History of pancreatitis: these compounds can rarely trigger pancreatitis. History of pancreatitis increases relative risk. That is a relative contraindication, not absolute, but requires monitoring.
31 likes 2mo
Safety · Contraindications · continued
Personal or family history of medullary thyroid carcinoma — what changed since posts 61–90
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
v.malinowski, post #50: Disordered eating history: appetite suppression can trigger relapse in people with history of anorexia, bulimia, or other eating disorders. This is a relative contraindication requiring specialist input. Go to post
Pregnancy: these compounds are not approved for pregnancy. The potential risks outweigh potential benefits. Planning windows and washout (several months) are the standard approach.
e.ferreira, post #2: Worth separating two things that the opening post runs together. Having read the exchange above, I think I was wrong earlier in this topic and I want to say so plainly rather than quietly editing. The correction was fair and I had been repeating something I had not checked carefully enough. Go to post
On post #60 — agreed on the reasoning, with one qualification.
Disordered eating history: appetite suppression can trigger relapse in people with history of anorexia, bulimia, or other eating disorders. This is a relative contraindication requiring specialist input.
This follows post #62 rather than contradicting it.
I disagree with the reply above, and I think the disagreement is substantive rather than terminological.
The distinction being drawn does not survive when you look at the published data for this specific question. I would be glad to be shown wrong on this, because the version I am arguing against is more convenient.
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ma.nascimento, post #46: On post #42 — agreed on the reasoning, with one qualification. Severe hepatic impairment: less is known than for kidney disease. Extreme caution or contraindication depending on the specific degree of impairment. Go to post
Allergy to the specific compound: true allergy is rare but possible. Any prior allergic reaction to the same compound or to structurally similar peptides warrants caution.
Medullary thyroid carcinoma (personal or family history) or multiple endocrine neoplasia type 2: absolute contraindication. The rodent preclinical signal is real enough to exclude this population.
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l.parkinson, post #47: Pregnancy: these compounds are not approved for pregnancy. The potential risks outweigh potential benefits. Planning windows and washout (several months) are the standard approach. Go to post
Coming back to post #68, because the follow-up matters more than the original answer.
Concurrent insulin or sulfonylureas: not an absolute contraindication but requires dose adjustment and close monitoring for hypoglycemia. The combination is used with caution, not avoided.
n.kuusela, post #64: On post #60 — agreed on the reasoning, with one qualification. Disordered eating history: appetite suppression can trigger relapse in people with history of anorexia, bulimia, or other eating disorders. This is a relative contraindication requiring specialist input. Go to post
History of pancreatitis: these compounds can rarely trigger pancreatitis. History of pancreatitis increases relative risk. That is a relative contraindication, not absolute, but requires monitoring.
eire_reader, post #41: post #40 is right about the mechanism and I think understates the practical bit. Concurrent insulin or sulfonylureas: not an absolute contraindication but requires dose adjustment and close monitoring for hypoglycemia. The combination is used with caution, not avoided. Go to post
Coming back to post #71, because the follow-up matters more than the original answer.
Severe renal impairment (eGFR <15): these compounds are renally cleared and accumulate in severe kidney disease. Risk-benefit is unfavourable without dose adjustment.
Picking up post #71: that is the part I would want checked first.
Thank you for the correction. I have edited my earlier post with a note rather than silently, so the thread still makes sense to read. The error was mine and it was the kind that comes from remembering a figure instead of looking it up.
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Concurrent insulin or sulfonylureas: not an absolute contraindication but requires dose adjustment and close monitoring for hypoglycemia. The combination is used with caution, not avoided.
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post #75 is right about the mechanism and I think understates the practical bit.
Gastroparesis or severe delayed gastric emptying: these compounds slow gastric emptying. Pre-existing severe gastroparesis can be worsened. That is a relative contraindication depending on baseline severity.
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s.beaulieu, post #51: Coming back to post #49, because the follow-up matters more than the original answer. Diabetic retinopathy complications: a signal for this was noted in SUSTAIN 6. Current evidence is mixed. The risk is not zero and some caution is appropriate in people with baseline retinopathy. Go to post
I read post #75 twice before replying, because I had assumed the opposite.
Medullary thyroid carcinoma (personal or family history) or multiple endocrine neoplasia type 2: absolute contraindication. The rodent preclinical signal is real enough to exclude this population.
On post #75 — agreed on the reasoning, with one qualification.
Two things before anyone answers the substance.
First, the context in the first post is clear and specific. Second, the question is framed so that an answer can actually address it. Both are the norm here and both matter more than they sound.
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Severe renal impairment (eGFR <15): these compounds are renally cleared and accumulate in severe kidney disease. Risk-benefit is unfavourable without dose adjustment.
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For anyone arriving from a search: the marked solution above is the direct answer, and the replies underneath it add the caveats that make it safe to use.
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Collapsed as off-topic by two members at trust level 3 or above
Pregnancy: these compounds are not approved for pregnancy. The potential risks outweigh potential benefits. Planning windows and washout (several months) are the standard approach.
post #84 is right about the mechanism and I think understates the practical bit.
Diabetic retinopathy complications: a signal for this was noted in SUSTAIN 6. Current evidence is mixed. The risk is not zero and some caution is appropriate in people with baseline retinopathy.
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integrator_draft, post #16: Picking up post #13: that is the part I would want checked first. Pregnancy: these compounds are not approved for pregnancy. The potential risks outweigh potential benefits. Planning windows and washout (several months) are the standard approach. Go to post
Worth separating two things that post #82 runs together.
Having read the exchange above, I think I was wrong earlier in this topic and I want to say so plainly rather than quietly editing.
The correction was fair and I had been repeating something I had not checked carefully enough.
s.stavrianos, post #77: I read post #75 twice before replying, because I had assumed the opposite. Medullary thyroid carcinoma (personal or family history) or multiple endocrine neoplasia type 2: absolute contraindication. The rodent preclinical signal is real enough to exclude this population. Go to post
Concurrent insulin or sulfonylureas: not an absolute contraindication but requires dose adjustment and close monitoring for hypoglycemia. The combination is used with caution, not avoided.