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DEAR DR. ROACH: I've been on Zepbound for about eight months. I've had fantastic results as far as weight loss, and I'm building muscle back. The problem is that I've constantly had to push back on increasing my dose. I started at 2.5 mg, then 5 mg, then 7.5 mg. My body couldn't handle 7.5 mg, so I asked to go back to 5 mg. My weight loss slowed down, but I was still losing weight and was happy with this.
With the 7.5-mg dose, I couldn't eat anything, which meant that I always felt tired, couldn't get my proteins, and didn't have energy to work out. Also, my hair started to fall out. I stopped Zepound for a while due to a switch in health insurance and had to start with a low dose again. But here we are again, with my having to explain why I'm happy with 5 mg.
This seemed common on online social boards, so I wondered if the rapid dose escalation is what's causing all the GLP-1 side effects. I understand that once you plateau, you need to increase the dose, but this wasn't my issue. I was happy losing a pound or two a week while being able to lift weights. Why do doctors do this? -- K.K.
ANSWER: I've also had patients who've done well on a low dose, and I agree that there's no need to push. I have a family member who had a similar reaction as you with dose escalation. It's true that many people plateau with their weight and don't have any significant side effects after just a few weeks at a particular dose, so increasing the dose every four to eight weeks works well for many. But I'm publishing your letter to remind both patients and physicians that some people do very well on lower doses.
DEAR DR. ROACH: We took the Shingrix vaccine when it was introduced. It's been over seven years, and neither the Centers for Disease Control nor our top hospital internal medicine group can advise us on whether we should get revaccinated. We're thinking about doing it for protection. Is this harmful or inadvisable? I can't find any useful information on this. -- C.C.
ANSWER: You're correct that there's no guidance about vaccination after completing the two-dose Shingrix immunization (one dose followed by a second in three to six months). At the time, the data showed good results seven years later, and current data shows that the protection remains strong after 11 years. The best estimates are that good protection is expected to continue for at least 15-20 years; however, we'll need more data to support this.
In studies that looked at a third dose about 10 years after the initial series, the "booster" did increase the body's defenses against shingles -- both through antibody titers and cell-mediated immunity. But additional doses (beyond the third) didn't provide a benefit. These small studies were designed to look at how effective booster shots are in the lab and weren't powered to detect improvements in the protection against getting shingles or its complications.
The studies showed that relatively minor side effects (a sore arm, fatigue, and muscle aches) occurred in about half of the participants, similar to the initial Shingrix dose in frequency and severity and without serious adverse effects.
The Shingrix vaccine was approved in October 2017, so the very first people to get the vaccine (outside of the studies) haven't even completed 10 years. Since guidance can't be expected in the short-term future due to ongoing legal issues with the CDC's Advisory Committee on Immunization Practices, I'm advising against a third dose of the Shingrix vaccine at this time, at least until additional data are available. It might be that revaccination will be recommended 15-20 years after the initial series.