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 tolerability convention.
The narrow version of the question is 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.
Happy to be told the question itself is wrong.
This one has a reasonably settled answer, so here it is. Holding longer is the underrated move. A step that is uncomfortable at week two is frequently comfortable at week six with no change in dose, because the gastric-emptying component tachyphylaxes while the appetite effect persists. Escalating at week two throws that adaptation away.
Dr.GutHealth said:A step that is uncomfortable at week two is frequently comfortable at week six with no change in dose, because the gastric-emptying component…
That is right for the weekly injectables. For the daily agents the interval logic is different and the four-week convention does not transfer.
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Browse GL BiochemBiostatsBrad 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…
Same position here, arrived at the long way round. 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 later. The end point of the ladder is set by tolerability, not by a schedule, and there is no evidence that reaching the top faster produces a better outcome.
Correct me if the detail matters more than I have assumed.
From the other side of the consultation, briefly.
PSA for titration users considering the 0.25mg starting dose: this dose is NOT intended for weight loss. It's a titration dose to let your body adjust. Don't be discouraged if you don't lose much in the first month.
The therapeutic dose for weight management starts at 1.7mg (semaglutide) or 5mg (tirzepatide). Be patient with the ramp-up.