Participants moved to placebo regained substantially; those who continued held or kept losing.
SURMOUNT-4 used a withdrawal design: an open-label lead-in on tirzepatide, then randomisation to continue or switch to placebo. Those withdrawn regained a substantial share of the weight lost over the following year, while those continuing maintained or continued to lose.
That result is why this site prices treatment over years rather than months. If the honest planning horizon is indefinite, the maintenance price matters far more than the entry price, and a program you cannot sustain is a clinical problem rather than a budgeting one.
It also reframes what 'stopping' means. There is no withdrawal syndrome and no taper is needed for safety, but appetite returns before the metabolic adaptation to a lower weight does.
Anyone considering a pause for cost reasons should price the market first. The gap between the cheapest verified route and the most expensive is wide enough that many people who stop did not need to.
Sources
- SURMOUNT-4, NCT04660643 — source
Dated 2025-11-10. If this item is out of date or wrong, tell us through contact and the change is logged in corrections.
Primary sources
Clinical, dosing and regulatory statements on this page rest on the documents below. Links go to the publisher, not to a summary of it. Prices are not sourced here — they carry a verification date instead, and the reason is set out in the source ledger.
- ZEPBOUND (tirzepatide) full prescribing information — DailyMed, US National Library of Medicine. Dose ladder, contraindications, warnings, storage.
- FDA’s concerns with unapproved GLP-1 drugs used for weight loss — US Food and Drug Administration. Compounded GLP-1 risks, API import alert, cold-chain complaints.
- FD&C Act provisions that apply to human drug compounding — US Food and Drug Administration. Why a compounded preparation is lawful without being FDA-approved.
- Tirzepatide once weekly for the treatment of obesity (SURMOUNT-1) — N Engl J Med 2022;387:205-216. Registration NCT04184622. The weight-reduction and adverse-event figures used across this site.
- The full source ledger — every primary source, what it supports, the date we read it, and the claims we deliberately do not source.