Foundayo (Orforglipron) for Weight Maintenance After Injections
Almost everyone who does well on a weight loss injection eventually asks the same question: what happens when I stop? The honest answer, for years, has been that most of the weight comes back. Foundayo (orforglipron) is the first UK medicine licensed specifically to help hold weight off as well as take it off — and there is now a trial that tested exactly that scenario in people coming off Mounjaro and Wegovy.
Quick verdict
Weight maintenance is written into Foundayo’s UK licensed indication, not just weight loss. That is unusual, and it means a prescriber can treat holding your weight as the goal in its own right.
In the ATTAIN-MAINTAIN trial, people who moved onto orforglipron after completing injectable treatment maintained approximately 74.7% of their previous weight reduction if they had been on tirzepatide, and 79.3% if they had been on semaglutide, at 52 weeks. The corresponding placebo figures were 49.2% and 37.6%.
So it is not weight neutrality, and it is not a replacement for what you built during treatment. It is a substantially better outcome than stopping — and roughly three-quarters of your result held over a year is a realistic frame for the conversation.
Maintenance is still ongoing treatment with an ongoing cost. It is a different plan from stopping, not a way of stopping.
✍️ Written by Shadeia Younis, Superintendent Pharmacist (GPhC No. 2052119) and the Slinic Clinical Team
Last medically reviewed: 15th August 2026 · Clinical content verified against the UK Summary of Product Characteristics published on the electronic Medicines Compendium, 14 August 2026
About the author
Shadeia Younis is the founder and Superintendent Pharmacist of Slinic (GPhC No. 2052119), with 25 years of clinical pharmacy experience. She has owned and operated community pharmacies in Lancashire since 2008, oversees the clinical governance of Slinic’s prescribing service, and holds SCOPE certification in obesity management. She has been recognised as a finalist or winner across 19 national and European awards spanning healthcare and business.
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Sources used
UK Summary of Product Characteristics for Foundayo (eMC, 14 August 2026) · MHRA authorisation, 10 August 2026 · ATTAIN-MAINTAIN (Aronne et al, Nature Medicine 2026) · ATTAIN-1 (Wharton et al, NEJM 2025) · SURMOUNT-4 (Aronne et al, JAMA 2024) · SURMOUNT-5 · NICE TA1026 and NG246. Full list in the references at the end.
Important
Foundayo (orforglipron) is a prescription-only medicine and carries a black triangle (▼), meaning it is under additional MHRA monitoring — report any suspected side effect through the Yellow Card scheme. This guide is general information and does not replace advice from a qualified healthcare professional. Treatment is supplied only after individual clinical assessment by a UK-registered prescriber and is not suitable for everyone.
Never stop, start or change a prescribed medicine without speaking to your prescriber. If you experience severe abdominal pain, persistent vomiting, breathing difficulty or facial swelling, seek urgent medical advice or contact emergency services immediately.
Why keeping weight off is the hard part
This isn’t a failure of willpower and it isn’t unique to you. It is what the trials consistently show.
SURMOUNT-4 is the clearest demonstration. Participants took tirzepatide for 36 weeks, then were randomised either to continue or to switch to placebo. Those who continued kept losing weight. Those switched to placebo regained a substantial proportion of what they had lost.
The reason is straightforward. These medicines work by acting on appetite signalling. When the medicine stops, that signalling returns to where it was. Your body does not “learn” a new set point because you spent a year at a lower weight — if anything, the physiological drive to regain gets stronger after weight loss, which is true of dieting too.
The framing that helps
Obesity is treated as a chronic condition in UK clinical guidance, and chronic conditions generally relapse when treatment stops. Nobody expects blood pressure to stay down after stopping antihypertensives. Regain after stopping a GLP-1 is the same category of thing — a predictable pharmacological outcome, not a personal one.
The licence point most providers are missing
Foundayo’s UK licensed indication reads, in the SmPC’s own wording, as an adjunct to a reduced-calorie diet and increased physical activity for weight management, including weight loss and weight maintenance.
That phrasing matters. It means a prescriber treating you for maintenance is prescribing within the licence rather than off-label. Your goal can legitimately be “hold what I have” rather than “lose more”, and the treatment plan can be built around that from the start — which dose you aim for, what your reviews look at, how success is measured.
