Most of it is timing.

For most people the gastrointestinal effects are worst in the first 24 to 72 hours after an injection and ease over the remainder of the week. Each dose increase tends to restart that pattern, which is why escalation weeks often feel like going backwards. Effects that persist at the same intensity for several weeks, or worsen rather than settle, should be raised with your prescriber.

Titration schedules step the dose up at intervals specifically so the body can adjust. Each step is a new exposure level, so symptoms that had settled commonly return for several days before easing again. This is why schedules hold each dose for weeks rather than increasing continuously.

Commonly they lessen as you stay at a given dose, then return briefly at the next step up. Many people find the pattern becomes predictable enough to plan around. Constipation and reflux can persist longer because they stem from slower stomach emptying rather than from adjustment.

Commonly suggested measures are smaller portions, stopping at the first sign of fullness, avoiding high-fat and very rich meals on dose day, and keeping fluids up. Because appetite suppression makes it easy to under-eat protein, a daily protein target is worth setting. Your prescriber may also slow your titration.

Immediately for severe or persistent abdominal pain, signs of gallbladder trouble, a neck lump or hoarseness, vision changes, or dehydration you cannot correct. These are covered in the official prescribing information, which should be your reference rather than any summary including this one.