quick one whats a sensible maintenance dose after a year at treatment dose
#dosing-titration 2025-07-03
Thursday37 messages6 participantstimes are UTC
Highlights from this day
- cagri_curious — with a roughly seven day half-life you are near steady state after about five weeks at a dose 18:58
- slow.taper — sorry to jump in if the current dose is still working, going up is spending headroom you might want later 20:45
- orfor_watch — while im here i log dose, day, weight and one line about how the week felt. thats enough to make decisions on, anyway 21:02
the ladder in the trials is a starting point, not a schedule you owe anyone
n of 1
end of week thing
steady state is 5 weeks
my rule: if a side effect is still there at day five, i hold. if it clears by day three, i step
not advice
go slower
🤝15
if it "stopped working after four days" that is almost never pharmacokinetics
with a roughly seven day half-life you are near steady state after about five weeks at a dose
👍8✅13
do you tell your prescriber you held or do you just hold
came down from a treatment dose to maintenance over about three months and it was uneventful
wk 1-4 2.5mg
wk 5-8 5.0mg
wk 9-20 7.5mg <- stayed here
wk 21-24 10.0mg (no extra benefit for me)
wk 25+ 7.5mg (came back down)i would hold
is there a trial anywhere that studied twice weekly, or is it all anecdote
the ladder in the trials is a starting point, not a schedule you owe anyone
stepping back down on purpose is a completely reasonable move and this channel should say so more often
after a gap of more than about three weeks i restart one rung lower. thats my own rule, not advice
how do you tell a plateau from just being at your set point
i went from 12 to 1 and honestly could not tell the difference in appetite
wk 1-4 0.25mg
wk 5-10 0.50mg (held 2 extra weeks)
wk 11-14 1.00mg
wk 15-26 1.70mg (held, long)
wk 27+ 2.40mgupdate on the earlier thing the people who do best here are almost always the ones going slowest
what does the room think about jumping a rung to catch up
if i took it 5 days late do i shift the schedule or go back to the old day
update from 20 months ago: held at the same dose the whole time and still losing slowly
anyone tracked whether a smaller more frequent dose changed their side effects
my titration ladder took 22 months to climb and i would do it slower again
📉5
too early imo
holding is not failing. most people here who lasted two years held at least one dose for months
sorry to jump in if the current dose is still working, going up is spending headroom you might want later
🙏18
anyone here split their weekly into two and would they do it again
i have been at 1.7 for 12 months and honestly i have stopped wanting to move
⚠️1
how do you decide between holding and stepping when both feel wrong
i went to the top of the ladder, felt no better than two rungs down, and came back. that is data for me and nobody else, from memory
while im here i log dose, day, weight and one line about how the week felt. thats enough to make decisions on, anyway
| Trial schedule | What most people here do | |
|---|---|---|
| Step interval | 4 weeks, fixed | 4-12 weeks, on symptoms |
| Holding | protocol deviation | normal and expected |
| Top dose | reached by design | often never reached |
| Coming down | not studied | common at maintenance |
if you are going up because the scale stalled for two weeks, wait. two weeks is noise
💀1
half life is a week
you do not have to escalate at all. that is a real option that gets forgotten
split dosing has no trial behind it. people here do it and report on it, thats all
how long did you hold at 0.25 before you moved up
the honest answer is that most of us are running protocols nobody has ever studied