What the trials counted as intolerance
We set out the questions that distinguish a symptom to manage from a dose to change.
Nausea
Page 4 of 5 of this archive, newest first.
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.
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.
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.
What actually helps, ranked by evidence
The intervention with the clearest evidence is the one nobody frames as an intervention: adjusting the dose.
The effect profile, predicted from an expression map
Delayed gastric emptying is a mechanism that becomes an adverse effect above a threshold. It is not a complication in the ordinary sense.
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.
Residual stomach content on endoscopy: the studies
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.
The interventions with trial support, and the much longer list without
The intervention with the clearest evidence is the one nobody frames as an intervention: adjusting the dose.
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…
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.
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.
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.
Reflux, early satiety, and the volume the stomach will accept
The clinical effect profile is almost fully predictable from where the receptor is expressed, which is unusual and useful.
Pancreatitis, obstruction, gallbladder: three things nausea can be
The features that should prompt urgent assessment, stated once and plainly.
What the trials adjudicated, and how
We give background rates alongside trial rates, because an event occurring during treatment is not thereby caused by it.
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.