How to taper off your GLP-1

GLP-1s like semaglutide and tirzepatide have proven wildly successful at helping treat type 2 diabetes, manage weight, and deliver a ton of other health benefits, such as improving heart health and reducing addictive behaviors like drinking. But what happens when you decide it’s time to stop?

Although GLP-1s are meant to be a forever medication, there might come a time when you need to wind down your relationship with the med. Maybe you’ve dealt with tough side effects, which include nausea and diarrhea, or are suddenly facing out-of-pocket costs that put it out of reach. But whatever your reason for calling it quits, slowing weaning off (instead of going cold turkey) may help make the process a little easier. Here’s what goes into it.

How do GLP-1 medications work?

GLP-1 medications — like liraglutide (Saxenda and Victoza), semaglutide (Wegovy or Ozempic), and tirzepatide (Mounjaro or Zepbound) — mimic a hormone that’s naturally produced by the body. In doing so, they help delay gastric emptying, which helps you feel full, and increase insulin secretion, which keeps blood sugar stable.

When it comes to people living with overweight and obesity, that can have some pretty big implications. “When patients use these medications, they have a physiologic benefit of lower appetite, increase satiety and improvement in fat cell metabolism as well as improvements in insulin resistance,” says Dr. Holly Lofton, M.D., professor of medicine and surgery at NYU Grossman School of Medicine and the director of the Medical Weight Management Program at NYU Langone Health in New York City.

And they can be incredibly effective, especially when used over a long stretch of time. After using them for over a year, people lost an average of 15% to 21% body weight, per studies on semaglutide and tirzepatide published in The New England Journal of Medicine. They’re “considered to be long-term medications because they are treating a chronic condition of overweight or obesity,” says Lofton.

Why people call it quits with GLP-1s

For some people, though, GLP-1s might not be forever. Over the past two years, patients have been stopping their medications due to “supply shortages, lack of insurance coverage, and out-of-pocket costs,” says Dr. Robert Kushner, M.D., professor of medicine and medical education at Northwestern University Feinberg School of Medicine in Chicago. He also points to intense side effects — such as nausea, diarrhea, constipation, and vomiting — as a reason for stopping.

Some people simply meet their weight-loss goal on GLP-1s and decide they don’t want to continue, he says. Also, “patients may also taper their medication if they are considering pregnancy,” says Lofton, who notes that it’s generally recommended to discontinue a GLP-1 agonist two months prior to a planned pregnancy.

But when you stop taking a GLP-1 for weight, all of those physiologic benefits — the feelings of fullness, the lack of cravings, and the control of blood sugar via an uptick of insulin — disappear. As a result, most people “likely see weight regain, even in the setting of continuing the lifestyle recommendations such as creating caloric deficit with diet and exercise,” says Lofton.

How tapering can help

Tapering is the process of either gradually lowering your dose over the course of several weeks or stretching out your dose frequency, going from weekly injections to every other week, then every three weeks, and so on.

Why bother? There aren’t many risks associated with going cold turkey, according to Dr. Jamil Alkhaddo, M.D., an endocrinologist and medical director at WeightWatchers. GLP-1s “do not cause any physiological dependence, and once-weekly GLP-1 medications, like Wegovy or Zepbound, have a long half-life in patients’ bodies,” he says. That long half-life, which is about one week, means that there aren’t any noteworthy side effects to stopping the medication.

The primary concern, especially for those taking GLP-1s for weight management, is the very real risk of regaining any weight you’ve lost while on the medication. “We have good data that suddenly stopping the medication leads to weight regain in the majority of people,” says Kushner. One study in Diabetes, Obesity, and Metabolism regained two-thirds of the weight they’d lost while on the drug, and similarly reversed any improvements in their cardiovascular health.

Some emerging studies suggest that tapering off GLP-1s can help blunt this effect. Research presented at the European Congress on Obesity in 2024, for instance, found that people who gradually reduced their dose to zero (over an average of nine weeks) maintained a stable body weight in the first 26 weeks after tapering. Not surprisingly, despite the evidence still being a work in progress, tapering “is the strategy that is most commonly done in the office setting,” says Kushner.

Research is currently underway to see if taking oral weight-loss medication (such as bupropion-naltrexone) can help ease the transition off GLP-1 receptor agonists and reduce the amount of weight that's typically regained after stopping them. According to Alkhaddo, even though these oral agents may not be as effective as GLP-1s, they may be a good choice to help patients maintain their weight.

How to taper off a GLP-1

If you’re interested in tapering off a GLP-1, first know that there’s no right way to do it. The manufacturers of these medications “do not offer guidance in the prescribing information about tapering off the medication because they are intended to be chronic medications — which means they can be taken safely forever,” says Lofton. “There are no guidelines about how, when, and how often someone should taper the medications.”

With that in mind, here’s how it might go:

1. Talk to your doctor: This isn’t a decision you should make alone; rather, discuss the decision with your health-care provider. “We consider the patient’s goals and values into account along with discussions of risk and benefits,” says Kushner.
   
   
2. Set your milestones: You and your provider might want to agree on a point at which you reconsider medication. “For example, if a patient has recurrence of a previously resolved medical condition or if they gain more than 5% weight above their goal weight, then they are likely to continue to gain weight,” says Lofton. At that point, they may need to consider restarting the GLP-1.
   
   
3. Create your tapering schedule: There are two ways to taper. It’s “most commonly done by reducing the frequency of injections — for example, injecting every 10 to 14 days instead of weekly — or reducing the dose of the medication,” says Kushner. Your provider will determine the best route for you.
   
   
4. Monitor your markers: If you were taking GLP-1s for weight loss, then you may want to track your weight as you taper. And if you were taking it for a medical reason like type 2 diabetes, then you may want to discuss a monitoring schedule with your doctor. That way, you can stick with the milestones you set ahead of time.

What to expect when you taper

Because of how long GLP-1s stick around in the body, “there are no symptoms due to the sudden stop of the medication,” Alkhaddo says. But that doesn’t mean there might not be downsides. For patients “who have resolved their diabetes using a GLP-1 for weight loss and glucose control, they may have a return of their type 2 diabetes,” says Lofton, who adds that it varies from person to person.

The most common sign of withdrawal (a.k.a. the medication withdrawing from your body) is the weight regain. You might also experience “reemergence of food noise, or intrusive thoughts about food and increased appetite,” says Kushner. However, keep in mind that the studies that show weight regain are based on thousands of people, so that might not be your exact experience. In other words, “it is possible for patients to maintain weight while stopping the medication — but some patients may also gain weight at a faster rate or a greater degree than what is seen in the scientific studies,” says Lofton.

To set yourself up for success, focus on following “a healthy eating pattern with ample amounts of lean protein, fruits, and vegetables,” says Kushner. He also recommends maintaining an active lifestyle with a mix of aerobic and strength-training exercises. These lifestyle behaviors — a cornerstone of the WeightWatchers Program — are one reason why members who discontinued GLP-1 medication not only maintained their weight loss, but dropped an additional 1.8% of their body weight after 13 weeks.*

Also, make sure you time it right. Don’t choose to taper before you head out on a weeklong vacation or before a series of weddings begin — or any time “in which you cannot control the food,” says Lofton. It can be a process, so give yourself time. And a little grace.