# What happens when you stop semaglutide or tirzepatide Canonical page: https://bodienvi.com/blog/stopping-semaglutide-tirzepatide-what-happens Published September 22, 2026. Updated September 22, 2026. By Bodi Envi Clinical Content Team. What the STEP 1 extension and SURMOUNT-4 found after treatment stopped, what the labels say about missed doses, and how to raise stopping with a provider. ## The question the trials were built to answer What happens after these medications stop is not a matter of opinion; two trials were designed to measure it. The STEP 1 extension followed people for a year after semaglutide was withdrawn, and SURMOUNT-4 randomized people who had lost weight on tirzepatide to either continue it or switch to placebo. This guide reports what each found, with its population and duration, then sets out what the labels say about doses that are missed or stopped, and ends with the conversation to have with a provider before deciding. This is general information and not medical advice. Both trials studied the branded products, Wegovy® and Zepbound®, and neither studied personalized compounded semaglutide or tirzepatide, which are not FDA-approved and are what Bodi Envi's programs may include. The results are averages, not predictions for any one person. Your licensed provider is the person to ask before stopping or changing treatment. Personalized compounded medications differ from commercially available brand-name products in formulation, concentration, excipients, preparation methods, and other characteristics. Accordingly, clinical data from studies involving brand-name products should not be assumed to apply to personalized compounded formulations. At this time, the studies referenced above have not evaluated the specific personalized compounded formulations being provided. Therefore, no claims of equivalence in safety, efficacy, quality, or clinical outcomes should be inferred from these studies. ## What the STEP 1 extension found STEP 1 gave 1,961 adults with obesity or overweight and no diabetes either semaglutide 2.4 mg once weekly or placebo for 68 weeks alongside lifestyle intervention. At week 68 all treatment, including the lifestyle intervention, stopped. The extension, published by Wilding and colleagues in Diabetes, Obesity and Metabolism in 2022, followed a representative subset of 327 participants who had completed the 68 weeks for a further year off treatment. According to its abstract on PubMed, all of the extension analyses were exploratory. From week 0 to week 68, mean weight loss in the extension subset was 17.3 percent with semaglutide and 2.0 percent with placebo. Over the following year off treatment, the semaglutide participants regained 11.6 percentage points of the weight they had lost and the placebo participants regained 1.9 percentage points. By week 120 the net loss from the start was 5.6 percent with semaglutide and 0.1 percent with placebo. The cardiometabolic improvements seen during treatment reverted towards baseline at week 120 for most variables. The authors' summary is that one year after withdrawal, participants had regained two thirds of their prior weight loss, and that the findings confirm the chronicity of obesity and suggest ongoing treatment is required to maintain improvements. Two caveats belong here. The extension was a subset, and its analyses were exploratory. And the lifestyle intervention stopped at the same time as the medication, so the extension measures the withdrawal of both. Personalized compounded medications differ from commercially available brand-name products in formulation, concentration, excipients, preparation methods, and other characteristics. Accordingly, clinical data from studies involving brand-name products should not be assumed to apply to personalized compounded formulations. At this time, the studies referenced above have not evaluated the specific personalized compounded formulations being provided. Therefore, no claims of equivalence in safety, efficacy, quality, or clinical outcomes should be inferred from these studies. ## What SURMOUNT-4 found SURMOUNT-4, published by Aronne and colleagues in JAMA in 2024, was designed as a randomized withdrawal. According to its abstract on PubMed, 783 adults with obesity or overweight and no diabetes took tirzepatide at their maximum tolerated dose of 10 mg or 15 mg for 36 weeks, during which they lost a mean 20.9 percent of body weight. At week 36, 670 of them were randomized to continue tirzepatide or to switch to placebo for 52 more weeks, with diet and physical activity continuing in both groups. From week 36 to week 88, weight changed by a further 5.5 percent downward in the group that continued tirzepatide and by 14.0 percent upward in the group switched to placebo. At week 88, 89.5 percent of those who continued had maintained at least 80 percent of the weight they lost during the lead-in, against 16.6 percent of those on placebo. Over the whole 88 weeks the mean reduction was 25.3 percent with continued tirzepatide and 9.9 percent for the group that had switched. The most common adverse events were mostly mild to moderate gastrointestinal events, more common with tirzepatide. The authors' conclusion is that withdrawing tirzepatide led to substantial regain of lost weight, while continued treatment maintained and added to the initial reduction. Read alongside the STEP 1 extension, the two trials describe the same shape from different designs: on average, the weight effect of these medications did not persist after they were withdrawn, and continued treatment maintained it. The placebo group in SURMOUNT-4 still had a mean net loss at week 88, as the semaglutide group did at week 120 in STEP 1, so the average course was partial regain rather than a return to the start. Personalized compounded medications differ from commercially available brand-name products in formulation, concentration, excipients, preparation methods, and other characteristics. Accordingly, clinical data from studies involving brand-name products should not be assumed to apply to personalized compounded formulations. At this time, the studies referenced above have not evaluated the specific personalized compounded formulations being provided. Therefore, no claims of equivalence in safety, efficacy, quality, or clinical outcomes should be inferred from these studies. ## What the averages do not say A trial mean is a summary of hundreds of individual courses, and