What Does It Mean to Microdose Ozempic?
Some patients take small amounts of the popular drug to avoid side effects or cut costs
As an acupuncturist and fitness aficionado, Bea has a deep understanding of the human body. But the changes she experienced with menopause took her by surprise.
"I have always been very fit and active. I have been resistance training and running all of my adult life, and even competed in natural bodybuilding when I was younger," explains the 55-year-old Santa Fe, New Mexico, resident. "[But] when menopause hit, all of my tools for keeping my body composition in check went out the window."
Although microdosing is usually associated with psychedelics, the practice has become increasingly popular among users of GLP-1 agonists like semaglutide. | Credit: Getty
After extensive research, Bea (last name withheld by request) thought GLP-1 agonists may help with this and her worsening arthritis symptoms, but she was wary of the side effects. Enter microdosing, which is taking the smallest dose of a drug possible to achieve benefits without as many drawbacks.
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Although microdosing is usually associated with psychedelics, the practice has become increasingly popular among users of GLP-1 agonists like semaglutide (the active ingredient in Ozempic and Wegovy) and tirzepatide (the active ingredient in Mounjaro and Zepbound). Many people, like Bea, do it to avoid side effects, such as nausea, vomiting, diarrhea and abdominal pain. Others do so to cut costs and sidestep shortages. Still others microdose to maintain results, as discontinuing the medication can lead to weight regain and the return of other symptoms.
Some experts say it can be effective when done appropriately with a medical professional's supervision. Others warn that it is an uncharted territory with a high potential for problems.
What are GLP-1s?
GLP-1 agonists like semaglutide and tirzepatide — which mimic glucogen-like peptide 1, a hormone with a crucial role in regulating insulin, satiety, appetite, cravings and metabolism — initially were developed to manage blood sugar in people with diabetes but are better-known right now for their potential to induce dramatic weight loss. They also have made headlines for their potential to help prevent or manage conditions such as osteoarthritis, substance use disorders, and cognitive decline. One 2023 study found semaglutide reduced the risk of death — from any cause — by 19%, even in people without diabetes. Research suggests that tirzepatide, approved for diabetes treatment in the U.S. in 2022, appears to be even more effective than semaglutide for weight loss. It's also less expensive.
These drugs aren't perfect. Along with gastrointestinal distress, possible side effects include pancreatitis, acute kidney injury and increased risk of thyroid cancer.
Beyond their clinical significance, GLP-1s also have changed the way society views obesity, says Mehmet Furkan Burak, M.D., endocrinologist and instructor at Brigham and Women's Hospital and Harvard Medical School in Boston. Thanks to the drugs' efficacy and high profile, more people now recognize what he and his colleagues have long known — that obesity is a chronic, treatable disease.
Still, these drugs aren't perfect. Along with gastrointestinal distress, possible side effects include pancreatitis, acute kidney injury and increased risk of thyroid cancer, according to Cleveland Clinic. And there's the cost. Without insurance, Wegovy can run about $1,350 for a 28-day supply, while Ozempic can cost around $1,143 or more, according to GoodRx. Although insurance typically covers the drugs for people with diabetes, providers often don't cover them for weight loss, or to treat high cholesterol, arthritis pain or other uses. Some folks also have trouble accessing them due to the astronomical demand and resulting shortages.
Dosage Dials
Ozempic and Wegovy come in injector pens with dosage dials. One way to microdose is by "counting clicks" on the dial to administer a custom dose. Many users and some doctors and pharmacists have shared "click charts," handy references that tell users how many clicks equal a particular dose, on social media platforms like Reddit, TikTok, Facebook and YouTube. However, most people microdose using compounded medications, which are much more accessible and cost a fraction of their name-brand counterparts.
The standard Ozempic dosing schedule for weight loss, for example, is to take 0.25 mg once weekly for one to four weeks, then up to 0.5 mg weekly for the fifth through eighth weeks, according to Novo Nordisk. Once a person reaches their health goals, their doctor may recommend they remain at their current dose or gradually decrease their dosage until they're taking as little as necessary to maintain their results.
Being someone who is "always looking for a way to take the least amount of medication possible," Prescott was intrigued by the idea of microdosing.
David Prescott of Sydney, Australia, received an Ozempic prescription to manage his obesity and prediabetes. Being someone who is "always looking for a way to take the least amount of medication possible," Prescott was intrigued by the idea of microdosing, which he heard about through Reddit and a podcast episode featuring Craig Koniver, M.D., in conversation with neuroscientist Andrew Huberman.
"[Koniver] talked about the dosing schedule being the same for everyone when, in reality, it's probably much too aggressive for some and triggers bad side effects for others," Prescott says. "He uses microdosing as part of his practice."
Although Prescott's doctor was "not fully supportive" of an alternative dosing schedule, he proceeded. Prescott says microdosing has suited him well and believes the "gentler approach" he's taken has helped eliminate side effects and facilitate a "smoother ride."
"Once the food noise was eliminated, I could listen to my body for the first time in a very long time and identify when I started getting hunger cues. I used this information to determine my dosing schedule," Prescott says. "Everyone responds a little differently to this drug, and starting low and slow makes sense to me."
Bea says she's had a similarly positive experience microdosing, with very few side effects, much less joint pain and better control over cravings.
"My experience has been absolutely amazing. The therapeutic potential for these drugs will change health care as we know it," Bea says.
What Are the Risks?
Burak takes no issue with microdosing, provided it's done under a qualified professional's supervision with approved medication and equipment. In his practice, he personalizes dosage recommendations and often suggests people start and stay at a very low dose for quite some time to evaluate their response.
"Some people don't necessarily go up. Some people do very, very low doses like microdosing, but continuously and in a controlled manner, which is fine," he says.
Patients who "count clicks" without their doctor's blessing may also be at risk of overdose. Not all injector pens administer the same amount of medication per click.
That said, he warns against the DIY approach, which could be dangerous. There have been reports, for instance, of users obtaining counterfeit semaglutide or tirzepatide — usually through online sources — mixing it themselves and injecting it with insulin syringes. Obviously, that's not recommended, but Burak says any method not facilitated by a qualified professional carries a high degree of risk.
"We can't recommend anything untested. We just don't know the effects. People are guesstimating according to how they feel, and it's uncontrolled," he says.
Patients who "count clicks" without their doctor's blessing may also be at risk of overdose. Not all injector pens administer the same amount of medication per click; different click charts are necessary for different pens. Using a click chart designed for a 1 mg pen to calculate a dose on an 8 mg pen, for example, could result in an incorrect and potentially harmful dose.
Novo Nordisk, the manufacturer of Wegovy and Ozempic, wrote in a statement that it does not support microdosing.
More Research Needed
Again, microdosing under a qualified provider's supervision doesn't carry the same risks. Still, more research is needed to explore the practice's potential efficacy, drawbacks and benefits, says Jaime Almandoz, M.D., doctor and associate professor at the University of Texas Southwestern Medical Center in Houston.
"Approved doses and schedules are based on extensive research showing the therapeutic benefits at specific doses," Almandoz says. "Although popular, there is a lack of rigorous scientific evidence to support microdosing."
Ultimately, Almandoz says, it's crucial for patients to speak with their health care provider for individualized guidance. Burak agrees, adding that the GLP-1 landscape is quickly evolving, and it's important for patients to understand their options.
