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Increase dose vs stack?

11 replies7 peopleMar 21, 2026☆ Follow
Summary

When tirzepatide effects plateau after a year at 15 mg, is it better to raise the dose, stack semaglutide, or try other options like cagrilintide while avoiding reta due to kidney disease?

The thread shows users who have plateaued on long-term 15 mg tirzepatide often consider either increasing the tirz dose beyond the labeled maximum or adding low-dose semaglutide to control returning food noise. Several report success with sema stacks for appetite without major new sides, while others note that weight-loss benefits tend to taper after roughly 72 weeks regardless. Higher tirz doses up to 17 mg are described as tolerable by some, and splitting doses or cycling are mentioned as alternatives. Cagrilintide is suggested by a few as a different-receptor option but remains unexplored by the original poster.

What this discussion establishesWhere people disagree

Whether stacking sema is preferable to simply raising tirz further or switching to cagri

Still open

How effective sema stacking would be for this user compared with cagri or a full switch, and what long-term maintenance plan works best after reaching goal weight

Nothing here is advice.

11 replies · 7 people
RustMarble49archiveopening postMar 21

Been on 15 mg tirz for roughly a year. The effects have faded and I'm no longer losing, plus I'm having trouble even holding steady. I dropped 85 lb at the start so it worked well initially, but now I'm not sure what to try next. Worried about adding reta because of chronic kidney disease, since I've seen that listed as a reason to skip it. Food noise is back hard and I really miss the stretch when I wasn't thinking about eating all day. Would raising the tirz dose be the better move, and if so how high? Any choices besides reta? Is stacking sema worth considering?

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WryLedger88archiveMar 21

Some people here have gone past the 15 mg limit from the maker, and there are studies looking at higher amounts. These questions don't have clear answers for everyone since responses vary. One approach is to lower the dose slightly and inject every four or five days. I switched to that after noticing strong suppression only through day four and then trouble on days five and six. Going straight to 15 mg gave me sides, and adding survo at a low dose also caused sides.

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SteadyTimber49archiveMar 21

Reta probably won't do much if appetite and food noise are the main issues. Stacking sema or cagri would be worth trying instead.

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LevelThistle44archiveMar 21

How are the sides for you? The highest dose tested in trials might be higher than what an individual can actually handle, and I suspect the reverse can also happen. I'm at 12 mg weekly of reta with no bad effects. Using grey-market material, nothing I've read or felt gives a reason not to raise the dose if it's tolerated. Not limited by the trial protocols. No hesitation about going past 12 mg per week. If tirz has been comfortable and effective, increasing the dose seems straightforward unless other options are already available.

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KeenMeadow35archiveMar 21

Have you tried sema before? It really cuts food noise for me. Mixing sema with tirz is working well.

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CopperFenwick68archiveMar 21

I sometimes add a small amount of sema to my tirz and it reduces the food noise and appetite. The trials show weight loss tends to level off around 72 weeks, so you might simply be at your maximum loss point.

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RustMarble49archiveMar 21
↳ replying to @LevelThistle44

That's a fair point. Main sides for me are fatigue and occasional headaches, though they haven't happened recently. They usually showed up right after a dose increase.

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RustMarble49archiveMar 21
↳ replying to @KeenMeadow35

I've been thinking about trying that. How exactly are you combining them?

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LevelThistle44archiveMar 21
↳ replying to @RustMarble49

Sounds like a reasonable idea. Assuming you still have plenty of tirz on hand. Do you have cagri? It works on a different receptor than sema, which is more GLP-focused. I've been splitting my dose twice a week since the third week on GLP, and that's been the last eleven weeks. Currently losing about 2.8 lb per week on average and sitting at 242 lb. I have good amounts of cagri, sema, tirz, and reta. Next step I'm considering is moving up to 14 mg weekly. Once I reach a comfortable target weight, one option is to taper down, or maybe take a two-to-three-month break and restart at a lower dose. Still listening to other people's reset experiences before deciding.

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RustMarble49archiveMar 21
↳ replying to @LevelThistle44

I have a decent supply of tirz but nothing else yet. I was checking options to add or switch before buying more. Lots of people mention adding sema, but I'm unsure if that would work better than cagri or just moving over to sema entirely.

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KeenMeadow35archiveMar 21
↳ replying to @RustMarble49

Just got some tirz and am testing combinations, but 1 mg sema plus 2.5 mg tirz leaves me barely able to eat.

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WarmMeadow92archiveMar 24
↳ replying to @RustMarble49

I've been on about 17 mg tirz for a while with no problems and started adding sema at the end of November. A small sema dose around 0.5 or 1 mg worked well at first, then sleep got disrupted. I thought the sema was to blame so I stopped it the last couple weeks, but sleep is still off, so maybe it wasn't the sema after all. Since you've already been at 15 mg tirz long-term, adding sema is probably a better step than going higher on tirz. I didn't see much extra effect moving from 15 to 17 mg. I had planned to reach 20 mg but the sema stack seemed like the smarter choice instead.

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