How to request a dose change: increase, decrease, or stay at your dose

Dose changes are clinical decisions you make together with your provider, so there's no dose change button in the portal. Whether you want to go up, go down, or stay where you are, requesting it takes about a minute through Messages, and your provider reviews every request.

How to request a change

• Sign in to your portal and select Messages in the menu (on a phone, tap the chat bubble).
• Tell us what you want and why, along with your current dose. For example: "I'm on 5 mg and would like to increase to 7.5 mg. My appetite has come back over the last two weeks." If you want to decrease, or stay at your current dose instead of stepping up, say that the same way. Please mention any side effects you're having, since that helps your provider decide safely.
• Your care team routes the request to your provider, and you'll get a reply in the same thread. Patients stay at a dose for a minimum of four weeks, and any increase is subject to provider approval.
• Once it's approved, your plan card on the Home page shows the new dose under Planned dose with its start date, and the Renewal starting dose on your plan page updates. Your new prescription appears under the Planned tab on the Treatments page.

Stay at your current dose

To stay at your current dose instead of stepping up, message us. Your provider will review it and keep you on your current dose for the rest of your plan.

• Wanting to stay on your current dose longer, for example 8 weeks across two prescriptions before moving up, is fine. Just let us know.
• Close to your goal? There's no pressure to increase. Stay at the lowest dose that's working for you.
• If you want to change your dose again later, message us before your next shipment is processed and we'll help.

When to ask for an increase, and when not to

A request makes the most sense when your weight loss has plateaued, side effects have settled, and cravings or food noise are returning. If you have no side effects and your current dose is no longer doing enough, it's appropriate to ask about the next dose level. Your provider reviews every request, including your symptoms, weight trend, and any recent gain.

• A couple of pounds of weight gain doesn't automatically need a higher dose. Check calorie intake, protein, hydration, and exercise first. If those are solid, your provider may suggest a gradual increase, then maintaining at the lowest effective dose.
• Want an increase but worried about side effects? Tell us in your message. Your provider can adjust the plan around how you've been feeling.
• Increase or switch medication? Whether to increase your dose or change to a different GLP-1 is a decision your provider makes after reviewing your full chart.
• If you're on semaglutide and want to move from 0.5 mg to 1 mg after 4 weeks, you can ask for it. You'll go through your supply faster, so message us so your next shipment matches.

Going up more slowly

You don't have to take the full next step. Ask your care team for a slower climb. A smaller step, or an in-between amount, is available when you're worried about side effects. Your provider can write the plan with smaller increases, or prescribe the next dose level and tell you exactly how many units to draw for a smaller amount. They'll confirm the amount for your vial's concentration, because units vary and milligrams are the standard measure.

• Examples at a given vial concentration: on an 18 mg/mL tirzepatide vial, 6.5 mg is 36 units. On a 10 mg/mL vial, 3 mg is 30 units. Your vial may be different, so always use the units your care team gives you.
• If the next step is a big jump, your care team can offer a slower titration, and the plan can move more slowly than the standard schedule.
• Staying put when side effects are mild: for example, if you only have reflux in the first couple of days after each injection, staying at your current dose longer before increasing is usually better than increasing.

Dosing should still follow the step-up ladder. Please don't skip steps or take more than your prescribed dose without asking your care team. Tell your care team what you're planning so your plan and records match. See "How does dosing and dose increases work for GLP-1s?" for the ladder and maximum doses.

Taking less than prescribed, or stepping down

Taking less than your prescribed dose is okay. If you want to take more, message your care team first. If side effects are hard to manage, a smaller amount is a reasonable first step.

To find the number of units for a smaller dose, use Belle's dosage calculator with the concentration (mg/mL) printed on the vial you're using now (see "How do I use Belle's dosage calculator?"). The same number of units is a different dose in a different vial, so never reuse a unit count from an old vial. Let your care team know you've lowered your dose so your plan and records match.

