The weight program
In a year, the numberis the least interesting part.
Most people arrive counting pounds and stay for something else entirely — the clothes, the energy, the quiet where the negotiating with food used to be. This page is the whole program: the medicine, the year, and the parts other places leave you to discover on your own.
- No insurance needed
- Free to start
- Licensed in your state
Nobody notices the number. They notice that you are the one suggesting the walk.
What actually changes
Almost nobody stays for the weight.They stay for the rest of it.
The pounds are what gets measured because they are what is easy to measure. Ask anyone a year in what actually changed and you will get an answer about a wardrobe, an evening, or a photograph.
Photographs are of models and are for illustration only. They do not depict Revani patients or treatment outcomes.
What you are actually prescribed
Two gut hormone receptors,not one.
Your formula is compounded tirzepatide with L-carnitine and NAD+, in a single weekly injection, at a dose a clinician sets for you. Not the same pen as everyone else.
What tirzepatide and semaglutide each do, and why you might get either
TirzepatideMost commonly prescribed
Acts on two gut hormone receptors, GIP and GLP-1, rather than one. It reduces appetite, slows how fast the stomach empties and improves how your body handles blood sugar. In trials it produced the largest average weight reduction of the options here.
SemaglutideWhere it suits you better
Acts on the GLP-1 receptor alone. Longer real-world track record, a slightly different side-effect profile, and for some people better tolerated. A smaller average reduction in trials than tirzepatide, which is not the same as a worse choice for an individual.
L-carnitine and NAD+In the compounded formula
Included in Revani's compounded preparation alongside tirzepatide, so the whole dose stays a single weekly injection rather than a stack of separate products. Your clinician will explain their role in your plan.
How it is taken, where it comes from, and what compounded actually means
How it is taken
One subcutaneous injection a week, into the abdomen, thigh or upper arm, on the same day each week. The needle is short and fine; most people describe it as easier than they expected.
Where it comes from
A licensed United States compounding pharmacy, shipped to your door in cold chain packaging with everything you need to administer it.
Compounded, not branded
Compounded medications are prepared by licensed pharmacies and are not FDA-approved, which is a genuine difference and not a technicality. It is what allows a combined formula and a dose specific to you. Your clinician will tell you plainly which category anything you are prescribed falls into.
What it does not do
It does not decide what you eat, and it is not a substitute for protein and resistance training while you lose weight. It removes the constant negotiation with food that makes those things feel impossible.
What you will not be offered: research peptides, unapproved fat-burning injectables or supplement stacks sold as medicine. Which medication you are prescribed, if any, is a clinical decision made after your evaluation.
How the dose moves
Four of the five stepsare optional.
Nearly everyone who quits in the first month quits because they assumed the starting dose was the dose. It is not. The right dose is the lowest one that is still working for you, and plenty of people never leave the second rung.
The rung where a meaningful number of people stop, because it is enough.
A typical tirzepatide titration. Your clinician sets your own schedule, and holding or lowering a dose is a normal clinical decision rather than a setback.The first ninety days
The first thing you noticeis not the scale.
It is that food stops asking for attention. Meals finish sooner, portions that used to feel normal start to feel like too much, and the running argument in your head goes quiet.
- Week 1Mostly uneventful, which surprises people.
- Weeks 2–4The noise gets quieter. Food stops asking for attention all day.
- Weeks 4–8Side effects, if you get them, land here — usually after a dose increase.
- Months 2–3A steadier weekly rhythm, and a real change in the mirror.
- ThroughoutSomebody is reading your results, on a schedule you did not have to ask for.
All five stages in full, and what gets done about side effects
Week 1. You inject once and wait. Some mild nausea in the first day or two is common, usually manageable and usually short. If you feel nothing at all, that is not a sign the medication is not working.
Weeks 2–4. The change most people notice first is not the scale. It is that food stops asking for attention all day. Meals finish sooner. Portions that used to feel normal start to feel like too much.
Weeks 4–8. Nausea, constipation and reflux are the common ones, and they typically cluster in the week after a dose increase. Most are managed with timing, hydration, fibre, smaller meals and, when needed, holding the dose rather than climbing. Tell us early; almost all of it is adjustable.
