Dr.PeteFamMed 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.

AussieAnna 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.

Dr.ReproEndo said:

I disagree that the ladder is purely tolerability.

There is a second half to this that has not been said yet. The version of this that has an answer is narrower than the version being asked. Narrow it and it becomes tractable; leave it broad and the thread will produce nine confident and incompatible replies.

Ask again with the specifics and you will get a better answer than this one.

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

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

Reporting back.

Update — I came back down one step, held for a month, then went up again and it was uneventful the second time. Same ladder, slower.