This content originally appeared on Everyday Health. Republished with permission.
By Ross Wollen
Medically Reviewed by Sandy Bassin, MD
If you’re taking semaglutide (Ozempic, Wegovy) or tirzepatide (Mounjaro, Zepbound), certain food-focused events like vacations and summer cookouts are probably very different for you now. After all, these powerful appetite-suppressing drugs can make indulging in rich foods an uncomfortable experience.
You might be tempted to skip or delay a dose in advance of a special occasion, whether that’s a big holiday meal, an expensive anniversary or birthday dinner, or some other celebration. Or maybe you’re planning a vacation and considering missing a dose in order to really get your money’s worth from an all-inclusive resort.
An informal review of social media forums dedicated to the use of weight loss injectables suggests that people are very much split on the issue of skipping doses. Some report they have happily delayed or missed doses for holidays and vacations and will do so again. Others have tried the technique and experienced poor results. Some people reject the idea entirely.
So, is it really safe to skip a dose once in a while? And is it a good idea?
New Weight Loss Drugs Significantly Reduce Your Interest in Eating
The new weight loss injectables, nicknamed GLP-1s, mimic the actions of hormones that the body naturally releases after meals, resulting in complex metabolic effects that work together to curb hunger.
They’ve become a global phenomenon for one big reason: They are extraordinarily effective appetite suppressants. Semaglutide users, for example, consume many fewer calories and experience fewer food cravings, enhanced self-control during eating, and even a diminished interest in fatty foods.[1]
That’s great news for weight loss and diabetes management. But using these drugs means learning how to navigate celebrations that involve being surrounded by loved ones deliriously gorging themselves on delicious foods.
Does Skipping Doses Work?
Katherine Saunders, MD, an assistant professor and obesity specialist at Weill Cornell Medicine in New York City and a cofounder of Intellihealth, says that while missing the occasional dose of weight loss medication is “technically safe,” she doubts it will allow patients to enjoy a large meal.
Dr. Saunders has seen patients underestimate how slowly these drugs leave their system. “People can get into trouble with this habit given semaglutide and tirzepatide’s long half-lives,” she says. “If someone skips medication for one week in order to eat larger portions, they might get sick if they assume the medication is out of their system and they eat more than they can handle.”
She says that even if appetite seems to return after a delayed or skipped dose, big meals can still provoke punishing side effects: “Eating heavy foods or large portions while on semaglutide or tirzepatide can lead to heartburn, nausea, and vomiting. Sometimes people feel fine while they’re eating and even afterwards for a while, but then they vomit out of nowhere several hours later,” she says.
Andrew Kraftson, MD, the director of the weight navigation program at Michigan Medicine in Ann Arbor, agrees. “Just because you skipped a dose doesn’t mean you aren’t at any risk of side effects. Individuals should still be counseled to chew very thoroughly, eat slowly, and moderate their portions to avoid getting into trouble,” he says.
Dr. Kraftson says that people who routinely experience gastrointestinal side effects from their medications may be “at higher risk of having more pronounced symptoms if they skip a dose.”
Delaying a Shot by a Day or 2 May Be ‘Totally Reasonable’
Kraftson adds that while delaying a dose to create hunger may be unwise, there are other valid reasons for changing your injection schedule around a holiday or other big event.
Many people experience their worst digestive issues during the first day or two after their weekly injection, and have learned to delay their shot on days when vomiting or diarrhea would be particularly inconvenient, such as during job interviews, air travel, or holiday parties. Kraftson calls these short delays “totally reasonable.”
If your usual injection is scheduled to occur immediately before an important day, it’s probably safe to wait a day or two — it could reduce the risk that you spend too much of your big day in the bathroom.
Skipping Doses Can Set You Up for Failure in the Long Run
Sean Hashmi, MD, the regional director of clinical nutrition and weight management for Kaiser Permanente Southern California and a medical reviewer for Everyday Health, says that delaying or skipping a single dose of your medication is medically harmless — in the short term. But he strongly cautions against the practice for a second reason. Dr. Hashmi is concerned that overindulging while on a “medication vacation” can do deep damage to the habits that GLP-1s help you build — habits that will be critical for weight maintenance if you ever need to discontinue the medication.
