How Prevalent Is Microdosing?
While complex data is scarce, the practice is gaining traction, primarily fueled by online discussions and social media platforms. A recent survey even indicated that as many as 36% of GLP-1 users might be microdosing, often learning about the practice through channels like TikTok.
Is this a new phenomenon?
Not at all. Those of us who have patients on subcutaneous biologics are aware that patients often reduce the frequency of injections to save costs. Or they feel well and decide they don't need the whole prescribed regimen.
Why and How It Became Popular?
Several factors are driving this trend. Firstly, the cost of these medications can be substantial, and microdosing is seen as a way to extend the life of an expensive prescription. Secondly, many users experience unpleasant side effects like nausea and gastrointestinal distress at standard doses; taking smaller amounts can make these drugs more tolerable. Thirdly, there is a belief, or hope, that microdosing can offer some health benefits (such as appetite control or cardiovascular protection) without the full commitment or impact of standard doses. The "how" often involves using compounded versions or attempting to administer "clicks" rather than full doses from injector pens – methods not approved or validated by manufacturers.
What Are the Scientific Factors Underlying the Use of Microdose?
Scientifically, this is where things get murky. GLP-1 agonists mimic a natural hormone, influencing insulin, glucagon, stomach emptying, and brain centers that regulate satiety.
While we understand how they work at therapeutic doses, there's virtually no clinical research on their effects at microdoses.
Some researchers speculate about achieving benefits independent of significant weight loss—for example, data suggests cardiovascular benefits might occur even with less weight reduction. This raises the question: Could lower doses still offer these perks?
The honest answer is: we don't know. There is no robust data to confirm that these benefits can be achieved through microdosing or that this practice is harmful.
What Are the Key Unknowns and Potential Risks?
This lack of data is the most enormous red flag. We don't know the dose-response relationship at these low levels. Do you think it will be effective? Will it only cause side effects? What are the long-term consequences of sustained, low-level exposure? There are concerns about dosing errors, especially with unvalidated methods, and the potential for reduced tolerability if the body isn't consistently exposed. Furthermore, using compounded versions carries inherent risks, such as contamination or inaccurate concentrations.
My conclusion
Based on the available body of knowledge, there may be a logical benefit to 'treating to target outcomes' that could reduce cumulative drug exposure. The FDA and other agencies approve label doses that are the smallest to provide optimal outcomes; using a dose smaller than that is unlikely to result in a toxicity level higher than that of the full label dose. Alas, I don't see any sponsors for testing this expectation in rigorous clinical trials.
Also see
WSJ news story (paywall) by Sumathi Reddy
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