Dr.NateNeph 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. Practical: whatever you change, write down the date and the reason. In three months the reason is what you will have forgotten, and the reason is what makes the record worth having.

Dr.NutriCornell said:

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

Adding the part of the answer the thread has not reached. Worth answering the question that was asked rather than the one behind it. The narrow version usually has an answer; the broad version usually does not, and answering the broad one is how a thread stops being useful.

A narrower follow-up, since the general answer is now clear:

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

Reporting back.

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.