09/10/2026
Stop titrating GLP-1 medications on a rigid calendar.
Start titrating to each patient's individual symptomatic threshold.
The standard escalation schedule — moving up a dose tier each month regardless of how the patient is tolerating the current dose — is a protocol written for trials, not clinical care.
Real clinical management means: if GI symptoms are disruptive, you hold the current dose. You don't escalate.
The therapeutic goal isn't the highest dose. It's the dose at which weight loss continues without exceeding the patient's tolerance for side effects.
2025 clinical guidance supports a "treat-to-target" model: dose increases only when response stalls — not on autopilot.
For a 70 kg patient: hold at a dose producing adequate satiety and steady weight loss, even if they never reach maximum approved dosing.
This isn't being conservative. It's being clinically intelligent.
Titration is the intervention. Reach out to your Steel City provider before making any dose adjustments on your own.