What to expect in your first month

What the first month is for

The first strength of a weight management medicine is an initiation dose. It exists so the body can get used to the medicine, and it is not a strength anybody is meant to stay on indefinitely. That is worth knowing at the start, because it reframes what a disappointing first month actually means: the first weeks are about tolerating treatment, not about what it does.

Judging a course by week three is judging the wrong thing.

Practical things, in order

Pick a day and keep it. Weekly injectable treatments are given on the same day each week. Pick one that suits your routine — many people choose an evening or a day off, because if a dose is going to make them feel rough it will usually be within the first day or two.

Read the leaflet before the first dose, not after it. The patient information leaflet in the box is the authoritative description of your medicine: how to use it, what to watch for, what to do about a missed dose, and how to store it. It is also on the electronic medicines compendium. If anything on this page and the leaflet disagree, the leaflet is right.

Get a sharps bin before you need one. Used needles do not go in household waste. How to get one and how to use a pen safely is in storing and using your medicine safely.

Weigh yourself consistently or not at all. Same day, same time, same clothing. Day-to-day weight moves for reasons that have nothing to do with fat, and watching it daily mostly produces anxiety. Once a week is plenty, and it is what your prescriber will ask for at the review.

What people commonly report early on

The commonest effects of this class of medicine are to do with the stomach and bowel: nausea, vomiting, diarrhoea, constipation, indigestion, burping, and a general feeling of fullness. The patient information leaflet for your medicine lists these, says how common each one is, and lists others besides. Many people find they ease over the first few weeks at a given strength, and many find they return briefly after each increase.

Feeling full sooner and being less interested in food is how these medicines work rather than a side effect of them. Eating less is expected. Eating almost nothing, or not being able to keep fluids down, is not, and is a reason to get advice.

General things that people often find help — none of which is advice specific to you:

• Smaller meals, more often, rather than three large ones.
• Stopping when you feel full rather than finishing the plate.
• Going easy on fatty, fried and very rich food while nausea is settling.
• Drinking enough. Dehydration makes nausea worse and is a real risk if you are also being sick or have diarrhoea.
• Keeping some protein and some fibre in what you do eat, because appetite dropping is not a reason for nutrition to.

If any of this is not settling, or you are managing it by skipping doses, tell us rather than carrying on. That is a reason to look at the strength, and it is exactly what the review is for.

What should not be waited out

Some things are not part of settling in. Get medical advice the same day — call 111, or 999 if someone is seriously unwell — for:

• Severe or persistent abdominal pain, particularly if it spreads through to your back.
• Vomiting or diarrhoea you cannot keep on top of, or not being able to keep fluids down.
• Yellowing of the skin or the whites of the eyes.
• Swelling of the face, lips, tongue or throat, or difficulty breathing.
• Shakiness, sweating, confusion or palpitations, particularly if you also take insulin or another diabetes medicine.

The fuller list, and who to contact when, is on urgent help and out of hours. Anything you suspect the medicine caused should also be reported, to us and to the MHRA — you do not need to be sure.

Alcohol, other medicines, and everything else

Tell your prescriber about anything you start taking while you are on treatment, including things bought without a prescription. If another clinician prescribes you something, tell them what you are taking; it is on your medicine’s label.

Questions about alcohol, about fasting, about surgery, about contraception and about travel are common and the answers depend on you. Ask your prescriber rather than a general article — including this one.

The review at the end of the month

Before a further supply, a prescriber looks at how the first strength went and decides what happens next. What they consider, and why an increase is never automatic, is covered in why dose increases are gradual and reordering and reviews.