After what time frame off GLP-1 RA therapy should you restart at the lowest starting dose?

When a patient has stopped an incretin agonist for more than 2 weeks, I suggest at least restarting at a reduced dose. After 3-4 weeks, I would suggest restarting at the lowest or next to lowest dose. Restarting at a higher dose with anti-nausea medication such as ondansetron may be an option for some people who had good medication tolerance at all of the lower doses.

I would usually restart the medication at the lowest dose if it has been 3-4 weeks, as with the half life of the current GLP-1RA, their levels should be almost gone. Also there is the issue of prioritizing long term adherence versus short term control. If patients have GI side effects with a restarted higher dose, it will be much more difficult to convince them to stay on the medication. Most of the Semaglutide trials (the STEP trials) showed that slow progression (over 4 weeks) of the dosage ha...