There’s a lot of chatter in the virtual space these days about microdosing GLP1 medicines [like GLP1 semaglutide (Ozempic/Wegovy) and the dual GLP1/GIP tirzepatide (Mounjaro/Zepbound)].
So what does ‘microdosing’ mean? This can refer to:
- taking a lower-than-approved dosage of GLP1 medicine
- taking a dose in between approved doses [especially in countries (including Canada) where the GLP1s are available in flexible dose pens, with the ‘click counting’ approach]
Here’s what microdosing is NOT:
- taking GLP1 medicine inappropriately – example: a person without excess body fat who wants to lose a few pounds to fit into a tight dress .
Microdosing is ‘off label’, meaning that this approach does not follow the official guidance recommended in the product monographs. Product monographs can only recommend the dosing approach that was studied in clinical trials, and so far, no clinical trial has looked at the microdosing approach.
While many people do very well with standard dose titration (per the product monographs) of GLP1 medicine, reasons to microdose can include:
- to increase dose more slowly to improve tolerability to side effects (usually gastrointestinal)
- for people who don’t need the maximum dose of medicine (for some people, the max dose can be too much)
- to use the best dose that works for that person to achieve health goals
- to stretch out prescriptions to save money
Clinicians (including myself) commonly support and recommend microdosing approaches. While not studied formally in clinical trials, anecdotally, here are some benefits we see:
- people who don’t tolerate the standard escalation in dose, can tolerate well with slower dose increase
- some people don’t need the full dose of medicine; microdosing helps them precisely find the best dose to achieve their treatment goals
- some people can’t afford the cost of the standard dosing, but can afford it when stretched out by microdosing (note: the GLP1 pens have maximum time in use as studied and established by the manufacturers; these times are exceeded with the microdosing approach)
It’s important to remember that GLP1 medicines are not just for weight loss and diabetes, but are also proven to have other health benefits, such as reduction in heart attack/stroke risk, MASH (‘fatty liver’) benefits, diabetes prevention, and improvements in sleep apnea, heart failure, and osteoarthritis pain. As discussed in our Obesity Canada 2025 Pharmacotherapy Clinical Practice Guidelines (disclosure: I am the lead author), we recommend that if a person is doing well as they work their way up on medication, that the dose should be progressed to the dose that has proven benefit, provided it continues to be well tolerated and is not causing excessive weight loss.
BOTTOM LINE: GLP1 microdosing (using lower than ‘approved’ dose, or using a dose in between approved doses) , while ‘off label’, is a very practical approach that can be valuable for people who don’t tolerate the standard dose titration, who don’t need or don’t tolerate the full dose of medication, or people who can’t afford the full dose of medication. In the future of obesity medicine, I would like to see clinical trials (and subsequent guidance on product monographs) that don’t have specific rigid dosing goals, but rather, with full flexibility to titrate medication as needed, as tolerated, and as appropriate for each individual to achieve treatment goals.
IMPORTANT: As always, this blog is not intended as individual treatment advice. Discuss your individual treatment needs with your health care professional. If you are microdosing, it is important to review the dosing carefully with your health care professional.
Disclaimer: I am/have been an investigator in clinical trials of semaglutide and tirzepatide. I receive honoraria as a continuing medical education speaker and consultant from the makers of semaglutide (Novo Nordisk) and tirzepatide (Eli Lilly).
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