After a course of tirzepatide ends, continuing the same dose kept weight best in trials. Stepping down to a lower dose of 5 mg also worked well. In SURMOUNT-MAINTAIN, people on 5 mg weighed 16.6 percent less after more than two years than at the start. After switching to placebo the loss was only 9.9 percent. Below we describe both trials on weight maintenance and what each option costs.
What did SURMOUNT-4 show?
SURMOUNT-4 tested what continuing tirzepatide gives compared with stopping it. The first part enrolled 783 adults with obesity, or overweight with a related condition, without diabetes. For 36 weeks everyone received the highest tolerated dose, 10 or 15 mg. The results were published in 2024 in JAMA.
People who completed this part had lost an average of 20.9 percent. Then 670 of them were randomly split into two groups for the next 52 weeks.
| SURMOUNT-4, weeks 36 to 88 | Continued tirzepatide | Switched to placebo |
|---|---|---|
| Change in body weight | loss of 5.5 percent | gain of 14.0 percent |
| Total loss from the start | 25.3 percent | 9.9 percent |
| Kept at least 80 percent of the loss | 89.5 percent of people | 16.6 percent of people |
People who continued treatment not only kept their weight but kept losing. Almost nine in ten kept at least 80 percent of their earlier result. The authors write that continued use maintained and increased the initial weight loss.
Will a lower dose keep the weight off?
Yes, although less well than the full dose. This was tested in SURMOUNT-MAINTAIN, published in June 2026 in The Lancet. It included 441 adults with an average weight of 113.8 kg, at 20 centres in the United States.
For the first 60 weeks everyone received the highest tolerated dose, 10 or 15 mg. Then 378 people were randomly split into three groups for the next 52 weeks. The first stayed on the same dose, the second stepped down to 5 mg and the third switched to placebo.
| SURMOUNT-MAINTAIN, result after 112 weeks | Same dose 10 or 15 mg | Stepped down to 5 mg | Placebo |
|---|---|---|---|
| Weight loss from the start | 21.9 percent | 16.6 percent | 9.9 percent |
| Needed renewed treatment because of weight regain | 8 percent of people | 25 percent of people | 67 percent of people |
From week 84, people who had regained more than half of their lost weight could go back to tirzepatide. In the placebo group two people in three did so, in the 5 mg group one in four. The authors write that stepping down to 5 mg may be a valuable alternative to stopping, although the response varies between people.
How fast does weight come back after stopping?
According to a meta-analysis from September 2026, weight comes back after stopping semaglutide or tirzepatide at about 1 kg a month. The work covered six trials and 1776 participants. According to the model, half of the earlier loss came back after about 7.5 months.
In the raw data tirzepatide showed a slightly faster return of weight than semaglutide. After accounting for the size of the earlier loss, there was no clear difference between the molecules. A greater earlier weight loss was most strongly linked to a faster return, although this result was also uncertain.
Diet and exercise after stopping were linked to a slower return of weight, although this result was imprecise. The authors write that after stopping it is worth checking weight early and planning maintenance in advance.
How does tirzepatide compare with semaglutide?
Both medicines were tested in similarly designed weight maintenance trials. In both, continuing gave further weight loss and stopping led to regain. The trials differed, however, in the length of the first part, so the figures need to be compared with care.
| Trial | Treatment before randomisation | Continued for 48 or 52 weeks | Switched to placebo |
|---|---|---|---|
| STEP 4, semaglutide 2.4 mg | 20 weeks, loss of 10.6 percent | loss of 7.9 percent | gain of 6.9 percent |
| SURMOUNT-4, tirzepatide 10 or 15 mg | 36 weeks, loss of 20.9 percent | loss of 5.5 percent | gain of 14.0 percent |
In SURMOUNT-4, participants had twice as large a loss behind them before randomisation, so they also had more to regain. The total loss after 88 weeks of continued treatment was 25.3 percent. The details of STEP 4 are in the guide on semaglutide after stopping.
How much does maintenance cost at each dose?
