Four dose steps in, holding each one the full four weeks, and I am trying to work out whether the interval is a pharmacological requirement or a tolerability convention.
What I actually want to know is why the interval is four weeks rather than two, and whether a slower ladder gets to the same place.
Not looking for reassurance. Looking for the part I have got wrong.
Taking the question as asked, rather than the general version of it. 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 later. The end point of the ladder is set by tolerability, not by a schedule, and there is no evidence that reaching the top faster produces a better outcome.
Dr.RaviCardio 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…
Agreed on the arithmetic, with 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.
Ask again with the specifics and you will get a better answer than this one.
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Shop Reference Standardspete_manc_UK said:Four dose steps in, holding each one the full four weeks, and I am trying to work out whether the interval is a pharmacological requirement or a…
Same position here, arrived at the long way round. Four weeks is the pharmacokinetics, not caution. With a one-week half-life you need four to five half-lives to reach steady state, so at two weeks you are dosing on top of a concentration that has not finished rising. Escalating then stacks exposure and you get the side-effect burden of the higher dose before you have seen the benefit of the current one.
If somebody has the primary source to hand I would rather cite it than paraphrase it.
From the other side of the consultation, briefly.
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.