The mechanism behind the mechanism
A single drug producing both constipation and diarrhoea looks contradictory until the motility data is read properly.
Dosing
Page 17 of 31 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.
SURMOUNT-OSA was built to answer the stopping question, and it did
The evidence on stopping is better than the evidence on almost anything else in this field, because somebody deliberately randomised it.
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.
How a correct calculation becomes a wrong dose
We have catalogued what readers report, ranked by the size of the dosing error each produces.
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.
Maintenance dosing: what is licensed, what is practised, and what is evidenced
Every withdrawal trial compared full dose against nothing. The clinically interesting comparison — full dose against a reduced one — has not been randomised.
A year after stopping: what the trials found at the far end
The variance around the mean regain trajectory is large and unexplained, exactly as it is for the weight loss.
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 Germany guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
What the new India guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
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.
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.
How a correct calculation becomes a wrong dose
A pharmacist catches most of these in licensed practice. In this market there is no pharmacist, so the checks have to be structural.
What the new South Africa guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
Gauge, pain and flow rate
The insulin injection-technique literature is large, well conducted and directly transferable on questions of depth and tissue. We say where it stops transferring.