When to stop escalating and when to stop entirely
The ceiling varies severalfold between people, and nothing measurable at baseline predicts where it sits.
Side effects
Page 9 of 21 of this archive, newest first.
The arithmetic of a step: what doubling a dose actually asks of you
The four-week step exists because four to five weeks is approximately how long a once-weekly drug takes to stop rising at a fixed dose. That is a good reason, and it is not…
What the new Australia guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
Saudi Arabia 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 trials counted as intolerance
Trial discontinuation figures are a floor, not an estimate: trial populations are supported in ways ordinary patients are not.
Pancreatitis, obstruction, gallbladder: three things nausea can be
A small number of serious gastrointestinal events occur in people taking these drugs. Distinguishing them from the expected effect profile is the most consequential…
The restart nobody plans for
We work through the residual-exposure table so the decision can be made from numbers rather than from feel.
The mechanism behind the mechanism
The clinical effect profile is almost fully predictable from where the receptor is expressed, which is unusual and useful.
What the new Japan guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
South Korea pharmacy body issues counselling standards for dulaglutide initiation
The evidence base is thin and the document says so, which is to its credit.
Saudi Arabia pharmacy body issues counselling standards for semaglutide initiation
The evidence base is thin and the document says so, which is to its credit.
Escalating onto a rising curve
The four-week step exists because four to five weeks is approximately how long a once-weekly drug takes to stop rising at a fixed dose. That is a good reason, and it is not…
New Zealand pharmacy body issues counselling standards for exenatide initiation
The evidence base is thin and the document says so, which is to its credit.
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…
What the new Mexico guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
The label says four weeks. The clinic says whatever holds.
Deviation from the printed ladder is not non-compliance. In this class it is the modal behaviour of competent prescribing.
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.
Switzerland pharmacy body issues counselling standards for semaglutide initiation
The evidence base is thin and the document says so, which is to its credit.
The mechanism behind the mechanism
Delayed gastric emptying is a mechanism that becomes an adverse effect above a threshold. It is not a complication in the ordinary sense.
The effect profile, predicted from an expression map
A single drug producing both constipation and diarrhoea looks contradictory until the motility data is read properly.