• Common reasons to step down: nausea, loss of appetite, heartburn, indigestion, or diarrhea after an increase, or losing weight faster than intended along with digestive symptoms. Nausea after an increase often means the new dose is a bit too high. You can go back to your previous dose, or try a smaller in-between step later.
• Check the basics first: food, hydration, protein, and your eating pattern can all cause nausea. Ask your care team whether an anti-nausea medicine is a good option for you.
• Stepping down gradually: lower one small step at a time and stay at each lower dose for about 2 weeks before the next one. Use Belle's dosage calculator to find the units for each step on your current vial. Microdose plans at lower set doses are also available (see "What is microdosing a GLP-1?").
• Staying lower is fine. The goal is the lowest dose that works for you without side effects that get in the way.
• Going up again later: when you feel ready, message us and your care team can help you increase more slowly. Wait about 4 weeks before judging how a dose change is working.
• Already lowered on your own? That's okay. Let the clinic know how you're doing on the lower amount so your plan can match.
• After reaching goal weight, you can ask to move to a lower maintenance dose. Your provider reviews and updates your plan.

Never take more than your prescribed dose without your provider's approval. If you want to take more, message us first and we'll confirm it with your provider before you inject.

Timing matters

Once a shipment has been processed, a dose change can't be applied to that order. Send your request with enough lead time before your next shipment date. If you want to avoid receiving a dose you're about to change, you can pause your plan or delay your next shipment while the change is reviewed (see How to delay, skip, reschedule, or change your next shipment date).

• How long it takes: provider review usually takes 1 to 2 business days. The pharmacy fills the order 2 to 5 business days after approval, and most orders arrive 5 to 10 business days after provider approval. Once approved, your treatment plan updates for your next order, usually within 1 to 2 business days.
• Higher dose, same supply: a dose increase doesn't add medication to what you already have. A higher dose uses your supply faster, so you'll need your next refill sooner. If you think you'll run short, message us before your next scheduled renewal and we can move your refill date earlier, or delay it if you need more time. If you increase sooner than scheduled, your current vial will run out before your next shipment arrives.
• Approved for an increase but afraid of running out? Keep taking your current dose if it's working well. The clinic will send a new prescription at the higher dose, and you don't have to increase just because you have it.
• Do I need to pause while I wait? No. If you're on an increasing plan, your next renewal already includes the increase. A pause or delay is only useful if you want to stop a shipment at a dose you're about to change.
• Order holds: to delay a shipment, we need to confirm your current dose with your provider first.
• Portal asks for payment when you request an increase? Message the care team. They'll review your request, update your treatment plan, and ask you to retry payment once it's approved.
• Before your next order, confirm your desired dose with your care team and make sure it's updated in your plan so you don't run short.

Restarting after a break or after side effects

After a break, restart lower and step back up every 4 weeks. After more than 8 weeks off, you restart at the starting dose. After 4 to 8 weeks off, you restart at least one step lower than your previous dose. Jumping straight to a higher dose, even one you tolerated before, raises the chance of severe stomach side effects. See "What if I miss my scheduled injection day?" for the full restart guidance.

If you stopped because of side effects, schedule a call with a provider to talk through what happened and plan how to move forward, including which lower dose to restart on. When you message us, please include the date and dose of your last injection and what symptoms you had, so your provider can decide whether to restart at the same dose or a lower one.

Keeping your plan and records right

• Dose changes apply to future shipments. Medication you already have keeps its original directions unless your provider tells you otherwise.
• If you take a different amount than your records show, message your care team with the dose you actually take and the date you started it. They'll review it and update your plan and portal to match. Your next renewal is based on your plan, so this keeps you from getting the wrong dose or running short.
• If your portal shows a dose that doesn't match what you expect, message us and we'll check your chart. To see where your dose is shown, see How to find your dose and how many units to inject.
• Want to talk with a provider before your renewal? Use the provider consult link in your account to schedule a call. This is a good option if your dose isn't working as expected, you're hesitant to increase because of side effects, or you're not sure whether to change your dose or switch medications.

Need help? Select Messages in your portal (on a phone, tap the chat bubble) and we'll help.