Posting this as a warning rather than a discussion, and I will edit the post if any of it turns out to be wrong.
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.
That is right for the weekly injectables. For the daily agents the interval logic is different and the four-week convention does not transfer.
What to check: The arithmetic in one line: half-life about a week, so steady state at four to five weeks, so a four-week interval is one steady state per step. Two-week intervals mean every step is dosed onto a rising curve.
If your experience contradicts this, say so in the thread — I would rather be corrected here than have people act on a warning that does not hold.
Dr.MetabolicMD 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…
That is correct as far as it goes, and here is where it stops going. 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.
Dr.MetabolicMD 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…
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.
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Shop Reference StandardsThis one has a reasonably settled answer, so here it is. 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.CardioMD 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…
Adding a me-too, because a thread of one person's experience is not much use.