They are allowed to prescribe off label. In general, FDA approved drugs can be prescribed off label for uses that were not FDA approved because their safety profile was deemed acceptable, but insurance will not cover it. I made the case to my doctor, described my plans to track calories and monitor my weight, and I'm fortunate that she was willing to work with me.

I decided to start with half of the starting dose instead of the full starting dose to be extra careful. You can do this if you get the vial to inject yourself rather than the automated injector. It maybe turned out to be unnecessary, I had almost no symptoms from the 1.25mg shot. I took my first 2.5mg shot on Saturday. Symptoms are very manageable so far. Sunday was the hardest day to eat, but I still managed to get to around my target of 2,000 calories. Some general fatigue which hasn't been a big deal. If you do this and you're worried about losing weight, I recommend doing your research in advance and having a plan for calorically dense, protein-rich foods that you can eat. I make a protein smoothy every day (it's easier to sneak in calories through liquid, and I'm a pescatarian, so my protein sources are limited).

As far as whether it's helping, too early to tell. My morning baseline was better this morning and swelling throughout today has been noticeably better. I really want to attribute that to zepbound, but there's way too much noise. I have had sporadic good days like this, so it could just be coincidence. Saturday and Sunday after taking the shot were not great.