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Standard 4-Step Escalation Schedule | Week Range | Dose | Clinical Decision Point | |---|---|---| | Weeks 1 to 4 | 2 mg SC once weekly | Assess nausea, vomiting, GI tolerability | | Weeks 5 to 8 | 4 mg SC once weekly | Hold if nausea grade 2 persists | | Weeks 9 to 12 | 8 mg SC once weekly | Check fasting glucose, LFTs at week 12 | | Weeks 13 to 24 | 12 mg SC once weekly (target) | Confirm tolerability before locking dose | Patients who cannot tolerate the step-up to 8 mg may remain at 4 mg for an additional 4 weeks before retrying escalation
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