How do I switch from semaglutide to tirzepatide (or between GLP-1 forms)?

Why people switch: plateauing below goal on semaglutide (tirzepatide’s head-to-head edge makes it the natural next move), intolerable side effects on one molecule (tolerability differs individually in both directions), insurance formulary changes, and cost (form-switches: brand ↔ compounded, injection ↔ sublingual). The core principle — no conversion chart exists. Semaglutide and tirzepatide milligrams are unrelated currencies; receptor profiles differ, and anyone quoting “1 mg sema = X mg tirz” is improvising. Prescribers therefore switch by judgment: land conservatively, reassess in 4 weeks, climb as needed. Typical patterns (your prescriber’s call, not a DIY recipe): - Sema → tirz, mid/high dose (1–2.4 mg): start tirzepatide at 5 mg (occasionally 2.5 mg for the side-effect-prone) — not at the ladder top, despite your “experience.” - Tirz → sema: commonly land at 0.5–1 mg, not 2.4. - Timing: take dose A’s final week, then start drug B when the next weekly dose was due. No washout needed in routine switches; gaps over 2–4 weeks start to reset tolerance (restart rules). - Brand ↔ compounded, same molecule: usually dose-for-dose — except anything involving sublinguals, whose scales are unrelated to injections. What to expect after switching: a brief side-effect blip as your gut meets a new molecule (treat it as a mini-titration; the nausea playbook applies), and judge the new drug at 8–12 weeks, not 2. Semaglutide non-responders often respond well to tirzepatide; the reverse also happens — individual biology keeps both switches on the table.