Plan your step-down.
Coming off tirzepatide is the part of the protocol that gets the least attention and matters as much as the ramp. SURMOUNT-4 showed cold-stop participants regained about half the lost weight at 22 months. A planned step-down gives the body time to recalibrate appetite signaling and metabolic rate; the math below shows what each plan actually looks like week by week.
Not medical advice. Tapering is a clinical decision; this tool shows the dose-curve shape so you can have an informed conversation with whoever prescribed.
Step down one increment every 3 weeks. The middle path most clinicians recommend.
Used to project regain risk. Leave 0 to skip the projection.
via Thailand clinic
Week-by-week schedule
| Week | Dose mg/wk | vs current |
|---|---|---|
| 1 | 10 | 100% |
| 2 | 10 | 100% |
| 3 | 10 | 100% |
| 4 | 7.5 | 75% |
| 5 | 7.5 | 75% |
| 6 | 7.5 | 75% |
| 7 | 5 | 50% |
| 8 | 5 | 50% |
| 9 | 5 | 50% |
| 10 | 2.5 | 25% |
| 11 | 2.5 | 25% |
| 12 | 2.5 | 25% |
| 13 | 0 (off) | 0% |
| 14 | 0 (off) | 0% |
Honest caveats
- Taper data is extrapolation, not RCT. The published trial that defines the post-discontinuation trajectory is SURMOUNT-4, and its comparator was cold-stop, not graduated taper. The regain multipliers here come from clinical practice and community reports, not from a head-to-head randomised trial of taper plans. If a taper-protocol RCT publishes, we will refresh the math.
- Maintenance habits move the line more than the dose curve. Resistance training 3 to 4 days per week, 1.6 to 2.0 g of protein per kg lean body mass per day, and continuous activity (12k+ steps daily) shift the regain curve more than the difference between an aggressive taper and a slow one. Plan the post-protocol phase before you stop.
- Microdose maintenance is community practice, not labelled. Continuing 2.5 mg/wk indefinitely as a "maintenance dose" is not the SURMOUNT trial protocol. It works for some users and the evidence is anecdotal but consistent. The cost is real (a year of 2.5 mg sourced via Thailand clinic is roughly $90 to $140/mo), and so is the long-term safety unknown — we have 3 to 5 years of phase-3 data, not 30.
- Hunger return is normal at week 2 to 4 off-protocol. The peak-pharmacology effect of tirzepatide takes 2 to 3 weeks to wash out fully. Hunger and food noise returning is not a failure mode; it is the predictable kinetics. Plan for it; plan the maintenance phase before the hunger comes back, not while you are managing it.
Where to next
- /blog · what SURMOUNT-4 actually showed about discontinuation →
- /blog · the muscle-loss + protein + resistance-training pack →
- /questions · what happens when you stop tirzepatide →
- /tools/tirzepatide-calculator · 12-week ramp planner (the on-ramp) →
- /tools/cost-by-region/tirzepatide · monthly cost ranked across regions →
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