BethLabQueen said:

Four weeks is the pharmacokinetics, not caution.

I disagree that the ladder is purely tolerability. The maintenance and regain data cluster at the top doses, so a ladder abandoned halfway leaves you outside the evidence base for the part that matters most — keeping it off.

If somebody has the primary source to hand I would rather cite it than paraphrase it.

Admin said:

I titrated faster than the label because I felt fine, hit a wall at the third step, and had to come back down — which I now think was the predictable…

Dose escalation anxiety for titration: I was terrified to move from 0.5mg to 1.0mg based on horror stories in this forum. But my actual experience? Slightly more appetite suppression, zero additional side effects.

Remember that the people posting about terrible side effects are a biased sample. Most people titrate up without drama — they just don't post about it because it's uneventful.

amsterdam_pete said:

I disagree that the ladder is purely tolerability.

Adding the part of the answer the thread has not reached. Take it one variable at a time. Almost every unanswerable question in these threads is unanswerable because three things changed in the same fortnight, and no amount of subsequent argument can untangle them after the fact.

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

Why the interval is four weeks rather than two, and whether a slower ladder gets to the same place?

OP back with an update, since a thread like this is useless without one.

I held the step an extra three weeks instead of stepping back down, and it settled. Same dose, same everything, just more time — which is exactly what was suggested upthread.