BariatricNurseD said:

The line between titrate-through and stop is not severity, it is trajectory and what else is present.

I dislike how confidently this board tells people to push through. Incidence figures around 20 to 25% at the higher doses are class-typical, but the trials also had a discontinuation column, and "manageable with protocols" is not the same as manageable for everyone.

One concrete data point for the thread. Trial-level incidence runs roughly 20 to 25% for nausea at the higher dose tiers and 12 to 17% for diarrhoea, with most events mild to moderate and concentrated in the weeks after each escalation.

Dr.SportsMedIN said:

I dislike how confidently this board tells people to push through.

Coming at Dr.SportsMedIN’s question from a different direction. The practical protocol is dull and it works: smaller meals, stop eating at the first sign of fullness rather than at the end of the plate, drop the fat fraction of meals in the two days after dosing, and do not lie down straight after eating. Most of what people call unmanageable nausea is a meal-size and meal-composition problem interacting with a stomach that is emptying slowly.

Correct me if the detail matters more than I have assumed.

One thing that is still open after DeniseRN_TPA’s answer:

Whether holding at a lower dose for longer actually reduces total side-effect burden or just spreads it out?

Reporting back.

Follow-up: smaller meals, less fat in the two days after dosing, and not lying down afterwards. Unglamorous, and it worked within a fortnight.