hi everyone: using 40 mg of tymlos is strictly off-label and i have never heard of anyone doing it -- i would not expect doctors to recommend it. i chose to do it because the side effects of the full dose were extreme for me -- not only did i have the racing heart, it was not a short-lived effect. my heart would still be racing hours later, and even on and off the following day. i saw online that some people were taking reduced dosages at the beginning as they got adjusted to the medication, and i decided to try that. unfortunately, my level of adjustment never changed, and that's why i continued at the lower dosage. it may be because i am a very small person (under 100 pounds). i don't advise others to do what i did, and especially not to start out at a low dosage -- you might get no effect at all and end up injecting yourself all year for nothing. if i could have tolerated it, i would have done the full dosage. on the other hand, i represent an N=1 experiment that suggests that body weight/size may have some bearing on the proper dosage, and smaller people may not need the full 80 mg.