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…
Pharmacology in 2024
Page 3 of 5 of this archive, newest first.
What actually helps, ranked by evidence
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.
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…
Reading the dulaglutide titration schedule as a regulatory artefact
The published ladder exists because a protocol needed a single number. Practice has never followed it exactly, and the regulatory file never assumed it would.
Why your endoscopist wants to know about your injection
This is the single interaction with ordinary medical care that patients most need to disclose, and it is the one most often not asked about.
A missed dose, modelled: what happens to liraglutide concentrations over the following fortnight
Half-life, accumulation ratio and time to steady state are three separate quantities, and confusing them produces most of the bad advice in circulation.
What STEP 4 and SURMOUNT-4 actually established
Weight reduction in the long programmes flattens at roughly sixty to seventy-two weeks. The timing is consistent, predictable and almost never mentioned in advance.
Three weeks off is a fresh start, whether or not you want one
Supply interruption is the commonest cause of unplanned re-titration in this market, and it is almost never framed that way.
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.
Adverse events by dose, adverse events by week
Almost every figure in circulation about tolerability comes from six publications. This is what they say.
Background rates, and why they matter for attribution
We give background rates alongside trial rates, because an event occurring during treatment is not thereby caused by it.
A schedule that bends does not break
Reducing a dose is not going backwards. In a tolerability-limited class it is the mechanism by which the ceiling is found.
What the anaesthetists said, and then said again
The evidence is real, modest, and mostly retrospective. The guidance is correspondingly cautious and has been revised toward individualisation.
Escalating past the approved maximum, examined honestly
Where the curve flattens, what flattens with it, and what does not.
Holding the dose before surgery: for whom, for how long
This is the single interaction with ordinary medical care that patients most need to disclose, and it is the one most often not asked about.
Gastric emptying is a mechanism, not a side effect
The central effects are not a bonus. On the current evidence they are the principal mechanism of weight loss.
Background rates, and why they matter for attribution
A small number of serious gastrointestinal events occur in people taking these drugs. Distinguishing them from the expected effect profile is the most consequential…
Target dose, effective dose, and the distance between them
What the trials measured was continuation against withdrawal. What patients want to know is continuation at a lower dose, and that study has largely not been done.
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.
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.