Delayed emptying explains some of this, and not all of it
A single drug producing both constipation and diarrhoea looks contradictory until the motility data is read properly.
Nausea
Page 3 of 5 of this archive, newest first.
The incidence tables, read line by line
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.
Antiemetics, laxatives and the thin literature underneath them
Constipation is the most tractable of the effects and the most consistently under-managed.
Delayed emptying explains some of this, and not all of it
What scintigraphy and breath-test studies established about emptying rate, and what they did not.
What the trials counted as intolerance
The ceiling varies severalfold between people, and nothing measurable at baseline predicts where it sits.
Holding the dose before surgery: for whom, for how long
A drug that delays gastric emptying complicates the assumption behind every fasting instruction in perioperative medicine. The professional bodies have moved twice on this…
Tolerability is the ceiling, and the ceiling is personal
Trial discontinuation figures are a floor, not an estimate: trial populations are supported in ways ordinary patients are not.
Attribution is the hard part
Pancreatitis is rare, was adjudicated in the outcome programmes, and did not show the imbalance early case reports suggested.
When to stop escalating and when to stop entirely
An effect is dose-limiting when it prevents adequate intake, prevents normal activity, or produces a risk of its own. Discomfort alone is not the test.
When to stop escalating and when to stop entirely
An effect is dose-limiting when it prevents adequate intake, prevents normal activity, or produces a risk of its own. Discomfort alone is not the test.
What the trials counted as intolerance
We set out the questions that distinguish a symptom to manage from a dose to change.
Hydration, protein and the two failures that compound each other
Dietary measures are widely recommended, plausible on mechanism, and supported mainly by observational data and clinical experience.
Gallstones during rapid weight loss: drug, or weight loss?
We give background rates alongside trial rates, because an event occurring during treatment is not thereby caused by it.
Reflux, early satiety, and the volume the stomach will accept
The clinical effect profile is almost fully predictable from where the receptor is expressed, which is unusual and useful.
Dose-limiting: a definition worth being strict about
Roughly four to seven per cent of trial participants discontinued for adverse events, mostly gastrointestinal, mostly during escalation. That is the empirical size of the…
Delayed emptying explains some of this, and not all of it
What scintigraphy and breath-test studies established about emptying rate, and what they did not.
Tolerability is the ceiling, and the ceiling is personal
Roughly four to seven per cent of trial participants discontinued for adverse events, mostly gastrointestinal, mostly during escalation. That is the empirical size of the…
The interventions with trial support, and the much longer list without
We separate what is supported, what is reasonable, and what is folklore, and we do not pretend the boundaries are crisp.
Constipation is the one that responds best to boring measures
Dietary measures are widely recommended, plausible on mechanism, and supported mainly by observational data and clinical experience.
Discontinuation rates, read honestly
Roughly four to seven per cent of trial participants discontinued for adverse events, mostly gastrointestinal, mostly during escalation. That is the empirical size of the…