Four dose steps in, holding each one the full four weeks, and I am trying to work out whether the interval is a pharmacological requirement or a tolerability convention.
What I actually want to know is why the interval is four weeks rather than two, and whether a slower ladder gets to the same place.
Numbers rather than impressions, if you have them.
This one has a reasonably settled answer, so here it is. Holding longer is the underrated move. A step that is uncomfortable at week two is frequently comfortable at week six with no change in dose, because the gastric-emptying component tachyphylaxes while the appetite effect persists. Escalating at week two throws that adaptation away.
Happy to go further on any of that.
JennaRN said:A step that is uncomfortable at week two is frequently comfortable at week six with no change in dose, because the gastric-emptying component…
That is right for the weekly injectables. For the daily agents the interval logic is different and the four-week convention does not transfer.
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Shop Reference Standardsgary_naperville said:Four dose steps in, holding each one the full four weeks, and I am trying to work out whether the interval is a pharmacological requirement or a…
Can confirm the pattern gary_naperville describes. The trials generally allowed a step to be held or reduced and then retried, and people who did that mostly arrived at the same place a few weeks later. The end point of the ladder is set by tolerability, not by a schedule, and there is no evidence that reaching the top faster produces a better outcome.
Clinical perspective, offered as context rather than as advice.
PSA for titration users considering the 0.25mg starting dose: this dose is NOT intended for weight loss. It's a titration dose to let your body adjust. Don't be discouraged if you don't lose much in the first month.
The therapeutic dose for weight management starts at 1.7mg (semaglutide) or 5mg (tirzepatide). Be patient with the ramp-up.