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The decision to escalate should be based on three factors

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If you have been on 2mg for 6+ weeks without progressing to 4mg and are tolerating the medication well, the delay in escalation is likely postponing the appetite benefits you are seeking

As Healio previously reported, the FDA removed tirzepatide (Mounjaro/Zepbound, Eli Lilly) and semaglutide (Ozempic/Wegovy, Novo Nordisk) from its drug shortage list in 2024 and 2025, respectively, and now prohibits both 503A compounding pharmacies and 503B outsourcing facilities from distributing compounded versions of the drug

(2) Biased signaling: Some GLP-1-biased agonists mentioned above, such as orforglipron and danuglipron, activate a biased signal cascade, in which GPCR binds preferentially or almost exclusively to G-protein instead to another associated effector protein, in this case, concretely with the -arrestin 2