Coming off a GLP-1: the planner
People stop these medicines for all sorts of reasons and get almost no guidance on what to do next. This builds you a list of things to ask your prescriber and things to sort out yourself. It does not tell you to stop, and it will never give you a schedule.
The short answer: stopping or changing the dose is a decision for you and your prescriber, never a website. Before that conversation, three things are worth knowing. Unless you are on the bottom step of the ladder, a lower maintenance dose is a licensed option worth asking about rather than stopping outright. In the trials that withdrew treatment, weight came back on average: STEP 1's extension saw about two thirds of the lost weight regained within a year. And the two things you can act on without a prescription are protein intake and resistance training, which is where the lean-mass evidence sits.
Read this first
Stopping a GLP-1, or changing the dose, is a decision to make with the prescriber who looks after you. It is not a decision to take from a website, including this one. This planner does not give you a schedule and it does not tell you to stop. It gives you a list of things to sort out and things to ask, so the appointment is a useful one. Information, not medical advice.
Nothing you pick here is sent anywhere or stored. It all stays in your browser.
Take these to your prescriber
Questions, in the order they tend to come up. Print it, screenshot it, or read it off your phone.
- 1
Is a lower dose an option instead of stopping?
You are on 10 mg. The licensed steps below that are 2.5, 5 and 7.5 mg. A lower dose sometimes costs less, so it is worth asking what each step down would actually cost you. Plenty of people stay on a lower maintenance dose for the long run rather than stopping.
- 2
If we do stop, how and over what time?
Prescribers differ on whether they would stop straight away or step the dose down first. Ask what they would do in your case and why, and what they want you to do if it does not go the way you both expect. Do not design a schedule from a website, including this one.
- 3
Is there a cheaper route I qualify for?
Ask whether you meet the the NHS criteria. NICE recommends tirzepatide for weight management under TA1026, but the rollout is phased, so what you can get depends on where you are and when. Also ask whether a different medicine in the same class, or a longer prescription interval, works out cheaper. Buying from sellers who do not ask for a consultation is where people come unstuck.
- 4
Which of my other medicines need reviewing?
Weight, blood sugar and blood pressure can all move after stopping, and other treatments are sometimes dosed around them. This matters most if you take insulin, a sulfonylurea such as gliclazide, blood pressure tablets or a statin. Ask which ones need checking and when.
- 5
What were my numbers before, and where are they now?
You have been on treatment long enough for things other than weight to have shifted. Ask for the before and after on blood pressure and any blood tests you have had, such as HbA1c or cholesterol. In the STEP 1 extension those improvements drifted back towards where they started once treatment stopped, so they are worth keeping an eye on rather than assuming they hold.
- 6
When do we review, and what gets measured?
Ask for a follow-up date before you have your last dose, and ask what gets checked at it. A date in the diary is the difference between a plan and a hope.
- 7
What would going back on look like?
Ask what would prompt restarting, whether you would begin again at the bottom of the ladder, how long working back up would take, and what it would cost. One label fact is worth having in your head first: The label says a missed weekly injection can be taken within four days. After that you skip it and go back to your usual day. Knowing the answer in advance takes the drama out of the first small gain.
For reference, the licensed Mounjaro steps below 10 mg are 2.5, 5, 7.5 mg. That is the ladder as published, not a suggestion about which step is right for you.
Sort these out yourself, before the last dose
Write down your baseline before the last dose
Weight, waist measurement, and what a normal day of eating actually looks like. Without a baseline you are guessing later, and guessing tends to be harsher than the facts.
Agree a number that means get back in touch
Pick it with your prescriber rather than on your own, and write it down while you are calm. It turns a vague worry into a specific, boring trigger.
Plan the first six weeks, not the first six months
Tirzepatide has an elimination half-life of about five days, so it takes roughly a month after your last injection before most of it has gone. The structure the medicine was providing quietly, on portion sizes and on how often you thought about food, now has to come from somewhere else. Deciding what that is beforehand beats improvising.
