The mechanism behind the mechanism
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…
Priya Ramanathan, PharmD
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Archive — page 4
131 piecesVitamin D, adiposity, and a volume-of-distribution problem
Micronutrient guidance for this drug class is borrowed almost entirely from post-bariatric surveillance, where the anatomy is different and the deficiency mechanisms are not…
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.
Why your laboratory interval differs from the one in the textbook
The arithmetic of the reference change value, worked for the analytes that matter here.
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.
Six things incretin pharmacology cannot currently predict
Receptor pharmacology is strong on average effects and almost silent on individual variation. That gap is where most reader questions live.
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.
The restart nobody plans for
We work through the residual-exposure table so the decision can be made from numbers rather than from feel.
What the trials counted as intolerance
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.
A number without a suitability record is a number from an unknown instrument
System suitability is the set of checks demonstrating that the instrument and method were performing adequately when your sample was injected. It is recorded as a matter of…
Why your laboratory interval differs from the one in the textbook
Two sources of noise sit under every number: how reproducible the assay is, and how much the analyte varies within the same person on the same day.
How a peptide that lasts seven days binds a receptor that recycles in minutes
A tour of what happens in the thirty seconds after binding, and why it matters at week thirty.
The lowest effective dose is a real concept with almost no data behind it
Dose reduction is not withdrawal, and the trials that tested withdrawal cannot be read as testing it.
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.
The site you keep using is the site that stops working
Lipohypertrophic tissue is less painful to inject into, which is precisely why people keep injecting into it.
Priming a pen is not optional
For licensed products the in-use period is established by stability data. For a peptide reconstituted at home there is no such data, and the honest answer is that nobody…
Rapid weight loss moves eight analytes for reasons that have nothing to do with the drug
Three different explanations for the same abnormal number, and how to tell them apart.
One method is one opinion
An orthogonal method separates on a different physical principle, so that species co-eluting in the first are likely to resolve in the second. Two runs of the same method at…
What changing your injection day does to tirzepatide exposure, and what it does not
What the pharmacokinetic data supports about dose timing, missed doses and interruption.
Why a drug that acts on the pancreas changes what food tastes like
A tour of the tissues where the receptor is expressed, and what happens in each.