My experience with semaglutide has been incredible. I went on it to help lose weight while waiting 6 months to get an appliance for newly diagnosed sleep apnea. My primary care didn't have appetite to prescribe it so I went through a telehealth. The telehealth at least gets you a prescription but it's a really impersonal funnel. Then you get locked into a really rigid process. The 1.5 mg oral was amazing. But then I hit the plateau. The obvious things to do was up the dose. I did that - the next dose was 4 mg and after a couple weeks had total gastroparesis and vomiting for 1-2 weeks. During this time I couldn't take the drugs, had to drop the dose to titrate back up, and gained some weight back over the next month or so. I was able to up the dose again but you can't cut the pills due to the coating so I instead alternated 1.5 mg and 4 mg pills for a couple weeks. I had to do this by not taking the 1.5 mg pills for a few weeks to build up enough of a reserve. The company I was using was totally inflexible with regard to helping me gradually ramp the dose up. The alternating eventually got me to 4 mg and I was steady on that for a while but ultimately had a couple incidents of puking. I really need something like a 3mg pill. I tried skipping a day every few because the long half life should in theory make that a reasonable way to lower the daily average dose, but then the food noise comes right back. I really need like a 3 mg pill but I cannot get one. I decided that I was done with it and went to cancel but found out that if I cancel early I need to pay $450 cancellation fee. :)
Despite having a PhD and working in obesity drug r&d I have found this one of the most complicated, stupidly inflexible, frustrating spaces I've ever seen. If I'm getting my ass kicked like this, I can only imagine what everyone else is experiencing.
The frustrating thing is I really want to be on this drug. I have latent/sub clinical HS which results in chronic low grade armpit pain - I have not had that on glp1s, my sleep apnea has improved, I've lost weight, my anxiety and ADHD have improved. But I just can't get the right dose.