Sort the food environment while appetite is still low
Fill the freezer and the cupboard with the meals you would want to be eating in two months. Doing it now, while decisions are easy, is much less effort than doing it later.
Work out the real monthly number
Include consultations, delivery and the dose you are actually on, not the headline price for a starting dose. If a lower maintenance dose is clinically reasonable for you, that number is what makes the conversation with your prescriber concrete.
What tends to happen to appetite
- Tirzepatide has an elimination half-life of about five days, so it takes roughly a month after your last injection before most of it has gone. Appetite tends to come back over weeks rather than overnight.
- In the withdrawal trials, weight came back gradually across months rather than all at once, and the averages hide a wide spread. Some people in those trials held most of their loss.
- In a US health system that followed 7,938 people who stopped, average weight a year later was 0.5% above where it was at the last dose, with individual results varying a lot around that. People there had lost less on treatment than trial participants did, and regained less.
- In the STEP 1 extension, improvements in cardiometabolic markers also moved back towards where they started for most measures, so it is worth asking about those as well as the scales.
Timings come from the UK summary of product characteristics for Mounjaro.
The two levers with the most behind them
Neither replaces the medicine. Both are the things you can act on without a prescription.
Protein
You said protein lands in some meals. The gaps are usually breakfast and whatever gets eaten in a hurry.
A review of muscle during weight loss found that higher protein intake helps hold on to lean mass, and a controlled trial in a calorie deficit found the higher-protein group gained lean mass and lost more fat than the lower-protein group. Most of the evidence sits around 1.2 to 1.6 g of protein per kg of body weight a day while losing weight, higher if you are 65 or over or you lift.
- Work out your own range with the protein target calculator rather than using a generic number.
- Anchor each meal with a protein before filling in around it.
- Log three ordinary days, including a bad one, to see where you really land.
Resistance training
You said you are not doing resistance training at the moment. NHS physical activity guidance puts muscle-strengthening work at 2 days a week for all adults, and it is the type of exercise most consistently linked with holding on to muscle while losing weight.
In a one-year maintenance trial after an initial low-calorie diet, exercise combined with a GLP-1 cut body-fat percentage by about twice as much as either on its own, and beat exercise alone on weight loss. Against the drug alone the extra weight loss did not reach statistical significance. That trial used liraglutide, an older daily GLP-1, so the principle transfers rather than the exact numbers.
- Two sessions a week is the usual starting point in the guidelines.
- Bodyweight, bands or machines all count. The equipment matters less than showing up twice a week.
- Starting before the last dose means the habit is already running when appetite comes back.
Your own protein range takes about ten seconds to work out with the protein target calculator.
Get urgent help for any of these
This part does not change based on what you picked above.
- Severe stomach pain that does not go away, especially if it spreads through to your back or comes with repeated vomiting. Pancreatitis is uncommon but it is an emergency. Contact NHS 111, or call 999 if you are very unwell.
- Vomiting or diarrhoea you cannot keep on top of, or signs of dehydration such as passing very little urine, feeling dizzy standing up, or confusion.
- If you have diabetes and take insulin or a sulfonylurea such as gliclazide, your blood sugar can move after stopping. Agree the monitoring plan and who to call before your last dose, not after.
- If you are pregnant or trying to conceive, tell your prescriber. It changes the conversation entirely.
What the withdrawal trials found
Group averages from randomised trials, quoted as the trials reported them. Averages are not predictions about you.
Semaglutide 2.4 mg (Wegovy injection)
STEP 1 trial extension, 2022 · 327 adults followed for a year after treatment stopped
- On treatment
- Mean weight loss of 17.3% over 68 weeks on treatment
- After stopping
- In the year after stopping, participants regained 11.6 percentage points, about two thirds of what they had lost. They averaged 5.6% below their starting weight at week 120. That figure comes from the trial's own analysis rather than a straight subtraction, which is why it is not exactly 5.7.
