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Because DSIP is not an approved medicine, there is no established therapeutic dose, no official prescribing information, and no clinically validated dosing schedule

The BBB, similar to the peripheral vasculature, is susceptible to degradation and dysfunction of endothelial cells through oxidative stress, inflammation, and mechanical hemodynamic stress (i.e., high systolic pressures and pulsatility) (Moyaert et al., 2023

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Conservative combination protocol (if attempting) Rationale for conservative approach: No safety data available Both peptides slow gastric emptying significantly Risk of severe GI complications Start low, go slow principle Tirzepatide component: Follow standard FDA-approved titration Weeks 1-4: 2.5mg weekly Weeks 5-8: 5mg weekly Weeks 9-12: 7.5mg weekly Weeks 13-16: 10mg weekly Week 17+: 12.5mg weekly (or stay at 10mg) Some reach 15mg weekly (maximum) Cagrilintide component (reduced from standard): Start AFTER tirzepatide stabilized at therapeutic dose (week 13+) Week 13-16: 0.6mg weekly (lower than standard) Week 17-20: 1.2mg weekly Week 21-24: 1.8mg weekly (may be maximum tolerable) Consider 2.4mg only if tolerating perfectly Conservative dosing comparison: Why sequential is safer: Tirzepatide establishes baseline first Can attribute new side effects to cagrilintide Easier to manage one variable at a time Option to stop cagrilintide if intolerable Less overwhelming than both simultaneously Expected benefits: 18-25% total weight loss (conservative estimate) Potentially superior to tirzepatide alone (15-22%) But incremental benefit may be modest (3-5% additional) Use SeekPeptides to plan sequential peptide additions safely