Collecting this in one place because it comes up every few weeks and the answer is always assembled from scratch. It is about the titration schedule, and it is deliberately narrow — everything I am not confident about is marked as such.
What is actually established
Holding longer is the underrated move. A step that is uncomfortable at week two is frequently comfortable at week six with no change in dose, because the gastric-emptying component tachyphylaxes while the appetite effect persists. Escalating at week two throws that adaptation away.
The condition it depends on
One condition: holding indefinitely at a dose that is not doing anything is not patience, it is a stall with a nice name. The distinction is whether appetite has changed at all at the current step.
The practical version
The arithmetic in one line: half-life about a week, so steady state at four to five weeks, so a four-week interval is one steady state per step. Two-week intervals mean every step is dosed onto a rising curve.
What I am not sure about
What I actually want to know is 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. I would rather have one careful answer than five confident ones.
— JennaRN · corrections welcome and will be edited into this post with credit