- Worth knowing
- The lifestyle support stopped at the same time as the medicine. Improvements in blood pressure and other cardiometabolic markers also drifted back towards baseline for most measures.
Tirzepatide 10 or 15 mg (Mounjaro)
SURMOUNT-4, 2024 · 670 adults randomised to keep going or switch to placebo for 52 weeks
- On treatment
- Mean weight reduction of 20.9% during the 36-week lead-in on tirzepatide
- After stopping
- Over the next 52 weeks the placebo group gained 14.0% of body weight while the group who kept going lost a further 5.5%. At week 88, 16.6% of the placebo group had held on to at least 80% of their lead-in weight loss, against 89.5% of those still on treatment.
- Worth knowing
- Both groups carried on with the diet and physical activity programme. This is a comparison of stopping the drug against continuing it, not of doing nothing against something.
Semaglutide 2.4 mg (Wegovy injection)
STEP 4, 2021 · 803 adults randomised after a 20-week run-in
- On treatment
- Mean weight loss of 10.6% during the 20-week run-in
- After stopping
- From week 20 to week 68, the group switched to placebo gained 6.9% of body weight while the group who continued lost a further 7.9%.
- Worth knowing
- Both groups stayed on the lifestyle programme throughout.
Semaglutide or tirzepatide injections, ordinary clinical practice
US health-system cohort, 2026 · 7,938 adults who stopped between 3 and 12 months in a health system in Ohio and Florida
- On treatment
- Mean weight change from starting to stopping was 8.4% down when the medicine was for obesity
- After stopping
- In the year after stopping, mean weight change was 0.5% up, with a confidence interval running from 0.0% to 1.0%. Over that year, 19.6% restarted the same medicine and 35.2% took up another obesity treatment.
- Worth knowing
- People here lost a lot less than trial participants did, and regained a lot less too. The authors are explicit that individual results varied widely around that average. It is data from two US states, so read it as a picture of ordinary practice rather than a rule.
Why stopping needs a plan at all
Starting a GLP-1 comes with structure. There is a titration schedule, a pharmacy, a review, someone to email. Stopping usually comes with none of that. The prescription lapses, or the money runs out, or the nausea wins, and that is the end of the process. There is no discharge letter and nobody books you a follow-up.
That gap matters, because the trials that deliberately withdrew treatment show weight coming back. In the extension to STEP 1, 327 adults who had lost a mean of 17.3% of their body weight over 68 weeks on semaglutide regained 11.6 percentage points in the year after treatment stopped, roughly two thirds of what they had lost (Wilding et al., 2022). The improvements in blood pressure and other cardiometabolic markers drifted back towards baseline too, which is the part people rarely hear about.
SURMOUNT-4 did the same thing with tirzepatide. After a 36-week lead-in where the average weight reduction was 20.9%, people were randomly assigned either to keep going or to switch to placebo for 52 weeks. The placebo group gained 14.0% of body weight over that year while the group who continued lost a further 5.5%. At the end, 16.6% of the placebo group had held on to at least 80% of their lead-in weight loss, against 89.5% of those still on treatment (Aronne et al., 2024).
Those are averages, and they are not a prediction about you. Both trials also kept the diet and activity programme running for the people who came off the drug, so this is a comparison of stopping the medicine against continuing it, not of doing nothing against doing something. Read the numbers as information about what to prepare for, not as a warning about what you are doomed to.
The question most people never ask
Stopping is usually framed as on or off. It is rarely that binary. Mounjaro is licensed at 2.5, 5, 7.5, 10, 12.5 and 15 mg. Wegovy injection runs 0.25, 0.5, 1, 1.7, 2.4 and 7.2 mg. Wegovy tablets run 1.5, 4, 9 and 25 mg. If you are anywhere above the bottom step, there are licensed doses underneath the one you are on, and whether one of them would work for you is a real question with a real answer.