in both trials the ranges around the means were wide. The STEP 1 extension reports standard deviations of several percentage points on every figure. Some participants regained more than the average and some less; some who continued treatment in SURMOUNT-4 did not maintain their loss, and some who stopped did. Nothing in either paper allows a prediction for a particular person, and this guide makes none. Both trials also studied the branded products at their approved doses. No trial of this design has been run on personalized compounded semaglutide or tirzepatide, which are not FDA-approved and are not equivalent to the approved products. Whether the same pattern would follow a compounded prescription has not been shown, and the honest position is that the trials describe the molecule in the approved product under trial conditions. Personalized compounded medications differ from commercially available brand-name products in formulation, concentration, excipients, preparation methods, and other characteristics. Accordingly, clinical data from studies involving brand-name products should not be assumed to apply to personalized compounded formulations. At this time, the studies referenced above have not evaluated the specific personalized compounded formulations being provided. Therefore, no claims of equivalence in safety, efficacy, quality, or clinical outcomes should be inferred from these studies. ## What the labels say about missed and stopped doses Neither label describes a withdrawal syndrome. What they describe is pharmacokinetics and missed doses. The Wegovy® label gives semaglutide a half-life of approximately one week and states that it remains in the circulation for about five to seven weeks after the last dose. The Zepbound® label gives tirzepatide a half-life of approximately five days. Stopping means the level in the body falls over weeks rather than at once. For missed doses, the Wegovy® label says that if one dose is missed and the next is more than two days away it should be taken as soon as possible, and otherwise skipped, and that if two or more consecutive doses are missed, escalation should restart at a lower dose to reduce the risk of gastrointestinal reactions. The Zepbound® label says a missed dose may be taken within four days and is otherwise skipped. The point of the restart rule is that tolerance to gastrointestinal effects is built by staying on the medication and lost off it, so a return after a gap is a return to the beginning of the schedule rather than to where you left off. Some situations, per the labels, call for stopping. Both labels direct that the medication be discontinued if pancreatitis is suspected. Both direct stopping for a serious hypersensitivity reaction. Both say to discontinue when a pregnancy is recognized, and the Wegovy® label says to stop at least two months before a planned pregnancy. Those are the label's instructions for the branded products and the decisions belong to a provider. Personalized compounded medications differ from commercially available brand-name products in formulation, concentration, excipients, preparation methods, and other characteristics. Accordingly, clinical data from studies involving brand-name products should not be assumed to apply to personalized compounded formulations. At this time, the studies referenced above have not evaluated the specific personalized compounded formulations being provided. Therefore, no claims of equivalence in safety, efficacy, quality, or clinical outcomes should be inferred from these studies. ## What this means when you talk to a provider If you are thinking about stopping, the conversation has a few natural parts, and they are questions for a licensed provider rather than for a guide. Why. Side effects, cost, a planned pregnancy, a procedure, a goal reached, or simply wanting to know what happens are all different conversations. The labels' own tools, slowing the escalation or choosing a lower maintenance dose, may be relevant if the reason is tolerability. What the trials suggest. The STEP 1 extension and SURMOUNT-4 are the evidence a provider will draw on, and they point, on average, to regain after withdrawal. A provider can put that alongside your own course. What a plan after stopping looks like. Both trials continued diet and physical activity in the groups that stopped medication and still saw regain on average, so a provider may want to discuss what monitoring, support or follow-up would look like rather than treating stopping as the end of a plan. What the label requires. If the reason to stop is one the label names, the timing is not optional, and a provider needs to know. Through Bodi Envi, a licensed provider through Wasef Health, PC for applicable programs makes the clinical decisions and can be reached through the patient portal. On the administrative side, cancellation and refunds are governed by Bodi Envi's published refund policy, which sets out the written request window after a provider review and states that dispensed medications are non-refundable once an order has been processed or shipped; the policy is the authoritative source and worth reading before a decision that involves a prepaid plan. Bodi Envi is a telehealth platform and not a medical practice, pharmacy or medication manufacturer. Personalized Compounded semaglutide and tirzepatide are not FDA-approved and were not studied in the trials above. This is general information and not medical advice, the trial results are averages and not predictions, and your licensed provider is the person to ask. Personalized compounded medications differ from commercially available brand-name products in formulation, concentration, excipients, preparation methods, and other characteristics. Accordingly, clinical data from studies involving brand-name products should not be assumed to apply to personalized compounded formulations. At this time, the studies referenced above have not evaluated the specific personalized compounded formulations being provided. Therefore, no claims of equivalence in safety, efficacy, quality, or clinical outcomes should be inferred from these studies. ## Frequently asked questions ### What did the STEP 1 extension find after semaglutide was stopped? In the extension published in Diabetes, Obesity and Metabolism in 2022, 327 participants were followed for a year after 68 weeks of semaglutide 2.4 mg or placebo ended. The semaglutide group had lost a mean 17.3 