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ForumsDosing & ProtocolsMy doctor says stay on 1mg but I feel like I need more — anyone have experience?

My doctor says stay on 1mg but I feel like I need more — anyone have experience?

AussieAnna Thu, Apr 4, 2024 at 3:35 PM 42 replies 2,345 viewsPage 1 of 9
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AussieAnna
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Apr 4, 2024 at 3:35 PM#1

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 outcome rather than bad luck.

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.

Happy to be told the question itself is wrong.

14 9TrialNerd_Beth, HPLC_Greg, LibrarianMeg and 11 others
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LipidDoc_ATL
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Apr 4, 2024 at 4:30 PM#2

Answering the narrow version, because the broad one does not have a single answer. 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.

Last edited: Apr 4, 2024 at 9:30 PM
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paige_pharma
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Apr 4, 2024 at 5:25 PM#3
LipidDoc_ATL said:
A step that is uncomfortable at week two is frequently comfortable at week six with no change in dose, because the gastric-emptying component…

That is right for the weekly injectables. For the daily agents the interval logic is different and the four-week convention does not transfer.

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lisa_labSD
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Apr 4, 2024 at 6:20 PM#4
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…

Same position here, arrived at the long way round. 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.

Last edited: Apr 4, 2024 at 9:20 PM
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Dr.RaviCardio
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Apr 4, 2024 at 11:33 PM#5

Clinical perspective, offered as context rather than as advice.

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.

Last edited: Apr 5, 2024 at 12:33 AM
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