Overview & mechanism
RC-R activates three metabolic receptor pathways. Adding the third (energy-expenditure) arm to the dual-incretin mechanism is thought to increase calorie burn in addition to reducing intake. Phase 2 research reported some of the largest weight reductions ever seen in this class at 48 weeks.
Research dose & half-life
- Half-life:
- ~6 days
- Research dose:
- Research titration: 2 mg weekly, escalated by 2–4 mg every 4 wks up to 8–12 mg weekly. Alternative approach: start at 1 mg weekly, then increase by 0.5–2 mg every 4 weeks as tolerated. Subcutaneous.
- Protocol notes:
- Schedule: once weekly subcutaneous, same day/time each week; take with adequate hydration. Start/stop: begin at the lowest dose; increase only if no significant nausea, vomiting, or palpitations. Stop and seek guidance if severe GI symptoms, chest pain, or rapid heartbeat occur. Cautions: contraindicated in personal/family history of medullary thyroid carcinoma or MEN2; use caution with gallbladder disease, pancreatitis, or concurrent glucose-lowering agents.
Safety & side effects
Incretin effects: nausea, vomiting, diarrhea, constipation, decreased appetite, fatigue. The third receptor arm adds: increased heart rate, mild blood pressure elevation, and transient increases in fasting glucose or liver enzymes at higher doses. Serious: pancreatitis, gallbladder disease, dehydration/kidney injury, hypoglycemia with insulin/sulfonylureas. Same MTC/MEN2 contraindication as other incretin-class peptides. Avoid in pregnancy, active pancreatitis, and unstable cardiovascular disease. Investigational — long-term human safety is not yet established.
