Modern Metabolic Health with Dr. Lindsay Ogle, MD
Join Dr. Lindsay Ogle, a board certified family medicine and obesity medicine physician, as she explores evidence-based strategies and practical tips to prevent and treat weight and metabolic conditions. Dr. Ogle provides insights on managing diabetes, PCOS, metabolic syndrome, obesity and related conditions through lifestyle optimization, safe medications and personalized care.
Modern Metabolic Health with Dr. Lindsay Ogle, MD
Split Dosing Zepbound
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We explain what split dosing Zepbound can look like in real practice and why some patients do better with a customized plan than a standard once-weekly schedule. We also walk through pen logistics, refill timing, and the questions people keep asking so you can bring smarter, safer questions to your clinician.
• what “split dosing” means in clinic and why off-label dosing is common
• three patient groups we consider for split dosing
• lowering or “in-between” doses to reduce GLP-1 side effects during titration
• dividing a weekly dose into two injections for steadier appetite control
• why tirzepatide’s half-life can create end-of-week drop-off for some people
• using higher-strength pens for cost savings by counting clicks with clinician oversight
• priming each dose and why it matters for air bubbles
• where to get extra pen needles and how much they cost
• LillyDirect refill rules and the 45-day ordering window
• expiration guidance, room-temperature handling, and common pen concerns
If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health.
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Welcome And Medical Disclaimer
Dr. Lindsay Ogle, MDWelcome to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Ogle, Board Certified Family Medicine and Obesity Medicine Physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, fatty liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatments. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you. Have
What Split Dosing Means
Dr. Lindsay Ogle, MDyou heard of split dosing and wondered if it was right for you? We're gonna talk about split dosing ZBound today. And lately, either through LilyDirect or the Medicare Bridge program, which I did a talk about both of those recently that I'll link below. Um I've been prescribing a lot of Z-Bound quick pens or their multi-dose pens, which look like this. Um and sometimes for patients I recommend split dosing. So what is split dosing? I don't know if there is a specific definition of split dosing, but my clinical definition is using a dose that is not the manufacturer's recommended dose or not the dose that was specifically FDA approved for a condition. And the truth is this happens all the time in clinical practice. We do individualized dosings for various reasons, for side effect management, for based on body weight or response to a medication. Many times we use medications off label for their not for a non-FDA-approved indication. So this is very common clinical practice. But as always, even though I'm a physician, I am not your physician unless you see me at Missouri Metabolic Health. Um, but you should always talk to your doctor about what is best for you and recommended for you. I'm not giving you direct medical advice, I'm just educating about options that are available that you may take that information and then talk to your own doctor. And then oftentimes split dosing also refers to spacing out the dosing. So splitting the weekly dose into two different doses that you take in the week. And so that could be every Monday and every Friday, you take half of your weekly dose, would be typically how this is done.
Who Might Benefit Most
Dr. Lindsay Ogle, MDSo there are three groups of patients that I consider split dosing
Using Lower Doses For Side Effects
Dr. Lindsay Ogle, MDfor. One is side effect management. If I have a patient who is very sensitive to GLP1 medications, then I may recommend starting at a dose that's lower than the 2.5 milligram dose. Or if we're titrating up, we may go between doses. So Z bound increases by 2.5 milligrams and all the way up to 15 milligrams. And so during those dose titrations, we may for a period of time utilize a dose that is in between that next higher dose to help manage and mitigate side effects during the dose titration. And that could be if we are keeping the dose throughout the week or if we are splitting up the dose and doing two doses in the week.
Splitting The Week For Consistency
Dr. Lindsay Ogle, MDIf we're splitting the doses up between the week, that is kind of my second group of patients. This is for people who really notice significant either side effects or significant positive effects. So appetite suppression, craving control, increased satiation or fullness for the first few days after their injection, but then that really dissipates and goes away at the end of the week after their injection, they are likely to benefit from that kind of true split dosing. And it's really important here, we are dividing their current weekly dose into two doses. So, for example, if they're at 10 milligrams, we are going to do 5 milligrams again, maybe on a Monday, and then another five milligrams on a Thursday or Friday. Talk to your doctor about what makes most sense for you, but that would be something that I would consider for a patient who had really strong effects on the first couple of days after the injection that go away towards the end of the week. And this is actually fairly common on Zetbound because the half-life of this medication or the amount of time that it takes for half of a medication to you know be processed through the body is about five days, and it's recommended to be taken every seven days. And it's true as you're taking it regularly, it kind of builds up in your system and you don't notice those swings as much. But everyone is different, and again, some people really notice that difference throughout the week, and the twice a week dosing does wonders for them.
