Building on the opening post rather than restating it.
A missed dose in a weekly schedule is not a trough to chase. With a week-long half-life you are perturbing a slowly moving average, and the labelling for licensed products in this class says take it if the next dose is far enough away and skip it otherwise.
Post #3 is the version of this I will quote in future. One addition.
How the published trials escalated: they used specific step sizes and intervals. The STEP programme used a particular cadence; the SURPASS and SURMOUNT programmes used slightly different ones. Reading them side by side shows the variation is real but small.
When a dose reduction is the correct response to a side effect: if a side effect is dose-dependent (nausea, constipation, injection discomfort), reducing the dose is a reasonable response. If the side effect is not dose-dependent (e.g., hypoglycemia with insulin), dose reduction does not address the issue.
The disagreement above is smaller than it looks once the terms are fixed.
Dose and effect are not linear across the studied range for every compound in this class. Assuming a doubled dose gives a doubled effect is the reasoning error behind most disappointment.
Read the full topic (29 posts)
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Revisiting: Holding a dose indefinitely: is there a documented downside?
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+26 | 30 | 4.5k | 18mo |
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Titrating on tolerability rather than on the calendar — the long version
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Stepping down deliberately, and how to do it without losing progress — what changed since
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+94 | 99 | 29k | 2d |
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Escalating every six weeks instead of four: what I observed over eight months
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+27 | 31 | 432 | 18mo |
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What steady state means for the decision to escalate
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+31 | 35 | 2k | 1d |
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Drawing from a pen cartridge with a syringe: how the risk profile changes
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2 | 159 | 19mo | |
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Rewriting my first post: a before-and-after, with commentary — what changed since
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+15 | 19 | 12k | 13h |
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GIP receptor agonism and the argument about direction
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2 | 867 | 10mo | |
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Revisiting: Five questions in one post gets you one answer — how to split them
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+2 | 6 | 13k | 20mo |
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Tracking semaglutide's approved indications across jurisdictions, dated
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+15 | 19 | 2.8k | 1d |