Dr.LipidDallas said:

Holding genuinely reduces total burden rather than redistributing it, because the gastric-emptying component adapts.

I dislike how confidently this board tells people to push through. Incidence figures around 20 to 25% at the higher doses are class-typical, but the trials also had a discontinuation column, and "manageable with protocols" is not the same as manageable for everyone.

Happy to go further on any of that.

Adding the numbers, since they settle part of this. The boring version of this is the one that works, and the boring version is: measure a baseline, change one variable, wait, measure again under the same conditions. Nobody wants that answer and it is still the answer.

PharmD_Rodriguez said:

I dislike how confidently this board tells people to push through.

Adding the part of the answer the thread has not reached. It helps to ask what evidence would change your mind before you look at any. If nothing would, the discussion is not about evidence, and it is better to say so early than to spend nine posts discovering it.

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

Whether holding at a lower dose for longer actually reduces total side-effect burden or just spreads it out?

Reporting back.

Holding the step for six weeks instead of four did it. Same dose, same food, and the nausea that had felt like a wall turned out to be a timing problem.