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c/tirzepatide·posted 1 year ago by u/nz_unfunded

someone explain dual agonist to me like I have not read a paper in years

Discussion The Quiet One ×5 Receipts ×1 Well Actually ×3

Genuine question, and the title is the question: someone explain dual agonist to me like I have not read a paper in years.

Came off sema and onto tirz with a two-week gap. The first month was flat and I assumed I had made a mistake. Month two it moved.

Held 7.5 for five months. Everyone kept asking when I was going to 10. The answer was never, because 7.5 was working.

The distribution matters more than the mean. In the trial population the interquartile spread was wide enough that two honest people can have completely different runs on the same arm.

Happy to answer the boring questions. Those are usually the ones worth asking.

4,998 up / 580 down90% upvoted62 commentsid op0ncj15 Jul 2025

62 comments

26 in this archive, depth 5

best — the order this archive was captured in

u/emil_wojcik479 points·1 year ago

The four-week interval in the label is a minimum. Nothing about the pharmacology requires you to step on schedule, and the trials stepped on a calendar because trials have to.

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u/ingrid_correia155 points·1 year ago

the trials titrated on a calendar, real people titrate on symptoms

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u/nordic_pricing118 points·1 year ago

the trials titrated on a calendar, real people titrate on symptoms

Agreed, with one qualifier: that is the mean of the top arm and the spread around it was enormous.

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u/throwaway_wl202675 points·1 year ago

the appetite effect is blunter than sema, in a good way, most weeks

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u/ahmed_iyer401 points·1 year ago

Yes — 10mg being a genuine landing place for a lot of people is underrated. There is no medal for 15.

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u/neha_falk469 points·1 year ago

Vials and pens carry the same molecule; what differs is fill volume, device tolerance and whether you are doing your own arithmetic. Neither is inherently more accurate.

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u/zeynep_zielinski-25 points·1 year ago

Agree. The GIP component is the interesting half and it barely gets discussed outside c/glp1science.

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u/incretin_ivypharmacology1 point·1 year ago

switching from sema is not a dose conversion, there is no clean equivalence

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u/nz_unfundedOP279 points·1 year ago

Pen or vial? The step sizes available differ and it changes this answer.

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u/emil_barros302 points·1 year ago

Do muscle cramps follow the day after the shot, or is it spread across the week?

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u/quiet_moderatormod244 points·1 year ago

pens and vials are the same molecule, the price is the difference

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u/amara_halonen172 points·1 year ago

20kg over 46 weeks, never went past 10mg, and fatigue stayed mild the whole way. Posting because the loud threads are all 15mg.

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u/ferritin_low84 points·1 year ago

20kg over 46 weeks, never went past 10mg, and fatigue stayed mild the whole way.

amara_halonen is right that the two molecules are not interchangeable. There is no published conversion and the ones circulating are invented.

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u/discount_math_dm235 points·1 year ago

The thing nobody warned me about was how much of this is logistics — storing it, remembering it, the same day every week.

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u/rania_diallo127 points·1 year ago

Push back: "gentler than sema" is a population statement. Plenty of people on this board have the opposite experience and they are not doing it wrong.

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u/ahmed_fonseca60 points·1 year ago

Push back: "gentler than sema" is a population statement.

Saving this one. It is the clearest statement of the stall problem I have read here.

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u/georgi_chowdhury153 points·1 year ago

SURMOUNT-1 landed around 21% at 72 weeks on the top arm

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u/bastian_ekstrom117 points·1 year ago

Weekly dosing again, half-life in the same neighbourhood as sema, so a step change takes about a month to reach steady state. Judging a new step at day five is judging noise.

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Tirzepatide-specific discussion: the dual-agonist pharmacology, the 2.5 → 15mg ladder, the appetite profile people describe as different from semaglutide, and the SURMOUNT/SURPASS trial programme. Comparisons with semaglutide are welcome as long as they are specific about dose equivalence being unknown.

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