Top cases
For many patients, GLP-1 therapy has been a game-changer for weight loss and metabolic health, but discontinuation often tells a different story.
Without the support of GLP-1s, patients may need to lean even more on lifestyle strategies like structured exercise, nutrition planning, and ongoing behavioral support to maintain results. In this case, the patient has achieved their goal weight, but their practitioner is wondering how to properly taper the dosage and whether full discontinuation has been successful for others.
Curious how other clinicians are successfully tapering GLP-1 doses for their patients? Log in or sign up to share how you handled the conversation and view the consensus summary.
Post:
38 yo female with PMH of HTN and Class I obesity presents for follow-up after 2 years on Zepbound 15mg. Starting BMI 32 and current BMI 24. HTN is well controlled and no longer needs lisinopril--stopped it 1 year ago. Lifestyle is drastically improved now compared to prior to GLP1 treatment. Has been on a regular routine for about 2 years. Has seen a dietitian and a personal trainer. Has been at goal weight for 9 months. All labs WNL. Pt has been hesitant to decrease dose since doing so well without side effects.
Questions for consult
1. Would you decrease the tirzepatide 15mg dose at this point?
2. Have you had success in discontinuing GLP1 therapy for weight loss in any of your patients?
Comments
Key takeaways about GLP-1 tapering and discontinuation:
- Mixed views on lowering tirzepatide at goal weight
Clinicians are split on whether to reduce tirzepatide once a patient reaches goal weight. Some recommend maintaining the highest tolerated dose to prevent weight regain, while others support gradual reduction with close monitoring and lifestyle changes. - Stopping GLP-1 therapy often leads to weight rebound
Most practitioners report that discontinuing GLP-1 therapy results in significant weight regain. A few have seen success with discontinuation or intermittent dosing, but these cases are rare and usually supported by other medications or strict lifestyle adherence. - GLP-1s remain key for long-term weight management
GLP-1s are considered essential for sustained weight control. Dose reduction may work for select patients, but complete discontinuation remains difficult without alternative therapies or a multidisciplinary approach.
Cardiology
"1. I would continue the current dose provided there are no untoward effects.
2. My experience is that patients who stop GLP meds experience near universal weight gain."
Family Practice
"1. Yes, I would recommend decreasing the dose. Give it a month on a lower dose, and if no weight gain, I would continue to decrease. She has been at her goal for a long time, and with lifestyle modifications, she should be able to maintain at a much lower dose.
2. Yes, I have several patients who have been able to maintain their weight loss after discontinuing it, 6-12 months ago. I also have several patients who will take the GLP1 for one week out of the month or one month on and then one month off."
Endocrinology/Diabetes
"1. Absolutely not- this scenario is a perfect one to outline that most patients need to remain at the highest tolerated dose in order to maintain their weight loss long-term. especially with the patient reporting concern for reducing. Her BMI is within normal range, and she is not continuing to lose weight, so there is no reason to reduce her dose.
2. Honestly, not really. It is just such a powerful tool that dropping it leaves a huge gaping void in their treatment plan that most everyone struggles to fill in with lifestyle changes. I have had success reducing dosage or frequency, but those individuals are typically on an oral agent as well, such as phentermine, so they have a bridge in the gap left by the GLP-1 reduction."
Endocrinology/Diabetes
"1. It makes sense to try reducing the dose and monitor weight closely.
2. Most of my patients are on it for the diagnosis of diabetes as well, so I don’t have much experience with discontinuation. There is concern for the high incidence of weight gain with discontinuation."
Internal Medicine
"1. No, I would not decrease the dose. Patient is tolerating it well, and she has had significant benefit from this medication ( as well as her change in diet and exercise)
2. I have not advised any patient to come off of a GLP-1 medication if they are doing well. I have had some patients who have stopped the medication on their own....over the course of 6-9 months, they have gained back the weight that they lost and are requesting to restart their GLP- 1."
Would you decrease the GLP-1 dose for this patient? Share your approach and read other practitioners' comments on the full post.
