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For most people, this is when the effect transitions from "I think something might be different" to "I am definitely eating less and it requires no effort." By weeks 4-8, particularly as doses reach 4 mg or higher, the appetite effect is typically well established

El-Agroudy NN, Kurzbach A, Rodionov RN, OSullivan J, Roden M, Birkenfeld AL, et al

The FDA-approved titration schedule begins at 2.5 mg weekly for four weeks, then increases to 5 mg weekly

Many patients begin to see improvement within a few months, although the exact timeline varies

[5] They can also cause kidney strain from dehydration, and gallbladder or biliary issues, with rare cases of pancreatitis showing up too