percent of body weight by week 68 and regained 11.6 percentage points of it by week 120, a net loss of 5.6 percent from the start. Cardiometabolic improvements reverted towards baseline for most measures. Personalized compounded medications differ from commercially available brand-name products in formulation, concentration, excipients, preparation methods, and other characteristics. Accordingly, clinical data from studies involving brand-name products should not be assumed to apply to personalized compounded formulations. At this time, the studies referenced above have not evaluated the specific personalized compounded formulations being provided. Therefore, no claims of equivalence in safety, efficacy, quality, or clinical outcomes should be inferred from these studies. ### What did SURMOUNT-4 find for tirzepatide? In the trial published in JAMA in 2024, 670 adults who had lost a mean 20.9 percent of body weight over 36 weeks on tirzepatide were randomized to continue it or switch to placebo for 52 weeks. Weight changed by a further 5.5 percent down on tirzepatide and 14.0 percent up on placebo. Of those who continued, 89.5 percent kept at least 80 percent of their earlier loss, against 16.6 percent on placebo. Personalized compounded medications differ from commercially available brand-name products in formulation, concentration, excipients, preparation methods, and other characteristics. Accordingly, clinical data from studies involving brand-name products should not be assumed to apply to personalized compounded formulations. At this time, the studies referenced above have not evaluated the specific personalized compounded formulations being provided. Therefore, no claims of equivalence in safety, efficacy, quality, or clinical outcomes should be inferred from these studies. ### Does that mean I will regain weight if I stop? The trials report averages across their participants for the branded products, and the ranges around those averages were wide. They do not predict any one person's course, and compounded versions were not studied. What they show is that, on average, the effect of these medications did not persist after they were withdrawn in those trials. Personalized compounded medications differ from commercially available brand-name products in formulation, concentration, excipients, preparation methods, and other characteristics. Accordingly, clinical data from studies involving brand-name products should not be assumed to apply to personalized compounded formulations. At this time, the studies referenced above have not evaluated the specific personalized compounded formulations being provided. Therefore, no claims of equivalence in safety, efficacy, quality, or clinical outcomes should be inferred from these studies. ### Is there a withdrawal syndrome? Neither label describes one. The labels describe missed doses in terms of when to take or skip the next dose and, for Wegovy®, restarting escalation at a lower dose after two or more missed doses because tolerance to gastrointestinal effects is lost. Stopping means the medication leaves the body over weeks, per the labels' half-lives, not that a specific syndrome follows. Personalized compounded medications differ from commercially available brand-name products in formulation, concentration, excipients, preparation methods, and other characteristics. Accordingly, clinical data from studies involving brand-name products should not be assumed to apply to personalized compounded formulations. At this time, the studies referenced above have not evaluated the specific personalized compounded formulations being provided. Therefore, no claims of equivalence in safety, efficacy, quality, or clinical outcomes should be inferred from these studies. ### How long does the medication stay in the body? The Wegovy® label gives semaglutide a half-life of approximately one week and says it remains in the circulation for about five to seven weeks after the last dose. The Zepbound® label gives tirzepatide a half-life of approximately five days. Personalized compounded medications differ from commercially available brand-name products in formulation, concentration, excipients, preparation methods, and other characteristics. Accordingly, clinical data from studies involving brand-name products should not be assumed to apply to personalized compounded formulations. At this time, the studies referenced above have not evaluated the specific personalized compounded formulations being provided. Therefore, no claims of equivalence in safety, efficacy, quality, or clinical outcomes should be inferred from these studies. ### Should I stop on my own? Talk to your provider first. Stopping is a clinical decision with consequences the trials above describe, and there are situations the labels say require stopping, such as suspected pancreatitis, a serious allergic reaction or a recognized pregnancy. Your provider can also discuss what a plan after stopping might look like. Personalized compounded medications differ from commercially available brand-name products in formulation, concentration, excipients, preparation methods, and other characteristics. Accordingly, clinical data from studies involving brand-name products should not be assumed to apply to personalized compounded formulations. At this time, the studies referenced above have not evaluated the specific personalized compounded formulations being provided. Therefore, no claims of equivalence in safety, efficacy, quality, or clinical outcomes should be inferred from these studies. ## Sources - Wilding et al., Weight regain and cardiometabolic effects after withdrawal of semaglutide, the STEP 1 trial extension, Diabetes, Obesity and Metabolism, 2022, PubMed: https://pubmed.ncbi.nlm.nih.gov/35441470/ (checked September 2026) - Aronne et al., Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity, the SURMOUNT-4 Randomized Clinical Trial, JAMA, 2024, PubMed: https://pubmed.ncbi.nlm.nih.gov/38078870/ (checked September 2026) - Wegovy® (semaglutide) injection prescribing information, DailyMed, revised June 2026: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee06186f-2aa3-4990-a760-757579d8f77b (checked September 2026) - Zepbound® (tirzepatide) injection prescribing information, DailyMed, revised August 2026: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b (checked September 2026) - Bodi Envi refund policy: https://bodienvi.com/refund-policy (checked September 2026)