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. If you are going to change something, change one thing and give it long enough to express itself. Four weeks is the usual minimum for anything pharmacological on this board, and two weeks of data has told you almost nothing.

kate.chem said:

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

Adding the part of the answer the thread has not reached. Whatever the answer turns out to be, the method for getting there is the same: state the assumption, do the arithmetic in public, and invite the correction. That is slower than asserting, and it is the only version that survives being wrong.

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

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

Closing the loop on my own question.

Holding the step for six weeks instead of four did it. Same dose, same food, and the nausea that had felt like a wall turned out to be a timing problem.