Cost Savings With Click Counting
Dr. Lindsay Ogle, MDAnd then last, sometimes we do split dosing for cost savings. If you do not have insurance coverage, these medications are very expensive, and so I sometimes prescribe a higher strength of the pen if they're going through LilyDirect and advise them to take a lower dose. And you can do that by counting your clicks in the pin. And this is something that I am not getting into the weeds during this conversation, but I'll include a chart here so you can reference what that might look like. But this is so important to talk to your doctor about because you guys need to be on the same page about how much medication you are actually taking, so they are giving you great advice. So again, if we're doing that 10 milligram pin example, you could be potentially prescribed the 10 milligram pin, but maybe you only need five milligrams a week. Then you would instead of turning the dial all the way to one, and there's 60 clicks or dashes till that one marker, um, the one indicates that is the amount of medication that the pin is prescribed for. So again, that would be 10 milligrams and a 10 milligram pin. But if you only needed five per week, you could count to 30 and then give yourself the medication at that time, and that would be your five milligram weekly dose. And then instead of only having four doses, you would have eight doses in that pen. And so just to show you, um I'm going to this is a sample, the pen starts at zero, and then you turn the dial all the way until it shows the one, and that one indicates the amount of medication that the pen is dosed for, and then when you were giving your shot, you would give your shot and it goes back to zero, and you have four of those in your Zephon quick pen. But if you use a lesser amount than is prescribed, the pen is going to last
Priming And Extra Needles
Dr. Lindsay Ogle, MDlonger. Now, a couple of questions I've gotten on a recent video that I made about this. Um, a very common question is do you prime each dose? Yes, you want to prime each dose. What is priming? Priming is when you just when you start at zero and you turn to it's just two clicks to that long knob. Um, and then you just press the button and it goes back to zero. All that that is doing is it's getting any air bubbles out. And what I'm gonna do very soon, once I get some um needles to actually show the whole process, although I'm not gonna inject myself because I don't take step bound personally. I'm going to show the whole process on how to prepare your pen and take your injection. Um, so stay tuned, subscribe so you can have access to that video. But you do want to prime your pen with each dose. Another question is where do you get the extra needles? So I have included information in the description below, both general information and then a link to Amazon. You can get a hundred needles for $20. So that should not be a worry that should not hold you back from using the split dose if cost is a concern, and that and you've talked to your doctor about utilizing that option.
Refill Timing With LillyDirect
Dr. Lindsay Ogle, MDAnother common question about split dosing is how often should we refill or order ours upbound? So if you are utilizing the Lily Direct, they require you to order your next pin within 45 days from your last purchase. So that is very important to know. If you are outside of that 45-day window, then you will have to pay a higher price. And it's about $699 for the higher price for 7.5 and higher. So this is something that you really want to stay on top of. So even if you have a couple of doses left, you want to order within that 45-day window. And it's okay to keep a little bit extra on hand. That's alright. Um, it's not going to go bad. But if you're having quite a few extra pens, talk to your doctor and maybe you can take a break from ordering for a while.
Expiration Temperature And Pen Concerns
Dr. Lindsay Ogle, MDThen the expiration date. Um, so it says on the manufacturer label that you should use it within 30 days, and there is no danger in utilizing the pen longer than that 30-day period. It doesn't go bad or become dangerous to take. Theoretically, it may become less effective, but my patients have not had that experience, but something to be aware of. Also, there are some people who are worried about the pen not working after the fourth dose. Also, not the experience of my patients. Um it seems that the pens that are provided in the United States at this time do not have that locking mechanism after the fourth dose. There are four doses for the prescribed amount. So, again, with that 40 or that 10 milligram pin, it has a total of 40 milligrams in the pen, four doses of 10 milligrams, not four, I guess, pushes on the button, if that makes sense. Hopefully it does. And then there's also been some questions about keeping the pen at a certain temperature. When you're utilizing the quick pen, it is best to just take it out, use it, put it back in the refrigerator. But if for any reason your pen stays and gets to room temperature, and that's considered between 46 and 86 degrees, then it should just stay at room temperature and you can continue to use it per regular. The manufacturer says it should only be at room temperature for that 30 days, but because you're paying cash for it and because it seems to maintain its effectiveness beyond that 30-day mark, I would continue to utilize it. You always could potentially call Lily and see if maybe they would give you a one-time replacement if you wanted to go through that process. I've seen that happen for a few reasons, like the pen overheating or accidentally getting frozen or a malfunction of the pen. But you would call Lily direct for that. And then if you're utilizing your insurance, I would still fill it every four weeks.
Final Takeaways And Share Request
Dr. Lindsay Ogle, MDThere's no reason not to utilize that program and fill your medication every four weeks. So I hope this gave you some more information about split dosing with Zapbound. I'm gonna look forward to seeing you next week. Take care. Thank you for listening and loving how you can improve your metabolic health in this modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health. I look forward to our conversation next week.