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The following stepwise schedule mirrors the inverse of the titration ladder: | Week | Taper Step | Notes | |---|---|---| | Week 1 to 2 | Reduce from 12 mg to 8 mg | Monitor weight and GI symptoms | | Week 3 to 4 | Remain at 8 mg | Confirm tolerability of step-down | | Week 5 to 6 | Reduce from 8 mg to 4 mg | Expect modest appetite increase | | Week 7 to 8 | Remain at 4 mg | Reinforce dietary structure | | Week 9 to 10 | Reduce from 4 mg to 2 mg | Begin transition plan | | Week 11 to 12 | Final 2 mg injection, then stop | Schedule 4-week follow-up | Patients stopping from an 8 mg maintenance dose begin the taper at that level and follow the same 4 mg and 2 mg steps over 8 weeks

Zhuo, N

Intestinal permeability was normalized in the glutamine group but not in the control group

H., & Simmonds, D

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