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2. Consult
After you’ve completed your health history form and signed consent, you’ll be contacted through whichever method you specify on the form.
3. Payment and shipping of any medications
Patients receiving brand-name Wegovy®/Ozempic®, Zepbound/Mounjaro®, or Saxenda®/Victoza® will receive their medications via FedEx from Genoa Pharmacy. Oral anti-obesity medications and medications to treat side effects like nausea will be sent to your local pharmacy unless you’d prefer to receive them by mail. Compounded medications (including combination pills with metformin, bupropion, topiramate, etc. and creams such as aminophllyine) will be either mailed or hand-delivered if you live in NYC.
If you are ordered a controlled substance such as phentermine or Vyvanse®, these will be sent to your local pharmacy and must be reordered every 30 days. We’ll do a check-in monthly, as New York State requires prescriptions for controlled substances be written for only one month at a time.
What are the doses for the GLP-1 agonists used for weight loss?
For tirzepatide, I recommend 2.5 mg weekly injection for the first month and then increasing to 5 mg/week in week #5. After the second month, I recommend only increasing your dose according to how you respond to the medication. If you are losing 1 lb/week and no longer snacking uncontrollably, then you should stay at the same dose. This way you can get the most out of the medication with the fewest side effects.
For semaglutide, I recommend increasing to 1 mg/week as quickly as tolerated (typically this is done in week #9) and then increasing your dose according to your response to the drug (goal is 1 lb/week weight loss). It takes longer to achieve therapeutic dosing with semaglutide, and weight loss is usually slower.
For liraglutide, I often recommend that most patients increase to the maximum dose of 3mg/day, which is usually achieved in week #5. Weight loss with liraglutide is not as quick or as profound as with the previous two medications, and we’ll often find that we need to individually tailor your plan with oral medications as adjuncts.
GLP-1 agonist dose progression:
| Semaglutide dosing | Maintain the same dose so long as you’re losing weight and blocking cravings. |
| Loading dose (week 1 – 4) | 0.25 mg once weekly |
| Second stage (week 5 – 8) | 0.5 mg once weekly |
| Third stage (week 9 – 12) | 1.0 mg once weekly |
| Intermediate dose | 1.25 mg once weekly |
| Forth stage (week 13 – 16) | 1.7 mg once weekly |
| Intermediate dose | 2.0 mg once weekly |
| Fifth stage (week 17 – beyond) | 2.4 mg once weekly |
| Tirzepatide dosing | Maintain the same dose so long as you’re losing weight and blocking cravings. |
| Loading dose (week 1 – 4) | 2.5 mg once weekly |
| Second stage (week 5 – 8) | 5.0 mg once weekly |
| Third stage (week 9 – 12) | 7.5 mg once weekly |
| Fourth stage (week 13 – 16) | 10.0 mg once weekly |
| Fifth stage (week 17 – week 20) | 12.5 mg once weekly |
| Sixth stage (week 20 – beyond) | 15.0 mg once weekly |
Liraglutide is injected daily, and the dose is increased each week as follows:
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