Practically, it also changes the conversation at assessment. If you say you have reached your goal on an injection and want to come off needles without losing the result, that is a different clinical question from “I want to lose weight”, and it should get a different answer.
ATTAIN-MAINTAIN: the trial that tested this exact question
Most GLP-1 trials study people starting from scratch. ATTAIN-MAINTAIN did something more useful: it took people who had already finished injectable treatment and asked what happens next.
It was a 52-week, randomised, double-blind, placebo-controlled phase 3b trial. All 376 participants had completed 72 weeks of tirzepatide or semaglutide in the SURMOUNT-5 trial and had reached a weight plateau, defined as less than 5% weight change between weeks 60 and 72. They were re-randomised 3:2 to orforglipron or placebo.
The trial did not use the standard 0.8 mg initiation dose
This detail is widely missed. Participants moved directly onto a 12 mg investigational capsule — equivalent to the 9 mg marketed tablet — within 14 days of their last injection, rather than beginning at the 0.8 mg initiation dose. It was reported as generally well tolerated.
The authors described this as raising the possibility of transitioning established injectable users to higher orforglipron doses, while stating that further research is required. It is trial evidence, not established UK prescribing practice — your starting dose is a decision for your prescriber using the UK product information.
What it found
| Previous injection | Participants | Maintained on orforglipron | Maintained on placebo |
|---|---|---|---|
| Semaglutide (Wegovy) | 171 | 79.3% | 37.6% |
| Tirzepatide (Mounjaro) | 205 | Approximately 74.7% | 49.2% |
Measured from the point of switching, participants on orforglipron recorded an average additional weight reduction of approximately 5 kg in the tirzepatide cohort and approximately 1 kg in the semaglutide cohort. The trial’s primary endpoint, though, was the percentage of previous weight reduction maintained. Individual responses varied considerably, so these are study-group averages rather than a prediction of what will happen to any one person.
Alongside weight, participants held much of the improvement in waist circumference, blood pressure, blood sugar, triglycerides and cholesterol that they had gained during injectable treatment.
If you are coming off Mounjaro specifically
The proportion maintained was numerically lower in the tirzepatide cohort than in the semaglutide cohort — approximately 74.7% against 79.3%. The two cohorts entered ATTAIN-MAINTAIN after different injectable treatments, and the result should not be read as a head-to-head comparison of switching effectiveness.
Both cohorts maintained substantially more than their placebo comparators. Interpretation of the placebo comparison after week 24 is complicated by rescue orforglipron being offered to participants who regained 50% or more of their earlier loss.
What the trial does not tell you
Everyone had already plateaued. It says nothing about moving to maintenance part-way through active weight loss. If you are still losing, this evidence does not apply to you yet — see our switching guide for that situation.
It ran in the United States only, across 29 sites, in a predominantly white population. The authors flag both as limitations.
The placebo comparison weakens after week 24, because of the rescue treatment protocol described above.
It ran for 52 weeks. What happens over three, five or ten years is not yet known for any medicine in this class.
It was sponsored by the manufacturer of all three medicines involved — normal for trials of this kind, but worth stating.
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Who maintenance treatment may suit
- You have reached your goal weight on Mounjaro or Wegovy and your weight has been stable for a couple of months
- You want to come off injections — needles, fridge storage, travel logistics — without losing what you achieved
- The ongoing cost of a high-dose injectable is what is prompting you to think about stopping
- You would rather step down gradually than stop abruptly
- You have stopped before, regained, and want a different plan this time
- You have a needle phobia that made adherence difficult even while it was working
Who may be less suited
- You are still actively losing weight and have not plateaued — the maintenance evidence does not cover you
- You are tolerating your current injection well and have no clinical or practical reason to change
- You are hoping maintenance will be cheaper than treatment — it is still monthly treatment at a monthly cost
- You are looking for a way to stop treatment rather than to change it
- You take a medicine that interacts with orforglipron and has not yet been reviewed
- You have not discussed it with a prescriber
Neither list replaces an individual assessment. They are a starting point for the conversation.
How maintenance works in practice
Timing matters more than people expect
In ATTAIN-MAINTAIN, participants started orforglipron within 14 days of their final injectable dose. The UK SmPC does not specify a switching or washout interval, so timing in routine practice remains a prescriber decision. What can be said is that a long unplanned gap is not the scenario the trial tested.
