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Trends show that some patients are choosing to microdose their glucagon-like peptide 1 receptor agonists (GLP-1RA) prescriptions for diabetes and weight loss, whether a provider advises it or not. It’s believed that microdosing can be helpful to quell significant gastrointestinal side effects or to titrate scheduled dosing with individualized provider recommendations, however, microdosing is still considered unconventional, according to the American Diabetes Association (ADA). For example, each semaglutide multidose pen delivers about 72 unnumbered “clicks” of medication, and ADA suggests clinicians should counsel patients on how to administer the appropriate number of clicks for specified dosing with verbal and written instructions. Even so, patients are able to reduce their dose independently without requiring a new prescription or refill, and many are doing just that to stretch their prescriptions and save money. What’s troubling is that there is no validated evidence demonstrating that microdosing is safe. Also fueling the trend, online direct-to-consumer health providers have recently started advertising “low cost” weight loss prescriptions as low as $45, built on a business model that relies on compounded drugs delivered in microdoses. By assembling microdoses, the telehealth companies technically are permitted to leverage a Food and Drug Administration provision that allows for personalized, compounded doses of medications—an ongoing point of contention with manufacturers.
Think twice: Microdosing might be seen as off-label, “DIY” experimentation, according to Northwell Health. Among the risks are unpredictable side effects, unpredictable outcomes, and waste (when the dose is ineffective). There are some clinical trials in progress right now to study microdosing. In the meantime, providers should be aware that some patients could be microdosing, even if they aren’t forthcoming with their choice to do so.