Dr.LipidDallas said:

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…

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.BariatricHTX said:

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

Coming at Dr.BariatricHTX’s question from a different direction. Holding genuinely reduces total burden rather than redistributing it, because the gastric-emptying component adapts. Receptor-level tachyphylaxis to the delayed-emptying effect develops over weeks while the central appetite effect persists, so the same dose is materially more comfortable at week six than at week two. A slower ladder therefore reaches the same dose with less cumulative nausea, not the same nausea spread thinner.

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

What distinguishes the nausea you can titrate through from the nausea that means stop?

Reporting back.

Update. It was not the dose, it was that I had stopped drinking anything because drinking made me feel full. Fixing that fixed most of it.