6-item list

6 signs your GLP-1 dose is too high (and what to do)

GLP-1 titration schedules are population averages, not personalized doses. About 15-20% of patients tolerate the standard schedule poorly and benefit from staying longer at a lower dose. These are the signals to flag to your prescriber.

1. 1

   Persistent nausea past week 4 of a dose

   Nausea is normal in week 1-2 of a step-up. If it lingers past week 4 or worsens, the next escalation will likely amplify it. Ask to hold the current dose another month.

2. 2

   Vomiting more than twice a week

   Beyond GI discomfort, vomiting risks dehydration and kidney injury. Hold the dose; if vomiting persists 7+ days, step down.

3. 3

   Resting heart rate dropping >15 bpm

   GLP-1s typically raise heart rate slightly. A drop often signals dehydration or undereating. Check intake and electrolytes before escalating.

4. 4

   Calorie intake under 1,200/day unintentionally

   Sustained extreme deficits cause muscle loss, fatigue, and slowed metabolism. Hold the dose, prioritize protein, add a daily shake.

5. 5

   New low mood or anxiety

   A small minority of patients experience mood shifts at higher doses. Don't white-knuckle through it — ask about staying at the prior dose.

6. 6

   Lightheadedness on standing

   Orthostatic symptoms = dehydration or low sodium. Increase fluids + electrolytes; if it persists, dose is too high for the current rate of weight loss.