I've been using these medications for around sixteen months now. That probably factors into the dosing adjustments. I usually switch between two different ones every four to six months. I'm not someone who loses weight quickly on them. When I began with the second one, I started low and increased fairly quickly over a couple months. Then I added a small amount of the third one to help with appetite control. I kept that combination going for about three months. Currently I'm using a higher dose of the second one. My pulse settled down after a few months on it. My blood work for fats came back really good, the best results in years. They stayed poor until I'd been on the meds for several months. Despite watching what I eat, doing some exercise and weights, my levels didn't drop much at first but now they're much better. I've only lost about twenty pounds total. Probably because I like to drink alcohol sometimes and my job as a driver means I'm sitting a lot during long hours, plus I'm in my fifties. For the first med I was using a high dose every five days along with a weekly dose of the third one.