genuine question do you count from injection day or from when you actually felt it
#dosing-titration 2026-06-03
Wednesday65 messages12 participantstimes are UTC
Highlights from this day
- per_mg_pete — anyone tracked whether a smaller more frequent dose changed their side effects 22:04
- two_four_ceiling — whats a sensible maintenance dose after a year at treatment dose 22:06
- marrow.mod — 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 i hold for two months minimum before i decide… 22:21
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update from 25 months ago: held at the same dose the whole time and still losing slowly
is there a trial anywhere that studied twice weekly, or is it all anecdote
i went up too fast and im paying for it, do i drop back or ride it out
| 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 |
dose day drift is mostly harmless with a weekly compound, but pick a day and defend it
you do not have to escalate at all. that is a real option that gets forgotten
if it "stopped working after four days" that is almost never pharmacokinetics
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nobody here can tell you what dose to be on and the ones who try get corrected
how do you tell a plateau from just being at your set point
is there a point where going up stops buying you anything
is week 27 too early to be thinking about the next step
holding is not failing. most people here who lasted two years held at least one dose for months
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right so my rule: if a side effect is still there at day five, i hold. if it clears by day three, i step
anyone tracked whether a smaller more frequent dose changed their side effects
| 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 |
whats a sensible maintenance dose after a year at treatment dose
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is it normal for appetite to come back at the end of the week
if the current dose is still working, going up is spending headroom you might want later
the argument for splitting is a flatter curve. the argument against is you have doubled your injections for a guess
my dose day has drifted 2 days later over 16 months, does it matter
update question: did anyone who held for 6 months regret it
thats noise
split dosing has no trial behind it. people here do it and report on it, thats all
*that should say weekly
came down, no regrets
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
i hold for two months minimum before i decide a dose has stopped doing anything
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ok so whats the longest anyone has stayed on one dose
after a gap of more than about three weeks i restart one rung lower. thats my own rule, not advice, your mileage will differ
go slower
| 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 |
stepping back down on purpose is a completely reasonable move and this channel should say so more often, someone check my working
no trial for that
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do you tell your prescriber you held or do you just hold
holding is not failing. most people here who lasted two years held at least one dose for months
hold
genuine question my titration ladder took 16 months to climb and i would do it slower again
not advice
i went from 10 to 7.5 and honestly could not tell the difference in appetite
i have been at 15 for 18 months and honestly i have stopped wanting to move
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is there any actual reason to escalate every 4 weeks other than the trial did it
update on the earlier thing i escalate on symptoms. if the current dose is still doing something i stay on it
whats your rule for when a side effect means hold rather than push
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+ 2.40mgend of week thing
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thats normal
i log dose, day, weight and one line about how the week felt. thats enough to make decisions on
whats the smallest step anyone has managed between doses
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appetite returning at the end of the week is extremely common and is not the dose failing
i would hold
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update on the earlier thing the argument for splitting is a flatter curve. the argument against is you have doubled your injections for a guess, not advice obviously
the trials escalated on a fixed schedule because a trial has to. you are not a trial
i went from 5 to 1.7 and honestly could not tell the difference in appetite
genuine question the honest answer is that most of us are running protocols nobody has ever studied
what does the room think about jumping a rung to catch up
too early imo
a missed week does not reset you, but going straight back to the top dose after a gap is how people get floored
small steps are better than big ones and the only reason people take big ones is impatience, i could be wrong
came down from a treatment dose to maintenance over about three months and it was uneventful
plateau versus set point is not answerable in under six months of data
unrelated but if i took it 7 days late do i shift the schedule or go back to the old day
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hold
update from 12 months ago: held at the same dose the whole time and still losing slowly
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coming down from 1.7 to 0.25, how bad is the appetite rebound
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two weeks is nothing
i drifted from sunday to wednesday over a year and only noticed when i checked the log, i could be wrong
i jumped a rung once to catch up after a supply gap and it was a bad week. would not repeat
half life is a week
pick a day and stick to it