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Microdosing GLP-1 Medications: Clever or Controversial?

As GLP-1s continue to reshape obesity, patients are increasingly exploring "microdosing", the practice of taking smaller than standard medication doses. While this trend has gained popularity on social media, some healthcare providers have been recommending microdosing as an off-label practice for some time. Something to keep in mind is that microdosing is not officially recommended by medication manufacturers or endorsed by regulatory bodies.

What exactly is microdosing?

Microdosing involves using doses lower than the established therapeutic amount needed to achieve the intended medical benefit. Originally, the term "microdosing" was associated primarily with psychedelic substances like psilocybin. Today, the concept extends broadly to include small or subtherapeutic amounts of medications, alcohol, supplements, or even certain foods.

The definition of a "microdose" for GLP-1 medications varies based on an individual's treatment stage and prior dosage. For example, a patient who was previously on 2 mg of semaglutide weekly might consider 0.25 mg a microdose, whereas for a new patient just starting treatment, 0.25 mg is the standard introductory dose. Similarly, someone transitioning off the medication might use 0.125 mg weekly as a microdose to gradually taper down.

Reasons people microdose

• Cost Management: GLP-1 medications are expensive, prompting some patients to microdose to stretch medication supplies.
• Medication Shortages: Supply disruptions have led individuals to microdose in order to extend their medication availability.
• Reducing Side Effects: Lower doses may help patients better tolerate common side effects such as nausea or gastrointestinal discomfort.
• Personalised Treatment Approach: Some patients and providers believe that standard dosing increments do not suit every individual and prefer more tailored dosing.

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​Common microdosing methods

Click Counting (Ozempic and Wegovy)

Some patients microdose by counting "clicks" on their injection pens, which represent incremental dosing adjustments smaller than those officially prescribed. For example, an Ozempic pen produces an audible click with each incremental adjustment. However, manufacturers strongly discourage this practice due to dosing inaccuracies and potential medication waste. Patients choosing this method should always consult closely with a clinician.

Breaking Open Pre-filled Pens (Mounjaro and Zepbound)

For medications only available in single dose pens, patients might manually extract smaller doses by breaking open pre-filled pens. This method bypasses the device's intended precision and safety mechanisms.

Using Vials (Compounded or Brand name)

For vials of GLP-1 medication, people have been manually drawing doses of any size with a syringe.

Is microdosing safe or effective?

Currently, microdosing lacks extensive clinical evidence. Potential concerns include:

• Reduced medication effectiveness from underdosing.
• Increased risks of dosing inaccuracies and contamination.
• Potential for unknown long term health consequences.

Regulatory perspective

Microdosing is considered an off-label practice and is not endorsed by drug manufacturers or regulatory bodies. This means:

• Pharmaceutical companies do not provide guidance or support for these dosing modifications.
• Healthcare providers prescribing off-label doses may assume liability if adverse effects occur.
• Regulatory bodies do not include these strategies in approved guidelines for GLP-1 medications.

Personalising GLP-1 dosing: Insights from recent research

A recent real-world study from Denmark suggests that a personalised approach to semaglutide dosing may help patients achieve significant weight loss while reducing side effects and medication costs. Instead of following the standard dosing schedule, patients in this study were given the lowest effective dose, with increases only if progress stalled.

Key Findings:

• The average maximum dose used was 0.77 mg, significantly lower than the standard dosing for Ozempic and Wegovy.
• Patients lost an average of 14.8% of their body weight at week 64.
• Patients used only around one-third of the typical cumulative dose at week 64 (36.1%).
• Reported symptoms were generally mild

Such findings highlight the potential benefits of personalised dosing strategies, including improved patient outcomes and resource management.

Recommendations for dietitians

Dietitians can play an essential role in patient education by:

• Understanding the rationale behind microdosing.
• Clearly communicating the potential risks and limitations of these practices.
• Encouraging patients to consult their healthcare provider before making dosing adjustments.
• Promoting evidence-based practices to ensure safe, effective patient care.

Microdosing of GLP-1 medications is increasingly common but remains controversial. Staying informed ensures dietitians can provide accurate guidance, support patient safety, and contribute positively to treatment discussions.

Boost Your Confidence with GLP-1s

If you're looking to enhance your skills in this rapidly evolving area, I've created two practical resources to support you:

The GLP-1 Handbook: A Practical Guide for Dietitians

The GLP-1 Handbook is your go-to reference, filled with clear guidance and patient ready resources designed for immediate application in your consults.

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Navigating Weight Loss Medications: A Short Course for Dietitians

Want to build a deeper, strategic understanding? This structured course offers theory and real world learning to solidify your expertise and help you navigate GLP-1s with confidence.

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Thanks for reading!

Leif

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References

Gudbergsen H, et al. Embla Clinic study (ECO 2024) – EASO Conference Abstract – Personalized dosing and tapering of semaglutide for weight maintenance (Is coming off semaglutide slowly the key to preventing weight regain? - EASO).

Note: This newsletter is for educational purposes only and should not be considered medical advice. Always consult a qualified healthcare professional for personalised guidance.

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