Titrate - How much to increase?

Go by how you felt at the start. If the first dose hit you hard with side effects, take it slow. I saw hunger return after four weeks on 1 mg and went straight to 2 mg. Even then the effect is milder than the first week, so the body seems to adjust.

I moved up from 1 mg in 250 mcg steps. Once I reached 2 mg I had to drop back down. Smaller amounts have been enough for me and I have stayed on that plan for 13 months.

Go to 2 mg. That is where I began.

Early on I had uncomfortable heart-rate problems, which is why I only added 250 mcg at a time. Good luck.

What is your current weight and what goal are you aiming for with this medication?

My experience has been the opposite. I have stayed at 1 mg for four weeks and the medication actually seems to be getting stronger. Hunger stayed away after week two, side effects like skin sensitivity and fatigue have increased, and gastric emptying is now so fast that five or six bites fill me up completely. Yesterday I spent an hour on a small yogurt and still felt overly full.

A lot of these reports sound like they need professional help. I do not get how people have such strong reactions—heart issues, nausea, near-zero eating—on doses like 0.25 mg, 0.5 mg or 1 mg and then stay there for weeks without moving up.

I did 0.5 mg for four weeks, then 0.8 mg for one week, now 1 mg. Weight loss is steady at two to three pounds a week with tracking and exercise. Everyone reacts differently, so listen to your body and increase slowly. The slow approach also helps build better eating habits.

Moving from 1 mg to 1.5 mg is a 50 % jump; going to 2 mg doubles it. I would pick the smaller step and test how it feels. It only costs a little time to try and adjust.

You could try 1.5 mg next time. If it does not feel like enough, go to 2 mg the time after that so you can judge your response clearly.

From what I have read here, people who are not starting from severe obesity often notice stronger effects and more side effects at lower doses than the studies would suggest. The studies mostly involved heavier participants, so the difference makes sense. Because your calories dropped so sharply at 1 mg, you are probably quite responsive, so smaller steps are likely safer. Side effects can still appear with any increase, but going slowly tends to make them less abrupt.

I agree there is no point pushing until you feel sick if you are not in a hurry. Nothing I have seen suggests that slower titration has any downside beyond slower progress.

Any problems after you increased?

I moved up to 8 mg on Friday with a new batch. I can feel the difference in several positive ways and the scale moved nicely after four days.

I wanted to go from 2 mg up to at least 4 mg but only added 0.5 mg. I am glad I kept it small. The suppression hit like a wall along with heartburn and a flat feeling. I seem to be quite sensitive.

I prefer to increase in very small steps, sometimes just one unit at a time over several weeks.

Glad I saw this thread. I am on week five at 1 mg and this week hunger and food noise are noticeably stronger than the first four weeks. I was debating 1.5 mg versus 2 mg and now think I will try 1.5 mg. Any update on how it went for you?