diff --git a/src/app/api/medications/[id]/titration/__tests__/route.test.ts b/src/app/api/medications/[id]/titration/__tests__/route.test.ts
new file mode 100644
index 000000000..f505fb912
--- /dev/null
+++ b/src/app/api/medications/[id]/titration/__tests__/route.test.ts
@@ -0,0 +1,227 @@
+/**
+ * v1.4.25 W19f — titration-ladder route tests.
+ *
+ * Mirrors the W19e cadence-route test fixture: external dependencies
+ * are mocked at module boundaries (prisma, session, logging
+ * transport) so each test pins one contract case. The pure ladder
+ * helpers are covered separately in
+ * `src/lib/medications/titration/__tests__/ladder.test.ts`.
+ */
+
+import { describe, it, expect, vi, beforeEach } from "vitest";
+import { NextRequest } from "next/server";
+
+vi.mock("@/lib/db", () => ({
+  prisma: {
+    medication: { findUnique: vi.fn() },
+  },
+}));
+
+vi.mock("@/lib/auth/session", () => ({ getSession: vi.fn() }));
+
+vi.mock("@/lib/logging/transports", () => ({ emitIfSampled: vi.fn() }));
+
+vi.mock("@/lib/db-compat", () => ({
+  ensureDbCompatibility: vi.fn().mockResolvedValue(undefined),
+}));
+
+vi.mock("next/headers", () => ({
+  headers: vi.fn(async () => ({ get: () => null })),
+  cookies: vi.fn(async () => ({
+    get: () => undefined,
+    set: () => {},
+    delete: () => {},
+  })),
+}));
+
+import { GET } from "../route";
+import { prisma } from "@/lib/db";
+import { getSession } from "@/lib/auth/session";
+
+const SESSION_OK = {
+  session: { id: "sess-1", expiresAt: new Date(Date.now() + 3_600_000) },
+  user: { id: "user-1", username: "marc", role: "USER" as const },
+};
+
+function makeMed(
+  overrides: Partial<{
+    name: string;
+    dose: string;
+    treatmentClass: "GLP1" | "GENERIC";
+    userId: string;
+    doseChanges: Array<{ effectiveFrom: Date; doseValue: number }>;
+  }> = {},
+) {
+  return {
+    id: "med-1",
+    name: overrides.name ?? "Mounjaro",
+    dose: overrides.dose ?? "5 mg",
+    treatmentClass: overrides.treatmentClass ?? ("GLP1" as const),
+    userId: overrides.userId ?? "user-1",
+    createdAt: new Date(),
+    doseChanges: overrides.doseChanges ?? [],
+  };
+}
+
+beforeEach(() => {
+  vi.resetAllMocks();
+});
+
+describe("GET /api/medications/[id]/titration", () => {
+  it("returns 401 when unauthenticated", async () => {
+    vi.mocked(getSession).mockResolvedValue(null);
+    const res = await GET(
+      new NextRequest("http://localhost/api/medications/med-1/titration"),
+      { params: Promise.resolve({ id: "med-1" }) },
+    );
+    expect(res.status).toBe(401);
+  });
+
+  it("returns 404 when the medication is not owned by the caller", async () => {
+    vi.mocked(getSession).mockResolvedValue(SESSION_OK as never);
+    vi.mocked(prisma.medication.findUnique).mockResolvedValue(
+      makeMed({ userId: "OTHER" }) as never,
+    );
+
+    const res = await GET(
+      new NextRequest("http://localhost/api/medications/med-1/titration"),
+      { params: Promise.resolve({ id: "med-1" }) },
+    );
+    expect(res.status).toBe(404);
+  });
+
+  it("returns 404 when the medication is not GLP-1", async () => {
+    vi.mocked(getSession).mockResolvedValue(SESSION_OK as never);
+    vi.mocked(prisma.medication.findUnique).mockResolvedValue(
+      makeMed({ treatmentClass: "GENERIC" }) as never,
+    );
+
+    const res = await GET(
+      new NextRequest("http://localhost/api/medications/med-1/titration"),
+      { params: Promise.resolve({ id: "med-1" }) },
+    );
+    expect(res.status).toBe(404);
+  });
+
+  it("returns 404 when the medication brand is not in the GLP-1 catalog", async () => {
+    vi.mocked(getSession).mockResolvedValue(SESSION_OK as never);
+    vi.mocked(prisma.medication.findUnique).mockResolvedValue(
+      makeMed({ name: "MysteryDrug" }) as never,
+    );
+
+    const res = await GET(
+      new NextRequest("http://localhost/api/medications/med-1/titration"),
+      { params: Promise.resolve({ id: "med-1" }) },
+    );
+    expect(res.status).toBe(404);
+  });
+
+  it("returns the ladder + current step for a Mounjaro user on 5 mg", async () => {
+    vi.mocked(getSession).mockResolvedValue(SESSION_OK as never);
+    vi.mocked(prisma.medication.findUnique).mockResolvedValue(
+      makeMed({
+        name: "Mounjaro",
