From milligrams in a vial to units in a barrel
A more concentrated reconstitution means smaller injection volumes, which means larger proportional errors from graduation, dead space and technique.
Dosing
Page 15 of 31 of this archive, newest first.
The intramuscular injection nobody intended
A 4 mm needle at ninety degrees without a skin pinch is adequate for essentially all adults. The persistence of 12.7 mm needles in this market is habit, not reasoning.
The shortage years, and what they taught about interruption
Real-world persistence figures, with their definitions stated, because the definitions are doing most of the work.
The label says four weeks. The clinic says whatever holds.
Deviation from the printed ladder is not non-compliance. In this class it is the modal behaviour of competent prescribing.
Switzerland pharmacy body issues counselling standards for semaglutide initiation
The evidence base is thin and the document says so, which is to its credit.
Diminishing returns, quantified
Where the curve flattens, what flattens with it, and what does not.
The withdrawal trials, read as designs rather than warnings
The evidence on stopping is better than the evidence on almost anything else in this field, because somebody deliberately randomised it.
South Africa pharmacy body issues counselling standards for tirzepatide initiation
The evidence base is thin and the document says so, which is to its credit.
The lowest effective dose is a real concept with almost no data behind it
Every withdrawal trial compared full dose against nothing. The clinically interesting comparison — full dose against a reduced one — has not been randomised.
From cell to clinic: where the extrapolation stops being safe
Receptor pharmacology is strong on average effects and almost silent on individual variation. That gap is where most reader questions live.
Gallstones during rapid weight loss: drug, or weight loss?
A small number of serious gastrointestinal events occur in people taking these drugs. Distinguishing them from the expected effect profile is the most consequential…
Germany pharmacy body issues counselling standards for exenatide initiation
The evidence base is thin and the document says so, which is to its credit.
What TRIUMPH-1 tells us about maintenance, and what it does not
Dose reduction is not withdrawal, and the trials that tested withdrawal cannot be read as testing it.
Side effects, cost, supply, target: four reasons with four trajectories
The trials studied planned withdrawal. Almost nobody stops that way.
What SURMOUNT-1 tells us about maintenance, and what it does not
The commonest real-world strategy in this drug class is the least studied one.
Do you need the top of the ladder?
A plateau at an intermediate dose and a plateau at the maximum dose look identical from the outside and mean different things.
What the new the Netherlands guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
What the trial protocols permitted, and what the labels omitted
The practice is near-universal, clinically sensible, and supported by observational data rather than randomised comparison. We say which is which.
Escalating onto a rising curve
We work the arithmetic out in full, because it is arithmetic and it is short.
From cell to clinic: where the extrapolation stops being safe
The mechanism is well described. The variance is not.