Months 2–3. Loss tends to settle into a steadier weekly pattern. This is also when eating too little becomes the risk rather than eating too much, because appetite is suppressed and you have to be deliberate about protein.
Throughout. Check-ins are scheduled, not left to you to request. If you are not losing, if side effects are not settling, or if something in your labs changes, the plan changes. Being on a dose that is not working is not a plan.
This describes common experience and is not a complete list of side effects. Serious reactions including pancreatitis and gallbladder disease have been reported with this class of medication. Read the important safety information and the labelling that arrives with your prescription.
Month three to six
Everyone plateaus.It is not you failing.
A smaller body needs fewer calories to run, so the deficit that was producing steady loss narrows until it closes. That is physiology working correctly, not the medication failing, and it is the most predictable event in the whole program.
Why it happens, and the four things we change when it does
As you lose, your maintenance requirement falls with you. Plateaus commonly arrive somewhere between month three and month six, and they can last weeks. Weight also moves for reasons that have nothing to do with fat, so a fortnight of a static number is information rather than a verdict.
What happens next is a clinical decision: reassess intake and protein, look at activity and sleep, consider whether a dose change is justified, and rule out the other things that stall weight, including thyroid disease and several common medications. Sometimes the correct answer is that you have reached a reasonable weight and the goal becomes holding it.
A number that stops moving is a reason for a conversation, not a reason to double the dose.
Losing fat rather than muscle, and the two things that decide it
Rapid weight loss of any kind takes lean tissue along with fat. That is true of surgery, of crash dieting and of this class of medication, and it matters more than the number on the scale does, because muscle is what keeps your metabolic rate up and what makes the result hold.
The countermeasures are unglamorous and well established. Enough protein, spread across the day, which is harder than it sounds when your appetite is suppressed. And resistance training two or three times a week, which does more to protect lean mass than any supplement on the market.
Your clinician will raise both of these rather than leaving you to find out afterwards, and will keep raising them. It is the part of the plan that is genuinely your work, and the part that decides what you look like at the end of it rather than simply how much less of you there is.
If you stop
Anyone selling you a three-month courseis selling you two thirds of your weight back.
This is treatment for a chronic condition, so withdrawing it does what withdrawing any such treatment does. Which is why this is built as ongoing care rather than a course with an end date and a renewal email.
Of the weight lost came back within a year of stopping, along with the blood pressure and metabolic gains.
Wilding et al., Weight regain and cardiometabolic effects after withdrawal of semaglutide, Diabetes, Obesity and Metabolism, 2022. Trial averages under trial conditions.Why that is an argument for treatment rather than against it
Blood pressure returns when you stop taking blood-pressure medication, and nobody concludes from that it never worked. The regain finding is what you would expect from treating a chronic condition and then withdrawing the treatment, and it tells you something about the condition rather than about the drug.
What it does mean is that a program with a three-month horizon is selling you an outcome it has no intention of helping you keep. Ask any service you are considering what happens in month thirteen, and see whether they have an answer in writing.
What maintenance actually looks like, and how coming off is planned
Nobody is quietly kept on a maximum dose indefinitely because renewing a prescription is easier than reviewing one. When you reach a weight that is right for you, the goal changes from losing to holding, and the plan changes with it.
For many people that means a maintenance dose, often lower than the dose they lost weight on. For some it means a planned taper, with the habits, protein and training built up deliberately beforehand rather than improvised afterwards. Either way it is a decision made with a clinician, in advance, and written down.
If you do decide to come off entirely, you get a conversation about it and a plan for it, including what to watch for. There is no contract holding you in and no penalty for stopping.
What you get
One program, andeverything it takes.
Included in the program
- A branching evaluation, read by a clinician licensed in your state
- Labs ordered and reviewed where they would change the decision
- Compounded tirzepatide with L-carnitine and NAD+, where a clinician judges it appropriate
- Titration that starts low and moves at the pace your response justifies
- Medication shipped to your door in cold chain packaging
- A plan for the plateau before you hit it, rather than after
- Maintenance or a planned taper when you reach the weight you wanted
- Direct messaging with your care team between check-ins
What it costs
Quoted in writing after your evaluation, and before you commit to anything.
The figure depends on whether medication is prescribed and which one, so quoting it before a clinician has read your case would be a guess. The evaluation costs nothing to complete and no insurance is required at any point.
