Switching from Ozempic to Mounjaro?

@tslayden

You might find some helpful information in this discussion, it has many comments about diarrhea after RNY:
https://connect.mayoclinic.org/discussion/anyone-have-trouble-finding-a-balance-between-constipation-post-rny/

Has anyone had chronic diarrhea since having roux-n-y (gastric bypass) surgery?

Ozempic doesn't take any food noise for me. That's why I wanted to switch.

Interesting that your husband has had the same experience with a six-day cycle. It makes sense given the rate at which it flushes out of the blood. I'm sure the primary reason to test a seven-day cycle was because it's so much easier for people to comply with a once-a-week schedule than a once-every-six-days pattern.

In terms of the food noise, I've found time-restricted eating is helpful -- the food noise doesn't kick in until after my first meal of the day, which I've pushed to late morning. I'm also leaning heavily into protein and fiber -- more fiber than I've ever eaten before. And a lot of processed foods still don't appeal, and I still can't handle large meals. Therefore, I eat lightly and frequently and more healthily, which so far is working out. It's been a question of building eating habits that don't make me feel deprived, because if I feel deprived, I'll be back into weight cycling.

My fallback option is going to be jacking up the dosage again. I use ozempic rather than wegovy specifically because the multi-pen lets me control the dose I'm taking. I'm maintaining at the moment at quite a low dose, which gives me room to ramp up if I need to. Also, of course, there are more options in the pipeline: https://www.primetherapeutics.com/web/primetherapeutics/search?q=GLP-1%20Pipeline%20Update.

@projfan - my husband found that semaglutide (Wegovy) drops off in effectiveness for him after 6 days, as well.

You mentioned the food noise was coming back on the maintenance dose and you are managing it. What are you doing to manage it, and do you find it effective?

Good to know other feel the difference on day 6 & 7. All my best.

Just FYI, I'm taking my GLP-1 RA every six days instead of every seven, and have had no problems. Just because the clinical trials tested every seven days (for very logical reasons -- I would have done that, too) doesn't mean that it's the best answer for everyone. That being said, if your insurance is covering it, they will balk at a six-day cycle, so you may need to talk to your pharmacist and doctor about doing a box occasionally on private pay to sync it all up.

And yeah, the single-dose injectors are annoying from a variety of perspectives, and in fact, are not necessarily used in other countries, as I understand it. But hey, it's not an aspect of this that is under our control, right? So it's just another thing to roll with.

I switched from OZ 2.0 to Monjaro a few months back. Started at 5 mg for 2 months, then 10 mg for same and am now moving to 12.5 mg. Good news was @ 10 of Monjaro, my A1C went from 6.8 to 6.2 without me making any changes. No weight loss over same period. I had RNY bypass 38 years ago. No problem with switching meds. My issue was on day six, Monjaro half life was over and I felt hungrier. It took another day after new injection for it to work again. I wish Monjaro had a screw top as the large gray plug is hard to refrigerate and carry enough when traveling for a few weeks. Best of luck to you.

I did this in the other direction. (I do not have diabetes -- just losing some weight I had gained back after bariatric surgery 15 years ago.) I lost weight on tirzepatide, struggled with the side effects, and shifted to semaglutide for maintenance. I have a history of weight cycling (which means I've gained and lost and gained and lost weight over much of my life), so I knew when I got on this ride, I would need to stay on it for life.

I would say that switching is a great choice, because people who have problems with one formulation don't necessarily have the same problems with the other. Also, not surprisingly, there is not a lot of research on this topic, because really, who would pay for it? This is a bit old, but the most helpful paper I found: https://pmc.ncbi.nlm.nih.gov/articles/PMC7900946/.

Yes, titration is critical if you are prone to side effects, and weight loss is unlikely at the initial low dose. I titrated up on the tirzepatide even more slowly than recommended, and held below the max dose until I lost most of my goal weight, because my side effects were pretty awful. Nonetheless, the tirzepatide got me there. I then titrated down before switching to semaglutide, and titrated back up a little bit for a maintenance dose.

Yes, it's really common for the weight to come back on when you stop, because the drugs do nothing structural, don't retrain us, and leave the body relatively fast. There are pretty deep arguments going on in the field between the on-it-for-life-this-is-equivalent-to-a-statin camp, and the make-lifestyle-modifications-and-then-stop-the-drug-and-it-will-all-be-fine camp. The problem is that insurance doesn't want to pay for the drug for life, and they also don't want to pay to support all the work needed for the lifestyle changes. It's a disease, and willpower doesn't work to conquer a disease, so the lifestyle changes are not trivial. As you can tell, I'm in the first camp. (As a result, I continue to keep an eye out for new formulations and options.)

Unfortunately, you can't click-count or microdose with the single-dose pens that Mounjaro and Zepbound use, which could otherwise be helpful in managing side effects and price.

Also unfortunately, the maintenance dose that is now managing most of my side effects pretty effectively, also brought back the "food noise". So far, I've been managing through that problem.

If you have not considered it, you might talk with your doctor about bariatric surgery. Surgery always comes with risk, of course, but I found it amazing and only wish I had been ready to consider it when I was younger. The weight regain was very slow and honestly, in part my own fault for not maintaining the behavioral changes. Unlike the drugs, where they just throw you in the deep end and walk away, the surgery should come along with comprehensive support for behavioral/lifestyle changes. And there is something to be said for one-and-done. I have no idea if insurance would require you to demonstrate weight gain after coming off the drugs before they would approve the surgery -- mine happened before the drugs were an option.

It was about 5 weeks, between the 4 weeks my doctor wanted me to trial off the semaglutide to isolate better what the cause of the severe GI side effects were and then the insurance approval for the different medicine. I did naturally eat more cause I was no longer on the appetite-suppressing medicine. My doctor advised me this would happen and that I might feel really hungry when trialling off.