Threw up at work today - do I tell my boss why?

Taking the question as asked, rather than the general version of it. Holding genuinely reduces total burden rather than redistributing it, because the gastric-emptying component adapts. Receptor-level tachyphylaxis to the delayed-emptying effect develops over weeks while the central appetite effect persists, so the same dose is materially more comfortable at week six than at week two. A slower ladder therefore reaches the same dose with less cumulative nausea, not the same nausea spread thinner.

MikeFit_NJ said:

Holding genuinely reduces total burden rather than redistributing it, because the gastric-emptying component adapts.

Agreed on adaptation, with a caveat: adaptation applies to gastric emptying and not to everything. If your problem is the aversion rather than the fullness, waiting does less, because the aversion is central and it is the mechanism working as intended.

NurseAsh_DET said:

Nausea arrived on day two of each dose step, lasted about four days, and disappeared entirely by the second week — until the step where it did not.

This matches mine closely enough to be worth saying so. The line between titrate-through and stop is not severity, it is trajectory and what else is present. Nausea that peaks and improves within a week is the expected pattern. Nausea that is escalating, or that comes with severe upper-abdominal pain radiating to the back, or that prevents fluids for more than a day, is a different conversation and belongs with a clinician the same day.

From the other side of the consultation, briefly. The mechanism and the magnitude are separate questions. Agreeing that something happens says nothing about whether it happens enough to act on.