5mg → 10mg → 15mg titration — looking for input

MikeKY_noInsulin said:

Four weeks is the pharmacokinetics, not caution.

MikeKY_noInsulin has the substance of this right. The condition it depends on is worth stating. 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.

MikeKY_noInsulin said:

Four weeks is the pharmacokinetics, not caution.

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.

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.ObesityMed 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…

Same pattern here, and in the same order. Nothing to add that would improve it.