+        dose: "5 mg",
+        doseChanges: [
+          {
+            effectiveFrom: new Date(Date.now() - 6 * 7 * 24 * 60 * 60 * 1000),
+            doseValue: 2.5,
+          },
+          {
+            effectiveFrom: new Date(Date.now() - 2 * 7 * 24 * 60 * 60 * 1000),
+            doseValue: 5,
+          },
+        ],
+      }) as never,
+    );
+
+    const res = await GET(
+      new NextRequest("http://localhost/api/medications/med-1/titration"),
+      { params: Promise.resolve({ id: "med-1" }) },
+    );
+    expect(res.status).toBe(200);
+    const json = await res.json();
+    expect(json.data.drugId).toBe("tirzepatide");
+    expect(json.data.ladder.length).toBe(6);
+    expect(json.data.currentStep.doseMg).toBe(5);
+    expect(json.data.currentStepIndex).toBe(1);
+    expect(json.data.weeksOnCurrentStep).toBe(2);
+    expect(json.data.nextStep.doseMg).toBe(7.5);
+    expect(json.data.escalationDue).toBe(false);
+  });
+
+  it("returns a null current step when the user dose is outside any ladder bucket", async () => {
+    vi.mocked(getSession).mockResolvedValue(SESSION_OK as never);
+    vi.mocked(prisma.medication.findUnique).mockResolvedValue(
+      makeMed({
+        name: "Mounjaro",
+        dose: "6 mg", // outside the ±10 % window of 5 and 7.5
+        doseChanges: [],
+      }) as never,
+    );
+
+    const res = await GET(
+      new NextRequest("http://localhost/api/medications/med-1/titration"),
+      { params: Promise.resolve({ id: "med-1" }) },
+    );
+    expect(res.status).toBe(200);
+    const json = await res.json();
+    expect(json.data.currentStep).toBeNull();
+    expect(json.data.currentStepIndex).toBeNull();
+    expect(json.data.nextStep).toBeNull();
+    expect(json.data.escalationDue).toBe(false);
+  });
+
+  it("returns a null next-step at the ladder ceiling", async () => {
+    vi.mocked(getSession).mockResolvedValue(SESSION_OK as never);
+    vi.mocked(prisma.medication.findUnique).mockResolvedValue(
+      makeMed({
+        name: "Mounjaro",
+        dose: "15 mg",
+        doseChanges: [
+          {
+            effectiveFrom: new Date(Date.now() - 5 * 7 * 24 * 60 * 60 * 1000),
+            doseValue: 15,
+          },
+        ],
+      }) as never,
+    );
+
+    const res = await GET(
+      new NextRequest("http://localhost/api/medications/med-1/titration"),
+      { params: Promise.resolve({ id: "med-1" }) },
+    );
+    expect(res.status).toBe(200);
+    const json = await res.json();
+    expect(json.data.currentStep.doseMg).toBe(15);
+    expect(json.data.nextStep).toBeNull();
+    expect(json.data.escalationDue).toBe(false);
+  });
+
+  it("flags escalationDue=true past the EMA dwell-time on a non-ceiling step", async () => {
+    vi.mocked(getSession).mockResolvedValue(SESSION_OK as never);
+    vi.mocked(prisma.medication.findUnique).mockResolvedValue(
+      makeMed({
+        name: "Mounjaro",
+        dose: "2.5 mg",
+        doseChanges: [
+          {
+            // Six weeks ago, past tirzepatide's 4-week interval.
+            effectiveFrom: new Date(Date.now() - 6 * 7 * 24 * 60 * 60 * 1000),
+            doseValue: 2.5,
+          },
+        ],
+      }) as never,
+    );
+
+    const res = await GET(
+      new NextRequest("http://localhost/api/medications/med-1/titration"),
+      { params: Promise.resolve({ id: "med-1" }) },
+    );
+    expect(res.status).toBe(200);
+    const json = await res.json();
+    expect(json.data.currentStep.doseMg).toBe(2.5);
+    expect(json.data.weeksOnCurrentStep).toBe(6);
+    expect(json.data.escalationDue).toBe(true);
+  });
+});
diff --git a/src/app/api/medications/[id]/titration/route.ts b/src/app/api/medications/[id]/titration/route.ts
new file mode 100644
index 000000000..e0cab8a41
--- /dev/null
+++ b/src/app/api/medications/[id]/titration/route.ts
@@ -0,0 +1,146 @@
+/**
+ * v1.4.25 W19f — GLP-1 titration-ladder read endpoint.
+ *
+ *   GET /api/medications/[id]/titration
+ *     - returns the EMA-reference ladder for the medication's drug,
+ *       the user's current step (matched within ±10 % tolerance to
+ *       their latest dose), how long they've been on that step, the
+ *       immediate-next step (if any), and the observational
+ *       escalation-due flag.
