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The clinically recommended starting dose is 2 mg weekly, administered subcutaneously, for 4 weeks as a titration period. After completing the initial phase, the dose is increased to 4 mg weekly and maintained for at least 4 weeks. If weight control is not as expected and the patient tolerates it well, the dose can be further increased to the maximum recommended dose of 6 mg weekly. If intolerance occurs at the 6 mg dose, the dose can be reduced back to 4 mg for maintenance therapy. Self-increase in dosage should be avoided throughout the entire process.
Patients with mild hepatic impairment or mild to moderate renal impairment do not require dose adjustment. However, clinical data is lacking for patients with moderate to severe hepatic or renal impairment, and caution is advised. The starting dose for elderly patients over 65 years of age remains 2 mg weekly, but close monitoring of heart rate and blood pressure is necessary. If a dose is missed, it can be made up within 2 days and administered as originally planned; if a dose is made up within 2-7 days, the dosing schedule needs to be reset; if more than 7 days have passed, the dose needs to be reduced and retied; if more than 21 days have passed, the starting dose should be returned.
### Dosage-Efficacy Relationship
Phase III clinical trials showed that the 4 mg weekly group achieved an average weight loss of 11% after 48 weeks of treatment, while the 6 mg group achieved 14%, with 49.5% of patients in the 6 mg group experiencing weight loss exceeding 15%. Although higher doses showed more significant efficacy, the incidence of side effects did not increase significantly, with a discontinuation rate due to adverse reactions of only 0.5%. It is worth noting that a high dose of 16 mg achieved a weight loss of over 20% in a Phase I trial, but this is not yet a routine recommended dose and is still under investigation.
The dosage regimen of Mastodextrin is designed to balance efficacy and safety, with a stepwise increase to reduce the risk of gastrointestinal reactions. Medication should be taken under the guidance of a physician and dynamically adjusted based on weight changes and tolerance, while also incorporating diet and exercise to enhance effectiveness.
