COA_Karl said:

The trials generally allowed a step to be held or reduced and then retried, and people who did that mostly arrived at the same place a few weeks…

I disagree that the ladder is purely tolerability. The maintenance and regain data cluster at the top doses, so a ladder abandoned halfway leaves you outside the evidence base for the part that matters most — keeping it off.

JenPlateau said:

Four dose steps in, holding each one the full four weeks, and I am trying to work out whether the interval is a pharmacological requirement or a…

Dose escalation anxiety for titration: I was terrified to move from 0.5mg to 1.0mg based on horror stories in this forum. But my actual experience? Slightly more appetite suppression, zero additional side effects.

Remember that the people posting about terrible side effects are a biased sample. Most people titrate up without drama — they just don't post about it because it's uneventful.

Dr.CardioMD said:

I disagree that the ladder is purely tolerability.

There is a second half to this that has not been said yet. Worth answering the question that was asked rather than the one behind it. The narrow version usually has an answer; the broad version usually does not, and answering the broad one is how a thread stops being useful.

Following on from MikeFit_NJ — and this may be the naive question:

What the trials actually did with participants who could not tolerate a step, because that is the situation I am in and the protocol summaries skip it?

Reporting back.

Update — I came back down one step, held for a month, then went up again and it was uneventful the second time. Same ladder, slower.