5mg → 10mg → 15mg titration — anyone have experience?

DataDave 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.

If somebody has the primary source to hand I would rather cite it than paraphrase it.

ChrisMacros 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…

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.

InsuranceTom said:

I disagree that the ladder is purely tolerability.

Adding the part of the answer the thread has not reached. The mechanism and the magnitude are separate questions. Agreeing that something happens says nothing about whether it happens enough to act on.

Ask again with the specifics and you will get a better answer than this one.

Following on from Admin — and this may be the naive question:

What the trials actually did with participants who could not tolerate a step, because that is the situation I am in and the protocol summaries skip it?

Closing the loop on my own question.

Closing this out: I held the step for six weeks rather than four and it settled without a dose change. The interval was the answer, not the dose.