What happens if my GLP-1 becomes unavailable or unaffordable?

Interruptions happen for many reasons. What matters clinically is that a GLP-1 is a chronic treatment, and an unplanned gap behaves like an unplanned discontinuation. The FDA declared the tirzepatide and semaglutide injection shortages resolved in December 2024 and February 2025 respectively, so national supply is no longer the usual cause. Access, tolerance and personal circumstances are.

Switching between agents

There is no published dose equivalence between semaglutide and tirzepatide. Someone on semaglutide 2.4 mg weekly does not have a corresponding tirzepatide dose. The safe approach is to start the new drug at its label starting dose, 2.5 mg weekly for tirzepatide or 0.25 mg weekly for semaglutide, and escalate on the label schedule. Expect a temporary dip in appetite suppression during that re-escalation, and expect some weight movement. Planning for that is better than being surprised by it. Oral options now exist, including semaglutide 25 mg tablets and orforglipron, which widens the alternatives if injection supply or tolerance is the issue.

If you have to stop completely

Appetite returns before weight does, usually within two to four weeks. The STEP 1 extension found participants regained 11.6 of the 17.3 percentage points they had lost within a year of stopping. In SURMOUNT-4, 82 percent of those switched to placebo regained more than a quarter of their lost weight in a year, with blood pressure, waist circumference and HbA1c deteriorating in proportion. Knowing this changes what you do in the gap: protein, resistance training and sleep become the whole plan rather than an add-on, and weekly weighing with a pre-agreed threshold for contacting your clinician becomes the monitoring.

What not to do during a gap

Do not switch to a compounded or online-sourced product. Since the shortages ended, most compounding of these molecules is no longer permitted, and the FDA has documented dosing errors of 5 to 20 times the intended dose, along with unapproved salt forms and counterfeit products. Do not stretch doses by injecting less at longer intervals without telling your prescriber, because that produces the same appetite return with none of the monitoring. Do not simply stop and say nothing: a planned reduction with review is a different clinical situation from a silent stop.

If you can see a gap coming, tell your clinician while you still have four weeks of supply. That is enough time to plan a switch, arrange a lower maintenance dose, or set up monitoring for a deliberate pause. It is not enough time if you say something on the day you run out.