Microdosing Weight-Loss Drugs Like Ozempic Sparks Debate Among Doctors

A growing trend of "microdosing" GLP-1 drugs, such as Ozempic, Wegovy, and Zepbound, is gaining popularity on social media platforms like Facebook and Reddit, with users sharing anecdotes about using a fraction of the FDA-approved dosage to reduce side effects and save money. While some claim this approach still helps with weight loss and curbing food cravings, medical experts warn that the practice lacks scientific evidence and poses potential risks.  

“There are no published studies assessing the effects of GLP-1-based medication microdosing,” said Daniela Hurtado, MD, PhD, an endocrinologist at the Mayo Clinic.  

Does Microdosing GLP-1s Work for Weight Loss?  

Semaglutide, the active ingredient in Ozempic and Wegovy, typically starts at a dosage of 0.25 mg, while tirzepatide, found in Zepbound and Mounjaro, begins at 2.5 mg. Patients are usually prescribed the starting dose for four weeks before gradually increasing the dosage to minimize side effects like nausea, diarrhea, and vomiting.  

Some users online have experimented with microdosing semaglutide at much lower levels, ranging from 0.05 mg to 0.125 mg, as a way to achieve moderate weight loss or reduce unpleasant side effects. But Hurtado noted that while lower doses can help patients who experience intolerance to standard dosages, the effects on significant weight loss are inconsistent.  

“While this approach has sometimes reduced side effects, it has not consistently yielded significant clinical improvements in terms of weight loss,” Hurtado said.  

Risks of Microdosing GLP-1 Drugs  

Using smaller-than-recommended doses of GLP-1 drugs raises several concerns, including insufficient weight loss for medical purposes and potential health risks tied to improper handling or storage of the drugs.  

According to Peminda Cabandugama, MD, an endocrinologist at the Cleveland Clinic and chair of the Clinical Practice Section of the Obesity Society, some people turn to microdosing because of drug shortages. Compounding pharmacies have also produced non-FDA approved versions of GLP-1 drugs, which some users purchase for microdosing.  

However, compounded drugs come with additional risks because they may contain unapproved ingredients or be prone to contamination. The FDA recently announced that shortages of semaglutide and tirzepatide have been resolved, meaning compounding pharmacies will soon be prohibited from producing these medications.  

Other risks stem from improper drug administration. For example, microdosing often involves patients filling syringes themselves or adjusting the number of clicks on autoinjector pens, which can lead to inaccurate dosing. Additionally, some may reuse needles, increasing the risk of infection, said Mansoor Amiji, PhD, RPh, a professor of chemical engineering and pharmaceutical sciences at Northeastern University.  

Storage is another concern. Patients who stretch out doses by microdosing could exceed the manufacturer’s expiration timeline of 56 days, which may jeopardize the drug’s safety and effectiveness. “We don’t know what happens to the stability of the drugs after that time period. You may not get any benefit whatsoever,” Amiji cautioned.  

The Need for Research on Microdosing  

Beverly Tchang, MD, an obesity specialist at NewYork-Presbyterian Hospital, believes more research is needed to assess whether microdosing is safe and effective. She recommends studying people’s experiences and needs in order to develop an evidence-based strategy for personalized use of GLP-1 drugs.  

“I am firmly neutral on microdosing because even though there is little evidence, I think it is counterproductive to come out against it since we know it is happening in the broad population, with or without medical supervision,” Tchang said.  

The Bottom Line  

As the microdosing trend continues to gain traction, medical experts stress the importance of using GLP-1 drugs under professional guidance and in accordance with FDA-approved dosages. Patients interested in weight-loss options should consult a healthcare provider to discuss safe and effective treatments tailored to their individual needs. While further research may clarify the risks and benefits of microdosing, the practice remains largely unexplored and unregulated.