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In the US, Novo expects a sales decline in the teens, driven by three forces: deliberate price reductions to expand market access the shift toward the cash-pay channel at lower price points the Most Favoured Nations agreement with the Trump administration Internationally, the picture is somewhat better, with expected mid-single digit growth, though dampened by loss of exclusivity for semaglutide in markets such as Canada and China

When to step back down If anxiety symptoms are clearly dose-related, meaning they appear or worsen shortly after a dose increase and do not resolve within two to three weeks, stepping back to the previous dose is a reasonable strategy

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Start retatrutide at a low dose and titrate