“This concept that we can stop this medicine to do something that we know isn’t good for us, it sets us up for failure in the long run,” says Hashmi. “From a medical perspective it’s fine, but just remember that if you were an alcoholic, I wouldn’t tell you to go have a drink every Saturday night.”
In the online weight loss community, there’s a contingent that agrees wholeheartedly with Hashmi’s perspective, and sticks to their regular dosing schedules during vacations and holidays. Some users are proud to enjoy only small portions of rich food and know that they’re keeping their health on track. And more than a few voices online have reported that when weight loss drugs quiet their “food noise,” it just makes it easier to appreciate everything else about vacations and family gatherings.
Tips on How to Enjoy Special Meals While on Ozempic or Other Weight Loss Drugs
Experts agree that the best strategy for people on weight loss drugs is to manage your expectations about what and how much you can eat, rather than skipping your doses.
Saunders suggests three simple tips for those still interested in partaking in rich foods now and then:
- Take small portions, especially if the food is very rich.
- Eat slower.
- Stop eating before you feel too full.
Official Guidelines for Delayed and Missed Doses
If you’re considering making a temporary change to your dosing schedule, the manufacturers of semaglutide and tirzepatide provide official guidelines:
- Semaglutide (Ozempic, Wegovy) users are advised to take a missed dose “as soon as possible within five days after the missed dose.”[2][3] If more than five days have passed, users should skip the week’s dose entirely and resume their regularly scheduled injections.
- Semaglutide users should never administer two doses within 48 hours of each other.
- Tirzepatide (Mounjaro, Zepbound) users are advised to take a missed dose “as soon as possible within four days (96 hours) after the missed dose.”[4][5] If more than four days have passed, users should skip the week entirely and resume their regularly scheduled injections.
- Tirzepatide users should never administer two doses within 72 hours of each other.
Long Medication Pauses May Mean Reverting to Smaller Doses
For short delays, there is no need to worry about dosage strength. “If it’s only a week or two, you go right back to the original dose,” says Hashmi.
Longer pauses may be more difficult to accommodate. There are no official guidelines on how to restart your GLP-1 drug regimen after missing two or more weeks. “Nobody really knows yet, because the data is still coming out on varied practice patterns,” says Hashmi.
The big question is whether or not you can go back to the dosage you were previously using, or if you need to step back down to a smaller dose.
New users of GLP-1 drugs always begin with small starter doses before gradually titrating up (increasing) their dosage. It takes the body some time to adjust to these potent medications, and those infamous gastrointestinal side effects tend to be at their very worst in the first few days of a new higher dose. With longer pauses, the worry is that your body might lose some of the tolerance that originally allowed you to step up your dosage. Going back to a high dose after a wait of several weeks could be more than your body is ready to handle, resulting in extremely uncomfortable side effects.
In the absence of clear guidance, Hashmi says that his clinic has taken a conservative approach: “When we stop patients for a month or so, we will restart them at a lower dose for safety reasons and then quickly ramp them back up. We do that to avoid any nasty side effects of nausea, vomiting, diarrhea, or constipation.” But at the moment that protocol is based only on educated guesswork. “That’s not evidence informed. Right now, we just don’t have the expert opinion.”
Saunders takes a similarly cautious strategy with her patients. “When our patients are off medication for an extended period, we generally recommend starting back at the lowest dose and titrating up gradually.”
If you’ve missed more than two regular doses, it might be unwise to start back on your prior dosage. Call your healthcare provider, who can provide a recommendation based on your unique situation.
The Takeaway
Skipping or delaying one dose of your weight loss medication is unlikely to let you truly indulge in rich foods. The better plan is to embrace your diminished appetite and change your expectations around special meals and vacations. Longer medication breaks raise new issues to deal with, as you may need to go back to a lower starter dose in order to comfortably transition back to your current level.
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