Microdosing GLP-1 weight loss drugs like semaglutide is trendy, with supporters touting benefits such as lower costs and potentially fewer side effects. But some doctors are skeptical, calling it “experimental.”
The practice has gotten celebrity endorsement.
Bravo TV host Andy Cohen says he lost “a good chunk of weight” by microdosing a GLP-1 drug all summer, though he didn’t say which one or offer details of his regimen.
“It kickstarted something,” he told TODAY in September.
Actor Rebel Wilson told USA Today that microdosing helps stabilize her weight after she lost more than 80 pounds in 2020 by working out and eating a high-protein diet. To keep that progress, she says she sometimes takes an unspecified GLP-1 medication.
“I had a very good response to it because it meant I could maintain my weight or roughly thereabouts,” Wilson told TODAY in September.
Wilson is now the chief wellness ambassador for Noom, an online weight-loss platform that launched a microdose GLP-1 program in August.
It allows a wider variety of patients to experience the benefits of GLP-1 drugs, says Dr. Jeffrey Egler, Noom’s chief medical officer, noting more than 10,000 people have signed up.
But Dr. Christopher McGowan, a North Carolina physician who is triple board certified in internal medicine, gastroenterology and obesity medicine, calls microdosing programs “murky” and a “complete Wild West.”
Dr. Shauna Levy, medical director of Tulane University’s Bariatric and Weight Loss Center in New Orleans, says there’s no evidence microdosing works for weight loss.
Both doctors call GLP-1 microdosing “experimental.”
What Is GLP-1 Microdosing?
There’s no standard definition, but microdosing generally means taking a much lower dosage of something, in this case a GLP-1 weight-loss drug like semaglutide or tirzepatide, than what’s recommended by the U.S. Food and Drug Administration and indicated by the manufacturer, the experts say.
Microdosing is considered off-label use, or prescribing an approved drug for an unapproved use, which doctors are allowed to do if they deem it medically appropriate.
Some people, like Wilson, also say they go on and off the mini doses, rather than taking the medication continuously.
To put it in context, the standard dose of semaglutide — the active ingredient in Ozempic and Wegovy — starts at 0.25 milligrams once a week. Doctors then gradually increase it so a patient’s body can get used to the drug, working up to a maximum dose of 2.4 milligrams a week, according to Novo Nordisk, the pharmaceutical company that makes it.
Noom’s program starts at 0.2 milligrams of semaglutide and goes up to a maximum of 0.6 milligrams, or one-quarter of the standard maximum dose. Noom uses compounded semaglutide injected using a vial and syringe, not the injector pen that typically comes with Ozempic and similar medications.
Before this past spring, many compounding pharmacies were selling copycat versions of GLP-1s, which the FDA permits if a drug is in shortage. But the GLP-1 shortage ended this year, so selling copycat GLP-1s became illegal. Still, pharmacies can distribute compounded versions of GLP-1s if the medication is personalized for the patient’s needs, according to the Center for Medicine in the Public Interest.
Egler says Noom’s compounding practice is allowed when patients need medication for a “personalized reason.”
Noom’s microdosing program also offers liraglutide, Egler says, an older generation GLP-1 drug that’s now available in generic form and comes in a pen.
What Are the Benefits of GLP-1 Microdosing?
Here are some of the reasons people may try microdosing and what doctors think:
It Costs Less
Wegovy has a list price of $1,349 for a month’s supply when insurance doesn’t cover it. Costco is now offering it for $499 for shoppers without insurance.
Noom’s microdose program starts at $119 for the first three weeks, and costs $199 per month after that, without insurance.
It May Have Fewer Side Effects
The most common side effects of GLP-1 drugs are gastrointestinal issues such as nausea, diarrhea, vomiting and constipation.
But with microdosing, the tiny doses and smaller dosing increments allow people to experience fewer side effects, Egler says.
Gastrointestinal side effects tend to be less at a lower dose so that’s possible, says Levy who has done consulting work for Novo Nordisk.
Still, side effects can occur at any dosage, so it depends on each person’s response to the medication, McGowan adds.
“It’s by no means a guarantee that a lower dose translates to lower side effects,” he says.