Start my evaluationCompounded medications are prepared by licensed U.S. pharmacies and are not FDA-approved. Your clinician will tell you whether what you are prescribed is FDA-approved or compounded, and why that one was chosen.
The nine histories that mean no, or not yet
Most programs mention that a prescription is not guaranteed and leave it there. These are the specific findings, so you can check yourself against them before you spend anything rather than after.
A history of medullary thyroid carcinoma
Personal or family history, or multiple endocrine neoplasia syndrome type 2. This class of medication carries a boxed warning for thyroid C-cell tumours and this is an absolute contraindication.
Pregnancy, or trying to conceive
These medications are not used in pregnancy or while breastfeeding. If you are planning a pregnancy, tell us at the evaluation and we will talk about timing before anything is prescribed.
A history of pancreatitis
Pancreatitis has been reported with GLP-1 therapy. A prior episode changes the risk calculation substantially and sometimes rules treatment out entirely.
Active gallbladder disease
Rapid weight loss of any kind raises gallstone risk, and this class has its own reported association. Existing disease needs addressing first.
Type 1 diabetes
These medications are not a substitute for insulin, and the combination needs management that belongs with your diabetes specialist rather than with us.
A current eating disorder
Appetite suppression is the wrong tool here and can do real harm. The right care exists and it is not this. We will say so and point you towards it.
Severe gastrointestinal disease
Gastroparesis or significant motility disorders are made worse by a medication whose mechanism includes slowing gastric emptying.
A weight that does not warrant it
There is a clinical threshold for treatment and we hold to it. If you are below it, the honest answer is that medication is not indicated for you, whatever you would prefer to hear.
And several that change the answer without ending it
Thyroid disease, kidney or liver impairment, and a number of medications that interact. A clinician weighs all of it against your history rather than running a checklist. If the answer is no, you will be told why and what would actually help.
Practical questions
The things people askonce they have decided.
Needles, travel, missed doses and alcohol. Small questions, but they are usually the last thing standing between deciding and starting.
Safety and side effectsDoes the injection hurt?
Much less than people expect. It is a short, fine needle into fat rather than muscle, and most people describe it as a pinch or as nothing at all. You will be shown exactly how to do it, and the first one is the only one that feels like an event.
What if I miss a dose?
If you remember within four days, take it and carry on with your normal day the following week. If more time has passed, skip it and resume on your usual day. Do not take two doses close together to catch up. If you have missed several weeks, message us before restarting, because you may need to step back down rather than resume where you left off.
Can I drink alcohol?
There is no absolute prohibition, but most people find their tolerance drops noticeably and that alcohol is more likely to provoke nausea. It also adds calories with no satiety at a point where your intake is already limited. Moderation genuinely matters more than usual here.
How do I travel with it?
It needs refrigeration, so you travel with a small insulated cooler and keep it in your hand luggage rather than checked baggage. We provide documentation for security if you need it. Tell us your dates and we will time your shipment so you are not waiting on a delivery while away.
Will I have loose skin?
It depends on how much you lose, how fast, your age and your starting skin quality, and we would rather say that than pretend otherwise. Losing at a measured pace and protecting muscle with protein and resistance training both help. Significant excess skin after very large losses is sometimes a surgical question, and we will tell you if that is the honest answer.
Do I have to change how I eat?
You will want to, and the medication makes it possible rather than doing it for you. The specific thing that matters is getting enough protein while your appetite is suppressed, because that is what protects muscle. Nobody is going to send you a meal plan you did not ask for.
Can I take this with my other medications?
Usually, and that is exactly what the evaluation is for. Some medications need timing adjusted because this class slows gastric emptying, oral contraceptives among them, and a few combinations need closer monitoring. List everything you take, including supplements.
How long until I get started?
The evaluation takes a few minutes. Once a clinician has reviewed it, and labs where they are needed, a prescription can usually be issued and shipped within days rather than weeks. Nothing is charged to find out whether you qualify.
You have read the difficult parts
Every service in this category has the same side effects, the same plateau and the same regain. We are the one that wrote them down,which is a reasonable thing to want in whoever treats you.
About three minutes. Nothing is prescribed at this step and nothing is charged.