Your dose is a clinical decision, not a formula
Standard dosing begins at 0.8 mg once daily for at least 30 days, followed by 2.5 mg for at least 30 days and then 5.5 mg. Further increases to 9 mg, 14.5 mg and 17.2 mg may be made after at least 30 days at each dose, according to response and tolerability. There is no published conversion from a tirzepatide or semaglutide dose to an orforglipron dose, and the SmPC does not carve out a separate starting point for people transferring from an injectable.
Your prescriber sets your starting dose using the UK product information and your recent treatment history. Do not use the trial protocol to choose your own.
Your ceiling may be 9 mg, not 17.2 mg
If you take a strong CYP3A4 inhibitor — ketoconazole, clarithromycin, itraconazole — or an OATP1B inhibitor such as ciclosporin, the maximum licensed Foundayo dose is 9 mg once daily. This is one of the most common reasons a prescriber sets a lower ceiling, and it is why your full medication list matters at assessment.
Do not deliberately overlap the two
Foundayo should not be taken alongside another GLP-1 receptor agonist. Tirzepatide and semaglutide remain pharmacologically active for a period after the last injection, so some overlap in the body is unavoidable in any transition — the point is that you should not be dosing both medicines.
What reviews should look at
Maintenance reviews ask different questions from weight-loss reviews. Rather than “how much have you lost”, the useful questions are whether your weight is holding, whether your waist measurement is stable, whether protein intake and resistance training are actually happening, and whether the dose is doing enough without causing symptoms you are quietly tolerating.
Blood pressure and diabetes medicines also need watching. If your weight is stable rather than falling, doses that were being reduced during active loss may now need to hold steady — that is a conversation with whoever manages those conditions.
The part the medicine cannot do for you
The people who maintain best are those who built the habits during treatment rather than starting them at the point of transition. If that is not you, the transition is the moment to start — not after regain has begun.
Why resistance exercise is not optional here
The ATTAIN-1 body composition sub-study used DEXA scanning and found weight reduction came primarily from fat mass, including visceral fat — but there was also a statistically significant reduction in lean mass. Resistance exercise is an important strategy for helping preserve muscle during and after weight loss, and it matters at exactly the point where you stop losing.
Protein first. When appetite is suppressed, total intake falls — and protein is the thing most worth protecting. Food sources first: meat, fish, eggs, dairy, beans, lentils, tofu, pulses. Requirements vary by body size, age and activity, and anyone with kidney disease needs individual advice before increasing intake.
Weigh weekly, not daily. Same day, same time. In maintenance you are watching for a trend over weeks, and daily fluctuation will only make you anxious or complacent for no useful reason.
Decide your action threshold in advance. Agree with your prescriber what change would prompt a conversation — a specific weight, or a period of steady upward drift. Deciding this while things are stable is far easier than deciding it while they are not.
Keep the eating patterns that got you here. Appetite suppression on a maintenance dose may feel weaker than you are used to. The portions you learned to serve are what carries you through that.
Safety essentials for long-term use
Maintenance means taking this medicine for longer, so the things that apply at every dose increase apply repeatedly over time.
Contraception — the rule that repeats
Orforglipron may reduce the effectiveness of oral hormonal contraceptives. The UK SmPC advises switching to a non-oral method, or adding a barrier method, for 30 days after starting Foundayo and for 30 days after every dose increase.
Because you may titrate through several steps to reach a maintenance dose, that is several separate 30-day windows. Plan each one before the increase rather than afterwards.
Pregnancy. Foundayo should not be used in pregnancy, and the SmPC advises stopping it at least three weeks before a planned pregnancy because of orforglipron’s half-life. It should not be used while breastfeeding. Weight loss can also restore fertility — relevant particularly if you have PCOS and were not previously ovulating.
Simvastatin. The simvastatin dose should be halved when taken with orforglipron. If you started a statin partway through treatment, flag it.
New medicines. Over a long maintenance period you will almost certainly be prescribed something new by someone else. Orforglipron is a substrate of CYP3A4 and CYP2J2, and of P-gp, OATP1B1 and OATP1B3 — a wider interaction profile than the injectables. Tell your prescriber about anything new, including short courses like antibiotics.
Surgery and procedures. Tell your surgical and anaesthetic team well in advance. Delayed gastric emptying increases aspiration risk under general anaesthesia or deep sedation.