It May Be for the Short Term
Noom doesn’t “necessarily frown” upon people starting and stopping its microdosing program, including losing weight for a wedding or a vacation, Egler says.
“They may hit their goals and stop and find that they’re losing ground and want to restart again,” he notes.
But GLP-1 drugs are meant to be taken long-term, not just for an event, both Levy and McGowan emphasize, warning that stopping or interrupting therapy can lead weight regain and increased side effects.
Levy also expressed concern that it could cause weight cycling, or yo-yo dieting — repeatedly losing and gaining weight, which can have negative health consequences like a higher risk of dying suddenly from a heart attack.
“It really goes against what we’re trying to do in the field of obesity and treat chronic illness,” Levy adds. “I don’t see myself in the business of treating appearance.”
It May Be Accessible to More People
Noom allows patients with a BMI of 25 or higher to take part in its microdosing program.
That’s a wider pool of people than those who normally qualify for a GLP-1 prescription. Wegovy and Zepbound are FDA-approved for patients with a BMI of 30 or greater; or a BMI of 27 or more if they have a weight-related complication.
Does Microdosing Curb Appetite?
GLP-1 drugs mimic a hormone the body produces after eating, which can decrease appetite and lead to feelings of fulness — a major reason people lose weight.
It’s unpredictable whether microdosing would have a similar effect since some patients feel almost nothing on the lower doses, McGowan notes.
“In somebody with obesity, these small doses are going to have negligible effect, if any,” Levy adds, though some people are “super responders” and see effects on very low doses.
Does Microdosing a GLP-1 Lead to Weight Loss?
Weight loss seems to be dose dependent, so people with obesity won’t see the same results as they would with regular doses, Levy says. It’s possible microdosing could lead to weight loss or help maintain previous weight loss, but that’s never been studied, she adds.
On average, people will lose significantly less weight than they would with the maximum dose of a brand name version of the drug, McGowan agrees.
“Drug dosing isn’t guesswork. Pharmaceutical companies spend years running tightly regulated clinical trials to determine the safest and most effective doses. So those approved titration schedules are the evidence-based doses,” he says.
People taking FDA-approved doses of Wegovy for one year and four months lost about 35 pounds, according to the manufacturer.
Noom’s data shows members in its microdosing program can lose up to 11 pounds in 30 days and up to 17 pounds in 60 days, Egler says.
Is Microdosing a GLP-1 Safe?
McGowan is concerned about using compounded GLP-1 drugs, which don’t get the same level of FDA oversight.
Levy worries that people with a lower BMI taking a GLP-1 may lose more muscle than fat.
Companies that make GLP-1 drugs urged patients to use the medications as intended.
“We do not condone the misuse of our products,” Novo Nordisk says in a statement to TODAY.com. “It’s important to understand that for Wegovy, only the marked doses on the single-use, fixed-dose pens … are approved for use and represent an authentic FDA-approved medicine.”
Eli Lilly says it doesn’t have any data on the benefits or risks of microdosing tirzepatide, the active ingredient in Zepbound and Mounjaro. Noom does not offer tirzepatide in its microdosing program.
Both Mounjaro and Zepbound injector pens and Zepbound single-dose vials don’t contain preservatives and are approved for single-use only, so dose-splitting or “microdosing” is not contemplated by the FDA-label, the company notes.
“As such, microdosing of Zepbound and Mounjaro may increase the risk of contamination and therefore pose patient safety risks,” Eli Lilly says in a statement.
Bottom Line:
Patients need to be cautious and understand microdosing is not evidence-based — it has not been studied in clinical trials, McGowan says.
Levy urged people interested in the practice to talk with their doctor or an obesity medicine specialist.
Neither doctor recommends GLP-1 microdosing.
“GLP-1s are great for patients, but I have a huge reluctance to see these third-party vendors managing this disease because they have limited expertise, and they’re using experiment and not data to treat their clients,” she says.
But Egler says he sees benefits of these medications in the scientific literature for doses that are considerably lower than the standard regimen. On its website, the company points to a study that found people taking 1 milligram of semaglutide, less than half of the maximum dose, lost an average of 16% of their body weight over 64 weeks. The paper has not been peer-reviewed.
Patients who qualify for Noom’s microdosing program get the medication plus psychological support to adopt healthier habits, Egler notes.
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