Tirzepatide stalled hard at week 18, what's the smartest way to add something without blowing up side effects

Posted by weekendnate in Weight Loss & Metabolic - 1 points, 4 comments.

Been on tirzepatide since March, lost about 38 pounds, then the scale just froze for three weeks. Cals are the same, steps are the same, sleep score is fine, nothing changed on my side.

I know the obvious move is a calorie audit and a deload week, which I already did. Sleep and HRV actually looked better during the deload and the scale did not move. So I'm now considering whether a short bridge makes sense for someone like me.

I've been looking at a couple of options. Tesofensine interests me because it's oral and seems to hit appetite plus thermogenesis, but the heart rate and blood pressure concerns are real and I have a family history there. Amlexanox also caught my eye since it works on a completely different pathway, the IKKε and TBK1 inflammation angle, and might actually help the stubborn visceral fat I still carry.

For those who stalled on a GLP-1 and added a second agent, what did you use and how did you titrate? Did anyone try combining with CagriSema logic, basically hitting amylin and GLP-1 together, and did it feel meaningfully different? Also curious if anyone has tried tesofensine alongside a GLP-1 and what bloodwork they watched.

Not looking for a magic fix, just trying to figure out the least reckless next step before I push tirzepatide higher.

Comments

• retired_coldplunge: I stalled around the same spot on sema last year and the thing that actually nudged the scale for me was not adding another agent, it was a small dose bump and waiting out the plateau. Three weeks is not that long eh, my body just seems to hang onto weight in bursts then drop it all at once. Fwiw I would be really cautious with tesofensine if you have family history of heart issues. The BP and resting heart rate jumps are not subtle from what I have read, and stacking that on top of a GLP-1 fee
• weekendnate: Yeah the dose bump was actually my first move, went from 10 to 12.5 right when the stall hit and it did nothing for three weeks. Which is partly why I'm exploring add-ons now instead of pushing dose again. Fair point on tesofensine, that's exactly why I've been hesitating. The CV load stacked on a GLP-1 is a real concern and my family history makes it worse. RMR is a good call. I haven't tested it formally but I've noticed my cold tolerance tanked around week 14, hands cold at room temp, which
• elle_z: Yeah the scale plateau thing is so real, my body does that too where it just holds on for weeks then suddenly drops a few pounds overnight. Three weeks really does feel early to add anything else imo. What dose are you on now, maybe theres still room to titrate up before reaching for another compound? 😅
• weekendnate: Fair point. I'm at 12.5 mg, so yeah, technically I could push to 15, but my nausea gets rough above this dose even with the split injection trick. I held off because adding a second compound felt more interesting than just going up, but you're probably right that 15 mg is the lower-risk move first.

Community discussion - research and educational context only. Not medical advice.