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.

The figures, for anyone assembling their own picture. The boring version of this is the one that works, and the boring version is: measure a baseline, change one variable, wait, measure again under the same conditions. Nobody wants that answer and it is still the answer.

Dr.MetabolicMD said:

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

Coming at Dr.MetabolicMD’s question from a different direction. It helps to say which part of this you are uncertain about. A precise question gets a precise answer; a general one gets everybody’s favourite anecdote.

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

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.