Dr.ObesityLA said:The dose-response is real but shallow at the top.
I will push back on the "any working dose is fine" framing. The maintenance evidence sits overwhelmingly at the top studied dose, and the extension data shows regain tracking dose reduction rather than tracking stopping. Holding low is reasonable; pretending it is evidentially equivalent is not.
One concrete data point for the thread. For anyone assembling their own picture: Tmax is one to three days, terminal half-life about 165 to 170 hours, steady state at four to five weeks, and subcutaneous bioavailability near 89%. Those four numbers explain most of the questions people ask about timing.
Worth separating that from renal function, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.
NeuroNate said:I will push back on the "any working dose is fine" framing.
There is a second half to this that has not been said yet. FLOW is the relevant trial and it reported a meaningful reduction in kidney-disease progression and related death in people with type 2 diabetes and chronic kidney disease. The mechanism looks to be a mixture of reduced albuminuria, better glycaemia and blood pressure, and a probable direct anti-inflammatory effect on the glomerulus. Separately, eGFR is genuinely noisy during rapid weight loss — a small early dip is common and usually haemodynamic rather than damage.
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View ResultsOne thing that is still open after laura_annarbor’s answer:
How to read eGFR during rapid weight loss, given that creatinine depends on muscle mass and muscle mass is changing?
Closing the loop on my own question.
Update since I posted: I held at 1.7mg for a further twelve weeks and lost another 4kg slowly, which settles it for me. I was escalating because the number was available, not because I had stopped responding.