Target dose, effective dose, and the distance between them
Two withdrawal-design trials tell us what happens when treatment stops. Neither tells us what the lowest effective maintenance dose is.
Dosing
Page 31 of 31 of this archive, newest first.
Stepping down is part of titration
The practice is near-universal, clinically sensible, and supported by observational data rather than randomised comparison. We say which is which.
What the new Argentina guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
Sweden pharmacy body issues counselling standards for semaglutide initiation
The evidence base is thin and the document says so, which is to its credit.
Italy pharmacy body issues counselling standards for dulaglutide initiation
The evidence base is thin and the document says so, which is to its credit.
What a 1 mL syringe does that a 0.3 mL syringe does not
Dead space in the needle hub is a real and calculable loss, and it matters more at small volumes than anybody expects.
Pancreatitis, obstruction, gallbladder: three things nausea can be
Pancreatitis is rare, was adjudicated in the outcome programmes, and did not show the imbalance early case reports suggested.
A needle is a single-use instrument
A needle blunts on first use. Reuse is uncomfortable, and it is a documented contributor to lipohypertrophy.
What STEP 4 and SURMOUNT-4 actually established
Two withdrawal-design trials tell us what happens when treatment stops. Neither tells us what the lowest effective maintenance dose is.
Forty-four per cent: reading the nausea figure properly
Trial adverse-event tables count episodes reported to a study nurse. They are the best data we have and they systematically under-record the mundane.
Attribution is the hard part
We give background rates alongside trial rates, because an event occurring during treatment is not thereby caused by it.
What a 1 mL syringe does that a 0.3 mL syringe does not
A unit is a volume. A dose is a mass. The bridge between them is concentration, and concentration is a number somebody has to calculate.
Background rates, and why they matter for attribution
The features that should prompt urgent assessment, stated once and plainly.