Escalating onto a rising curve
We work the arithmetic out in full, because it is arithmetic and it is short.
Side effects
Page 15 of 21 of this archive, newest first.
What the new Japan guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
Hydration, protein and the two failures that compound each other
Almost nothing in the standard management repertoire has been tested in a randomised trial in this specific population. We say what is extrapolated and from where.
Holding the dose before surgery: for whom, for how long
The evidence is real, modest, and mostly retrospective. The guidance is correspondingly cautious and has been revised toward individualisation.
What the new Nigeria guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
What STEP 4 and SURMOUNT-4 actually established
A plateau at an intermediate dose and a plateau at the maximum dose look identical from the outside and mean different things.
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.
The tolerability data everybody quotes and nobody reads
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.
Norway pharmacy body issues counselling standards for tirzepatide initiation
The evidence base is thin and the document says so, which is to its credit.
Switzerland pharmacy body issues counselling standards for exenatide initiation
The evidence base is thin and the document says so, which is to its credit.
Gallstones during rapid weight loss: drug, or weight loss?
Pancreatitis is rare, was adjudicated in the outcome programmes, and did not show the imbalance early case reports suggested.
Spain pharmacy body issues counselling standards for dulaglutide initiation
The evidence base is thin and the document says so, which is to its credit.
Holding a dose is a decision, not a failure
Reducing a dose is not going backwards. In a tolerability-limited class it is the mechanism by which the ceiling is found.
The United Kingdom pharmacy body issues counselling standards for dulaglutide initiation
The evidence base is thin and the document says so, which is to its credit.
Discontinuation rates, read honestly
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.
Reflux, early satiety, and the volume the stomach will accept
The receptor populations that produce satiety and the ones that produce nausea overlap substantially. That is why the ceiling of this drug class is where it is, and it is…
Delayed emptying explains some of this, and not all of it
The clinical effect profile is almost fully predictable from where the receptor is expressed, which is unusual and useful.
A schedule that bends does not break
Nausea and gastric delay attenuate over weeks at an unchanged dose. That single physiological fact is the entire justification for holding.
Diminishing returns, quantified
Where the curve flattens, what flattens with it, and what does not.
The area postrema, and the anatomy of an unwanted effect
A single drug producing both constipation and diarrhoea looks contradictory until the motility data is read properly.