Stepping down to 5 mg cuts the cost of a week to a third of the cost at 15 mg. A 20 mg vial of tirzepatide costs 200 EUR, so 10 EUR per milligram. The 40 mg pen costs 350 EUR, so 8.75 EUR per milligram.
| Maintenance dose | Result in SURMOUNT-MAINTAIN | 20 mg vial, cost per week | 40 mg pen, cost per week | How many weeks a pen lasts |
|---|---|---|---|---|
| 15 mg | 21.9 percent, together with 10 mg | 150 EUR | 131.25 EUR | almost 3 weeks |
| 10 mg | 21.9 percent, together with 15 mg | 100 EUR | 87.50 EUR | 4 weeks |
| 5 mg | 16.6 percent | 50 EUR | 43.75 EUR | 8 weeks |
At 5 mg one 40 mg pen lasts eight weeks. A year of maintenance therefore needs just over six pens. Supplies for any period are calculated in the guide on how long a GLP-1 vial lasts.
What else helps keep the result?
In all the SURMOUNT trials tirzepatide was combined with a reduced-calorie diet and more physical activity. The habits built during treatment remain after it ends. It is also worth measuring weight and waist circumference at regular intervals, so that a change of direction is noticed early.
- The same dose: in SURMOUNT-4 and SURMOUNT-MAINTAIN it gave the best weight maintenance.
- A lower dose: 5 mg kept a 16.6 percent loss after more than two years.
- Checking weight: in SURMOUNT-MAINTAIN people with a large regain could go back to tirzepatide.
- Diet and exercise: were linked to a slower return of weight after stopping.
Which measurements are worth taking is described in the guide on how to measure peptide results. The course of weight loss during treatment itself is shown in the guide on tirzepatide results, and the result of each dose in the guide on tirzepatide doses in trials.
Where to buy tirzepatide?
In the shop, tirzepatide comes in three versions from three manufacturers. Tirzepatide 20 mg Bio-Peptide costs 200 EUR and is in stock. Tirzepatide 20 mg Genheal costs 200 EUR and is available on backorder. Tirzepatide 40 mg Nouveaux in a pen costs 350 EUR and is in stock.
The products in the shop are material for laboratory research, not the medicines Mounjaro or Zepbound. The doses described above come from clinical trials and are not a recommendation, and decisions about treating obesity are made by a doctor. All versions are on the tirzepatide page.
Frequently asked questions
What happens after stopping tirzepatide?
In SURMOUNT-4, people switched to placebo regained 14.0 percent of their weight within 52 weeks. After 88 weeks their weight was still 9.9 percent lower than at the start.
How to keep weight off after tirzepatide?
In SURMOUNT-4, people who continued tirzepatide lost a further 5.5 percent, and 89.5 percent of them kept at least 80 percent of their earlier loss.
Can you step down to a lower dose of tirzepatide?
In SURMOUNT-MAINTAIN, stepping down to 5 mg kept a 16.6 percent weight loss after 112 weeks. The full dose kept 21.9 percent and placebo 9.9 percent.
How much does a week of maintenance at 5 mg cost?
From a 20 mg vial at 200 EUR it comes to 50 EUR a week, and from a 40 mg pen at 350 EUR to 43.75 EUR. One pen lasts eight weeks.
How fast does weight come back after treatment ends?
A 2026 meta-analysis estimated the pace at about 1 kg a month. According to the model, half of the loss comes back after about 7.5 months.
Sources
- Aronne LJ, Sattar N, Horn DB et al. Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial. JAMA, 2024, 331(1): 38-48. https://doi.org/10.1001/jama.2023.24945
- Horn DB, Aronne LJ, Wharton S et al. Tirzepatide for maintenance of bodyweight reduction in people with obesity in the USA (SURMOUNT-MAINTAIN). The Lancet, 2026, 407(10545): 2305-2318. https://doi.org/10.1016/S0140-6736(26)00656-2
- Rubino D, Abrahamsson N, Davies M et al. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial. JAMA, 2021, 325(14): 1414-1425. https://doi.org/10.1001/jama.2021.3224
- Kow CS, Thiruchelvam K, Ramachandram DS, Zaihan AF. Weight Regain Trajectories After Discontinuation of Semaglutide or Tirzepatide: A Reconstructed Aggregate-Data Bayesian Longitudinal Meta-Analysis. Endocrinology, Diabetes and Metabolism, 2026, 9(5): e70325. https://doi.org/10.1002/edm2.70325