De-escalation protocols — January 2024

PeptideChemSF said:

The trials generally allowed a step to be held or reduced and then retried, and people who did that mostly arrived at the same place a few weeks…

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.

KevinCompounds 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…

PSA for titration users considering the 0.25mg starting dose: this dose is NOT intended for weight loss. It's a titration dose to let your body adjust. Don't be discouraged if you don't lose much in the first month.

The therapeutic dose for weight management starts at 1.7mg (semaglutide) or 5mg (tirzepatide). Be patient with the ramp-up.

Dr.ObesityMed said:

I disagree that the ladder is purely tolerability.

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

That is the short version; the long version is somebody else's post.

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

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

Closing the loop on my own question.

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.