Dr.GutHealth said:

Four weeks is the pharmacokinetics, not caution.

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.

A1cHero_PHX said:

I titrated faster than the label because I felt fine, hit a wall at the third step, and had to come back down — which I now think was the predictable…

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.

anders_CPH said:

I disagree that the ladder is purely tolerability.

There is a second half to this that has not been said yet. There is a difference between no evidence and evidence of no effect, and this subject is one where the two get swapped freely in both directions.

Following on from tammy_FL — 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.