Ongoing side effects. Gastrointestinal effects are usually worst during titration and settle. If nausea, constipation or reflux are still bothering you months into a stable dose, that is worth raising rather than tolerating — a lower dose may hold your weight just as well.
The cost of maintenance
This is worth being clear-eyed about, because it is where plans most often fall apart.
Maintenance is ongoing monthly treatment. It may cost less than a high-dose injectable, and for some people that difference is the whole reason for switching — but it is not free and it is not temporary. If the plan only works on the assumption that you will stop in six months, it is worth thinking through what happens then.
Compare on twelve-month totals at the dose you are likely to settle on, including delivery and any consultation or programme fees. Some providers bundle coaching into the monthly figure; others charge separately. Our complete UK guide to Foundayo covers pricing across providers as it develops.
Your other options
Moving to a tablet is one route. It is not the only one, and it is not automatically the best one for you.
| Option | What it involves | Worth considering if |
|---|---|---|
| Stay on your injection | Continue at your current or a reduced dose | You tolerate it well and the practicalities aren’t a problem. Best-evidenced option. |
| Reduce your injectable dose | Step down rather than switch medicine | Cost or side effects are the issue rather than the injection itself. A prescriber decision, not one to trial alone. |
| Move to Foundayo | Daily tablet, no needles, no fridge | Injections are the barrier. Around three-quarters retention in trial. |
| Stop with a structured plan | No medicine, with support and monitoring | Habits are well established and you accept the regain risk. Least well supported by evidence. |
Talk a maintenance plan through
Which route makes sense depends on what you came off, at what dose, how long ago, and what else you take. A UK-registered prescriber will review it with you.
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Common misconceptions about maintenance
| Claim | Reality |
|---|---|
| “Maintenance means I’m coming off treatment” | It means changing treatment, not ending it. Ongoing medicine, ongoing cost, ongoing reviews. |
| “I’ll hold my weight exactly” | Roughly three-quarters of prior loss was maintained on average. Some regain is likely, particularly coming off tirzepatide. |
| “A maintenance dose will be tiny” | ATTAIN-MAINTAIN escalated participants toward the higher end of the range. Your dose is set clinically, not by the label “maintenance”. |
| “I can start maintenance whenever” | The trial started the tablet within 14 days of the last injection. Timing was part of the design. |
| “Regain means I failed” | Regain after stopping is a pharmacological outcome seen across the whole class, not a personal one. |
| “Habits don’t matter once I’m on a maintenance dose” | Lean mass is lost during weight loss, which makes regain easier. Protein and resistance training matter more at this stage, not less. |
Frequently asked questions
1. Is Foundayo actually licensed for weight maintenance?
Yes. The UK licensed indication covers weight management including both weight loss and weight maintenance, as an adjunct to a reduced-calorie diet and increased physical activity.
2. How much of my weight loss would I keep?
In ATTAIN-MAINTAIN, approximately 74.7% of prior reduction was maintained by people coming off tirzepatide and 79.3% by those coming off semaglutide, at 52 weeks. Individual responses varied considerably — those are group averages, not a forecast.
3. What happens if I just stop instead?
Regain is the expected outcome across this class. In ATTAIN-MAINTAIN, placebo maintained 49.2% of prior reduction in the tirzepatide cohort and 37.6% in the semaglutide cohort, against 74.7% and 79.3% on orforglipron. SURMOUNT-4 showed the same pattern for tirzepatide withdrawal.
4. How soon after my last injection should I start?
Your prescriber decides. In ATTAIN-MAINTAIN, the first orforglipron dose was ideally administered within 14 days of the last injectable dose. The UK SmPC does not specify a washout period or switching interval.
5. What dose would I be on?
There is no conversion from your injectable dose. Standard dosing starts at 0.8 mg for at least 30 days, then 2.5 mg, then 5.5 mg, with further increases to 9 mg, 14.5 mg and 17.2 mg after at least 30 days at each dose. The trial used a higher transition dose, but the authors described that as warranting further research rather than established practice.
6. Is a maintenance dose lower than a weight-loss dose?
Not necessarily. ATTAIN-MAINTAIN escalated participants toward the higher end of the range. Your dose is set by response and tolerance, not by what the treatment is called.
7. Can I do this if I’m still losing weight?
The maintenance evidence covers people who had already plateaued — less than 5% weight change over twelve weeks. If you are still losing, that evidence doesn’t apply to you yet, and it’s a different conversation.
