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Hold your current dose when: You are still losing weight consistently (1-2 pounds per week) at your current dose Side effects from the last increase have not fully resolved after four weeks Your appetite suppression is adequate for your dietary goals You have been at your current dose for less than four weeks You are managing comorbidities (like blood sugar) effectively at this level Consider escalating when: Weight loss has stalled for two or more consecutive weeks despite dietary adherence Appetite suppression has diminished noticeably You have been at your current dose for at least four weeks with minimal side effects Your clinician agrees that escalation is appropriate You have not yet reached your weight management goal Consider reducing or pausing when: Severe nausea or vomiting persists beyond two weeks at the new dose You are unable to maintain adequate nutrition or hydration You experience signs of pancreatitis or gallbladder issues Weight loss is occurring too rapidly (more than 3-4 pounds per week consistently) New symptoms appear that concern you or your clinician The most common mistake is escalating on schedule regardless of how you feel

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Lifelong therapy is often necessary to maintain normal TSH levels (Ralli et al

Jan 15 2017;13(1):19-26