+ *
+ * Pure computation — no writes. Delegates math to the
+ * `src/lib/medications/titration/ladder` module so the route, the
+ * Coach snapshot (future wave), and the detail-page section all read
+ * the same numbers.
+ *
+ * Auth: cookie-session via requireAuth(); medication is verified to
+ * belong to the caller before any read. Defence-in-depth: returns
+ * 404 for non-GLP-1 medications (the UI already gates on
+ * `treatmentClass === "GLP1"`).
+ */
+
+import { NextRequest } from "next/server";
+
+import { prisma } from "@/lib/db";
+import { apiHandler, requireAuth } from "@/lib/api-handler";
+import { annotate } from "@/lib/logging/context";
+import { apiError, apiSuccess } from "@/lib/api-response";
+import { findDrugByBrand, GLP1_DRUGS, type Glp1DrugId } from "@/lib/medications/glp1-knowledge";
+import {
+  escalationDue,
+  findCurrentStep,
+  ladderFromRecord,
+  nextStep,
+  weeksOnCurrentStep,
+} from "@/lib/medications/titration/ladder";
+
+type RouteParams = { params: Promise<{ id: string }> };
+
+export const GET = apiHandler(
+  async (_request: NextRequest, { params }: RouteParams) => {
+    const { user } = await requireAuth();
+    const { id } = await params;
+
+    const med = await prisma.medication.findUnique({
+      where: { id },
+      include: {
+        doseChanges: { orderBy: { effectiveFrom: "asc" } },
+      },
+    });
+    if (!med || med.userId !== user.id) {
+      return apiError("Medication not found", 404);
+    }
+    if (med.treatmentClass !== "GLP1") {
+      // Defence-in-depth: the UI already gates the section on this
+      // class, but the route refuses to surface the ladder for a
+      // non-GLP-1 row so we never leak a misleading "you are here"
+      // on a generic medication.
+      return apiError("Medication not found", 404);
+    }
+
+    // Resolve the GLP-1 drug record from the medication name. Same
+    // path the DrugLevelChart uses; null when the medication name
+    // doesn't map to a catalog brand (e.g. user typed a generic
+    // INN instead of a brand).
+    const record = findDrugByBrand(med.name);
+    if (!record) {
+      return apiError("Medication not found", 404);
+    }
+    let drugId: Glp1DrugId | null = null;
+    for (const [id, r] of Object.entries(GLP1_DRUGS)) {
+      if (r === record) {
+        drugId = id as Glp1DrugId;
+        break;
+      }
+    }
+    if (!drugId) {
+      return apiError("Medication not found", 404);
+    }
+
+    const ladder = ladderFromRecord(record);
+
+    // Resolve the user's most-recent dose. Prefer the
+    // MedicationDoseChange stream (the history of record); fall back
+    // to the legacy free-text `medication.dose` if the stream is empty.
+    const latestChange =
+      med.doseChanges.length > 0
+        ? med.doseChanges[med.doseChanges.length - 1]
+        : null;
+    const latestDoseMg = latestChange
+      ? latestChange.doseValue
+      : parseDoseString(med.dose);
+
+    const currentStep = findCurrentStep(drugId, latestDoseMg);
+    const next = nextStep(drugId, currentStep);
+    const asOf = new Date();
+    const weeks = weeksOnCurrentStep(
+      drugId,
+      currentStep,
+      med.doseChanges.map((dc) => ({
+        effectiveFrom: dc.effectiveFrom,
+        doseValue: dc.doseValue,
+      })),
+      asOf,
+    );
+    const due = escalationDue(drugId, currentStep, weeks);
+
+    annotate({
+      action: {
+        name: "medication.titration",
+        entity_type: "medication",
+        entity_id: id,
+      },
+      meta: {
+        drug_id: drugId,
+        step_index: currentStep?.stepIndex ?? null,
+        weeks_on_step: weeks,
+      },
+    });
+
+    return apiSuccess({
+      drugId,
+      drugInn: record.inn,
+      ladder,
+      currentStep,
+      currentStepIndex: currentStep?.stepIndex ?? null,
+      weeksOnCurrentStep: weeks,
+      nextStep: next,
+      escalationDue: due,
+      sourceEMA: record.sourceEMA,
+    });
+  },
+);
+
+/**
+ * Parse the legacy free-text `medication.dose` ("0.5 mg", "5 mg",
+ * "0.25") into a numeric mg value. Returns null when the string
+ * doesn't carry a parseable number — the helper above treats null
+ * as "no current step" rather than 0.
+ */
+function parseDoseString(dose: string): number | null {
+  const match = dose.match(/[-+]?\d*\.?\d+/);
+  if (!match) return null;
+  const n = Number(match[0]);
+  if (!Number.isFinite(n)) return null;
+  return n;
+}