A lower dose can cost less, and side effects often ease as the dose comes down. If you have reached the weight you wanted, obesity is treated as a long-term condition, and continuing at a maintenance dose is something plenty of prescribers will discuss. None of that means a lower dose is right for you. It means the question is worth asking out loud before the prescription lapses by default.
What this page will not do is tell you which step to move to, or over how long. There is no licensed tapering schedule for these medicines, prescribers differ on how they handle it, and the person who knows your history is the one to decide. Anyone handing you a week-by-week reduction plan online is doing something they are not qualified to do.
What happens to appetite
Not overnight. According to the UK summaries of product characteristics, semaglutide has a half-life of around a week, so it is still in your system for roughly five weeks after the last dose. Tirzepatide sits at about five days, so it largely clears over roughly four weeks. Appetite tends to return across that stretch rather than the morning after you skip an injection.
The practical effect is that the medicine was doing a lot of quiet work you never had to think about. Portion sizes, second helpings, how often food crossed your mind. When that fades, the same decisions have to be made deliberately. Deciding what your defaults are while your appetite is still low is a lot easier than improvising in month three.
The two levers
Protein comes first. A review of muscle during weight loss concluded that high protein intake helps preserve lean body and muscle mass, and that both endurance and resistance exercise help preserve muscle, with resistance work also improving strength (Cava et al., 2017). In a controlled trial where people ate in a deficit alongside hard training, the higher-protein group gained lean mass and lost more fat than the lower-protein group (Longland et al., 2016). Most of the evidence sits around 1.2 to 1.6 g per kg of body weight a day while losing, and higher if you are 65 or over. The protein target calculator works out your own range and shows its working.
Training is the second lever, and there is trial evidence for it in exactly this situation. In a one-year maintenance study after an eight-week low-calorie diet, people were assigned to exercise, a GLP-1, both, or neither. The combination held weight loss better than either alone and cut body-fat percentage by about twice as much (Lundgren et al., 2021). That trial used liraglutide, an older daily GLP-1, so treat the principle as transferable and the exact figures as specific to that study. UK physical activity guidance puts muscle-strengthening work at two days a week for all adults regardless of any of this.
This page is information, not medical advice
Mounjaro and Wegovy are prescription-only medicines. Everything here is written to make your next appointment more useful, not to replace it. Do not start, stop, stretch, split or change a dose based on anything you read on this site. If you feel unwell, contact your prescriber, call NHS 111, or call 999 if it is an emergency.
Written for the UK. Brand names, licensed doses and NHS access rules are different elsewhere.
Sources
Withdrawal-trial figures and guidance last reviewed 25 July 2026.
- Wilding et al., Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes, Obesity and Metabolism, 2022 (PMID 35441470)
- Aronne et al., Continued treatment with tirzepatide for maintenance of weight reduction in adults with obesity: the SURMOUNT-4 randomized clinical trial. JAMA, 2024 (PMID 38078870)
- Rubino et al., Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 randomized clinical trial. JAMA, 2021 (PMID 33755728)
- Lundgren et al., Healthy weight loss maintenance with exercise, liraglutide, or both combined. New England Journal of Medicine, 2021 (PMID 33951361)
- Cava, Yeat & Mittendorfer, Preserving healthy muscle during weight loss. Advances in Nutrition, 2017 (PMID 28507015)
- Longland et al., Higher compared with lower dietary protein during an energy deficit combined with intense exercise promotes greater lean mass gain and fat mass loss. American Journal of Clinical Nutrition, 2016 (PMID 26817506)
- Mounjaro (tirzepatide) summary of product characteristics, electronic Medicines Compendium
- Wegovy (semaglutide) summary of product characteristics, electronic Medicines Compendium
- NICE TA1026: tirzepatide for managing overweight and obesity
- NHS physical activity guidelines for adults aged 19 to 64