New patient orientation: Your guide to starting GLP-1 medications

The first month is mostly about settling in. Starting doses are intentionally gentle so your body can adjust, and it is common not to notice big changes early on. That is by design, not a sign something is wrong. Rather than adjusting your dose on your own, bring how you are feeling to your provider at your check-in, who reviews your progress before any change.

Yes. At starting doses, you draw only a tiny amount based on the number of ‘units’ listed on your prescription, so one small vial covers your full starting stretch, often with a little to spare. Nearly every new patient is surprised by how small the draw looks. It is working as designed.

These are two different molecules in the GLP-1 class. Compounded semaglutide acts on the GLP-1 pathway, and compounded tirzepatide acts on the GLP-1 and GIP pathways. Cost can differ, and some people tolerate one better than the other. Whether a compounded GLP-1 is appropriate for you, and which one, is a determination your licensed provider makes based on your individual needs. If you want to explore a switch for tolerance, cost, or preference, raise it at your next refill. Because the two are not dosed one-to-one, your provider handles the dose conversion. You do not do that math yourself.

A day or two late, take it when you remember and stay on your weekly schedule. Around a week late, resume your usual dose. Between two and four weeks, message your provider before your next injection for a step-down plan. After that, they may restart you at a lower dose. Never double up to catch up.

Not necessarily. Many people work with their provider on a gradual step-down over time while building lasting nutrition and movement habits. How long you stay on a compounded GLP-1 is an individual decision your provider makes with you. When it is time to step down, the approach is a slow taper rather than an abrupt stop.

How and when to stop is a decision to make with your provider, not on your own. In general, the approach is a gradual taper rather than an abrupt stop, and the habits you build around nutrition and movement while on the medication are meant to carry forward. Everyone’s situation is different, so bring your questions about stepping down to your care team, who can build a plan around your individual needs.

Sometimes, yes. Whether to hold steady or move up is a decision your provider makes with you based on how you are doing and how you are tolerating the medication. If you are feeling good and would prefer not to increase on a set schedule, raise it at your check-in. Moving up gradually can also help keep side effects easier to manage.

Not for how well it works. The belly, thigh, and back of the upper arm are all effective. Start with the abdomen or thigh so you can keep an eye on the site, then use the arm once you are comfortable. Rotate sites weekly to avoid irritation.

There is no clinically better time. Morning and evening work equally well. If nausea tends to peak after your dose, injecting at night lets you sleep through it. What matters most is picking one day and time and staying consistent every week.

Start with the basics that address it at the source: daily movement or walking, plenty of water, more fiber from foods like beans, broccoli, and oats, and smaller, more frequent meals. Cutting back on processed foods and added sugar helps too. If you need more support, over-the-counter options exist, but check with your provider through the portal before adding anything.

Yes, this is common at lower doses. The medication eases before your next injection, so the background pull toward food can return late in the week. As your dose builds in your system over time, this tends to smooth out. If you are otherwise doing well, this is worth mentioning at your check-in rather than changing anything on your own.

Feeling cooler than usual is very common as your body adjusts to eating less. It usually settles on its own. Shaking or chills are different and worth a message to your provider.

Avoid eating within about three hours of bedtime, and go easy on acidic and spicy foods, citrus, alcohol, and caffeine; eat smaller meals. If you already have reflux, it may get worse for a while. Over-the-counter options exist, but talk it through with your provider first.

Very common. Go gentle that day and lean on fluids and protein water rather than a big meal. Getting protein in through a drink when solid food sounds terrible makes a real difference in how the day-after feels.

The first four to six weeks can be the hardest emotionally and physically as your body adjusts to eating less. Many people notice a clear lift around week five or six. If mood changes feel persistent or heavy, tell your provider. You do not have to wait it out alone.

Mild symptoms for a day or two after your injection are usually fine to power through. Message your provider for anything mild to moderate that lasts more than a day or two, or that diet changes do not fix. Seek in-person care right away for severe or sudden symptoms, such as intense abdominal pain, not being able to keep fluids down, or signs of dehydration.

A simple target of around 100 grams a day works for most people starting out. If you like the detail, a common range is 1.2 to 1.6 grams per kilogram of body weight. To find your kilograms, divide your weight in pounds by 2.2, then multiply by that range. For example, a 180-pound person is about 82 kilograms, which works out to roughly 90 to 131 grams a day. Aim for the higher number so you still land in a good range on the days you fall short, and spread protein across every meal and snack.

Strongly encouraged. The main reason is to help protect muscle. Aim for two to three times a week, and know that body weight, bands, or weights all count, as do active jobs and caregiving. Start small and build. Even short bursts of activity through the day help.

Already fast and it works for you? You can usually continue, just keep an eye on your energy. New to fasting? Wait until you are steady on the medication first, and avoid starting both at once. And if you feel lightheaded or run down while fasting, ease off the fasting before anything else.

Yes, you can travel with your compounded GLP-1. It is easy to carry with you, and it tolerates some time out of the refrigerator, so travel days are usually not a problem. A few tips make it smoother: keep it in its original packaging, carry it with you rather than checking it, use an insulated bag or small cooler for longer trips, and refrigerate it as soon as you reach your destination. Never freeze it. Always follow the storage instructions and beyond-use date on your label, and message your care team ahead of time if you have questions about a specific trip. If your package happens to arrive warm before a trip, that is generally fine, since it handles time outside the fridge, but reach out if anything looks off.

This is common and generally not a problem, since the medication handles time outside the fridge during shipping. Refrigerate it as soon as it arrives. If anything looks off, such as the liquid appearing cloudy, discolored, or containing particles, don’t use it and message your care team.

Keep it in the refrigerator in its original packaging, away from the door where temperatures swing. Hold on to your prescription information rather than tossing it, since it has your complete dosing instructions, including the number of units per dose. When traveling, it is safe in your carry-on; just refrigerate it again on arrival.

Tell your surgical team you are on a GLP-1, because these medications slow stomach emptying and timing matters before anesthesia. The usual guidance is to pause the medication about a week before a procedure. Message your provider ahead of time so you have a plan.