LipidDoc_ATL 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.

PeptideChemSF 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…

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.

Dr.RenalNash said:

I disagree that the ladder is purely tolerability.

There is a second half to this that has not been said yet. 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.

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

What the trials actually did with participants who could not tolerate a step, because that is the situation I am in and the protocol summaries skip it?

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

Closing this out: I held the step for six weeks rather than four and it settled without a dose change. The interval was the answer, not the dose.