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For patients who start on 2.4 mg and then hit a frustrating plateau, or for those with a very high baseline BMI who may need a stronger metabolic push, this creates a legitimate, evidence-based escalation path rather than forcing an early switch to another drug class, Balazs, who was not involved in the study, told Fox News Digital

43 Although causative effect has not been established, DPP-4 inhibitor therapy should be discontinued immediately if a patient presents with signs of pancreatitis, such as severe abdominal pain, nausea, vomiting, and weight loss

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You are to slowly increase the amount every 4 weeks (refer to your specific protocol)