8. How long would I stay on it?
There is no fixed maximum. Obesity is treated as a chronic condition, and some people need long-term treatment. This should be reviewed with you periodically rather than decided at the outset.
9. Will maintenance cost me less?
It may cost less than a high-dose injectable, but it is still monthly treatment at a monthly cost. Compare on twelve-month totals at the dose you’re likely to settle on.
10. Does the contraception advice still apply on a stable dose?
The 30-day precaution applies after starting and after each dose increase. Once you are on a stable dose with no further increases, those windows have passed — but check with your prescriber, and plan ahead for any future increase.
11. Can I go back to injections if maintenance isn’t holding?
That would be a prescriber decision, and restarting an injectable after a break may mean restarting at a lower dose than you previously took rather than resuming where you left off.
12. Do I still need to watch what I eat?
Yes, and arguably more carefully. The ATTAIN-1 body-composition sub-study found weight reduction came primarily from fat mass, but lean mass was also reduced. Protein intake and resistance exercise remain important at the maintenance stage.
13. Is maintenance available on the NHS?
Not currently. Foundayo was licensed by the MHRA on 10 August 2026, but NHS funding is a separate NICE decision that has not concluded.
14. Is there long-term evidence?
Not yet. ATTAIN-MAINTAIN ran for 52 weeks. What happens over three, five or ten years isn’t known for any medicine in this class, and anyone telling you otherwise is going beyond the evidence.
Summary
Maintenance after injections is the question this medicine answers best. Weight maintenance is in the licence, there is a trial designed around exactly this scenario, and the result — roughly three-quarters of prior weight loss held over a year — is a genuine option where the alternative was regain.
What it is not is a way of finishing treatment. It is ongoing medicine with an ongoing cost, and if you are coming off Mounjaro specifically the proportion maintained was numerically lower — approximately 74.7% against 79.3% for those coming off semaglutide. The habits built during your weight loss do more of the work at this stage than at any other.
If you have reached your goal and are wondering what happens next, say exactly that at assessment. It is a different clinical question from wanting to lose weight, and it should get a different answer.
Plan your maintenance with a prescriber
Slinic is a GPhC-registered, NHS-contracted pharmacy providing clinician-led weight management, with monthly clinical reviews included as standard.
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Related guides
- Foundayo (Orforglipron) UK — the complete guide to the oral GLP-1 tablet.
- Switching from Mounjaro to Foundayo — what the evidence actually shows.
- Mounjaro UK — costs, eligibility, doses and side effects.
- Wegovy UK — the complete clinical guide.
- Weight Loss Injections UK — the full overview of treatment options.
- Restarting Mounjaro After a Break — safe reordering guide.
- Slinic Weight Loss Clinic — start an assessment.
References
- Foundayo 17.2 mg film-coated tablets — Summary of Product Characteristics. Eli Lilly and Company Limited. electronic Medicines Compendium, last updated 14 August 2026. medicines.org.uk
- MHRA — UK first in Europe to authorise orforglipron for weight management and type 2 diabetes. GOV.UK, 10 August 2026.
- Aronne LJ, Horn DB, le Roux CW, et al. Orforglipron for maintenance of body weight reduction: the double-blind, randomized phase 3b ATTAIN-MAINTAIN trial. Nature Medicine. 2026;32(7):2679–2687. doi:10.1038/s41591-026-04386-7
- Wharton S, Aronne LJ, Stefanski A, et al. Orforglipron, an Oral Small-Molecule GLP-1 Receptor Agonist for Obesity Treatment. N Engl J Med. 2025;393(18):1796–1806. doi:10.1056/NEJMoa2511774
- Aronne LJ, Sattar N, Horn DB, et al. Continued treatment with tirzepatide for maintenance of weight reduction in adults with obesity (SURMOUNT-4). JAMA. 2024;331(1):38–48. doi:10.1001/jama.2023.24945
- Aronne LJ, et al; SURMOUNT-5 Trial Investigators. Tirzepatide as compared with semaglutide for the treatment of obesity. N Engl J Med. 2025.
- NICE NG246 — Overweight and obesity management. nice.org.uk/guidance/ng246
- MHRA Yellow Card scheme — report suspected side effects. yellowcard.mhra.gov.uk
