Switching between GLP-1 meds

Of all the GLPs, sema most likely brings the harshest side effects and the smallest loss, and reta beats it for fatty liver too, although reta studies are still early. I'm not neutral here, sema gave me twelve months of nausea and a general unwell feeling during my attempt to tame hunger once half my body weight had gone. For me 15mg tirz together with 5mg reta weekly means less nausea and zero malaise versus 0.8mg/w ozempic. You could begin with Wegovy and judge from experience, as side effects differ widely by person and you could get very few, and should it cause trouble, move to reta, or if it doesn't help the NAFLD much. Head to head, reta is miles ahead.

A straight swap to tirz ought to work. Your sema dose is low, 0.25 twice weekly, and it still causes side effects. Tirz generally brings less nausea, so starting at 2.5mg weekly is unlikely to be worse than half a mg of sema. Probably wait until nausea from the last sema dose has settled, say 4-6 days after it, to be safe. For me even tiny sema doses, 0.22mg every second day, caused far worse nausea than 15mg of tirz weekly. Insurance versus getting it outside insurance is harder to judge, though outside it nobody else controls your supply, while people in the US often complain that insurers change rules and cancel GLP coverage.

I make sure to hit at least 2g of protein per kilo of my body weight daily to guard against muscle loss. Don't exercise much, just occasional long walks. Switched meds twice total. First moved off liraglutide onto semaglutide after eight months, mostly cost driven, the stronger effect broke a plateau and got me to a genuinely good weight that held for a while. Tolerance eventually crept in and the weight crept back, so about five months ago I switched to tirzepatide, which has helped enormously. Down 18kg in those five months, landed a normal BMI for the first stretch in decades, something semaglutide got me close to before regain pulled me back near normal, low end of overweight. Staying on tirzepatide going forward, three years nine months on GLP-1s total as of today.