mg each week until he finds a comfortable level or reaches 4 mg. Hold at 4 mg for several weeks before going higher.

Even at 146 kg I would not start higher simply because of size. Begin low and increase every two to four weeks as usual. With retatrutide, tolerance is the real limit, not body weight. If semaglutide stopped working, that does not mean much; many people plateau on it yet respond well to the newer drugs. The main error I see is rushing the dose increases to reach the higher levels quickly. Taking a few extra weeks is better than pushing too fast and ending up with side effects that force a stop.

The main practical difference with his starting weight is that he will probably need to go toward the top end of 12 mg over time. If he is still on semaglutide at 2.4 mg then 4 mg of retatrutide should be tolerable, but if he has been off it for a while then 2 mg is safer. Retatrutide can raise heart rate and cause skin sensitivity more than semaglutide, though it tends to cause less nausea and vomiting. Because he has type 2 diabetes, careful glucose monitoring is needed when starting or raising the dose, especially if he uses other diabetes medications. People with diabetes consistently lose less weight than non-diabetics, so realistic expectations are around 15-20 percent rather than the higher figures seen in non-diabetics. The standard approach of 2 mg to start with 2 mg increases every four weeks is reasonable.