Clinical perspective, offered as context rather than as advice. Order of operations matters more than any single choice here: establish a baseline, change one thing, wait long enough for it to express itself, then measure again under the same conditions.

Worth separating that from the pharmacology, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.

Following on from lori_vegas — and this may be the naive question:

Whether anyone has held at a sub-maximal dose long term and kept the result, or whether the maintenance data only exists at 2.4mg?

andrew_nyc said:

Order of operations matters more than any single choice here: establish a baseline, change one thing, wait long enough for it to express itself, then…

Pushing back on andrew_nyc here. Steady state is the thing most people miss. The terminal half-life is about a week, so every dose step takes four to five weeks to fully express itself. Judging a step at day ten is judging the ascent, not the plateau, and it is the single commonest reason people escalate before they needed to.

andrew_nyc said:

Order of operations matters more than any single choice here: establish a baseline, change one thing, wait long enough for it to express itself, then…

Agreed, and the adaptation point cuts both ways: tachyphylaxis to gastric emptying is why tolerability improves, and it is also why people who were relying on physical fullness feel the effect fade while the appetite effect is still working.

Moderator note: leaving this open. It is being argued well and the disagreement is the useful part. No action needed from anybody.