The mechanism behind the mechanism
A single drug producing both constipation and diarrhoea looks contradictory until the motility data is read properly.
Side effects
Page 11 of 21 of this archive, newest first.
What the new Singapore guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
The Netherlands pharmacy body issues counselling standards for tirzepatide initiation
The evidence base is thin and the document says so, which is to its credit.
What the new Ireland guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
When a symptom is information and when it is noise
A dose held long enough stops being a pause and becomes a maintenance decision. That transition is rarely made explicitly.
What the new the United Arab Emirates guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
Do you need the top of the ladder?
The dose-response curve in this class flattens near its top. That has direct consequences for whether the final rung is worth climbing.
When a symptom is information and when it is noise
The practice is near-universal, clinically sensible, and supported by observational data rather than randomised comparison. We say which is which.
What the new India guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
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.
Tolerability is the ceiling, and the ceiling is personal
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.
Antiemetics, laxatives and the thin literature underneath them
Constipation is the most tractable of the effects and the most consistently under-managed.
What the new the United Arab Emirates guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
What the new South Africa guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
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.
Holding a dose is a decision, not a failure
Nausea and gastric delay attenuate over weeks at an unchanged dose. That single physiological fact is the entire justification for holding.
The restart nobody plans for
We work through the residual-exposure table so the decision can be made from numbers rather than from feel.
Japan pharmacy body issues counselling standards for exenatide initiation
The evidence base is thin and the document says so, which is to its credit.
What the new Australia guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
What the trials counted as intolerance
The ceiling varies severalfold between people, and nothing measurable at baseline predicts where it sits.