Because of extreme exhaustion I asked my Dr. if I could scale back on the dosage. My pen says 80 also-but she said it was impossible to do that, so I appreciate your information, Windyshores. Of course, after complaining to the Dr. within a few days my exhaustion did get better. So a big thank you for the people on here that told me to hold on-that it would get better. She did tell me to go off the Tymlos for 2-3 weeks and see if that made a difference. She also said tiredness was not a side effect of Tymlos, but I see other people on here have experienced extreme tiredness too. I am almost a month in, so I did not want to do that and go through the side effects all over again. Although I am still tired the extreme has disappeared, and walking does help in the morning.