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Safety · Contraindications · continued

Pregnancy as an absolute contraindication posts 31–60

This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1 · go to the accepted answer.

EH
e.halonenTL218 May 2025 · edited#31
glossary_check, post #28: Anyone posting a contraindication claim should include the source. Without one it circulates and hardens. Go to post

Pregnancy is a good example of a question where the honest answer is boring and the interesting answers are unsupported. I would go with boring.

32 likes in reply to #28 14mo
JW
journalclub_wrenTL3Regular18 May 2025#32
buffer_review, post #5: Post #3 describes the usual case. This is about the unusual one. 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 is the sort of thing the wiki should carry and currently does not. Go to post

Where I part company with post #28, and it is a narrow parting.

Adding a small correction to the pregnancy summary above rather than a disagreement with it. The substance holds; one of the figures is out by a factor that matters.

0 likes in reply to #5 14mo
YA
y.asanteTL218 May 2025#33

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.

6 likes 14mo
SS
steady_stateTL318 May 2025#34
SV
s.vukovicTL218 May 2025#35

Building on post #33 rather than restating it.

Pregnancy: these compounds are not approved for pregnancy. The potential risks outweigh potential benefits. Planning windows and washout (several months) are the standard approach.

One more caveat and then I will stop qualifying: the sample selected itself.

24 likes 14mo
NE
n.ekstromTL2Regular18 May 2025#36

Post #32 put the caveat in the right place and I want to underline it.

Severe hepatic impairment: less is known than for kidney disease. Extreme caution or contraindication depending on the specific degree of impairment.

0 likes 14mo
CC
c.castellanosTL218 May 2025#37

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.

Someone should write this up properly, and it should probably not be me.

3 likes 14mo
YM
y.mensahTL3Wiki editor18 May 2025#38
s.perrin, post #27: Asking a pharmacist to check a contraindication takes minutes and is more reliable than any thread, including this one. Go to post

Following, with nothing to contribute beyond having asked the same thing elsewhere.

11 likes in reply to #27 14mo
VB
v.baptistaTL218 May 2025#39

Taking post #37 at face value and following it one step further.

Where a condition appears as a warning rather than a contraindication, the decision is a clinical one rather than a prohibition.

0 likes 14mo
BN
bench_notesTL4 Moderator18 May 2025#40

A caution and a contraindication are different levels and the difference is not stylistic. Conflating them makes the labelling sound more restrictive than it is.

3 likes 14mo
AR
ambient_reviewTL3Regular18 May 2025#41

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.

On balance I think that is right, and I would not bet much on it.

25 likes 14mo
NS
ni.stanescuTL218 May 2025#42
n.ekstrom, post #36: Post #32 put the caveat in the right place and I want to underline it. Severe hepatic impairment: less is known than for kidney disease. Extreme caution or contraindication depending on the specific degree of impairment. Go to post

Practical note on pregnancy: write down what you expect before you look. The number of times I have found what I went looking for is higher than chance would allow.

11 likes in reply to #36 14mo
SP
s.poulsenTL3Regular18 May 2025#43

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.

3 likes 14mo
AP
a.petrovTL218 May 2025#44

This follows post #41 rather than contradicting it.

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.

0 likes 14mo
KF
k.farrugiaTL3Regular18 May 2025 · edited#45
methods_draft, post #9: Grateful for the specificity. Vague answers to this question are what sent me looking. Go to post

Noted, and thank you for writing it out rather than summarising it.

33 likes in reply to #9 14mo
CB
c.balogunTL218 May 2025#46
a.petrov, post #44: This follows post #41 rather than contradicting it. 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

A contraindication in labelling is a specific statement about a specific product and population, and quoting the actual text is more useful than paraphrasing it.

17 likes in reply to #44 14mo
JH
j.habermannTL3Regular18 May 2025#47

On post #46 — agreed on the reasoning, with one qualification.

Personal or family history of medullary thyroid carcinoma, or multiple endocrine neoplasia type 2, is the clearest contraindication in this class and it is specific rather than general.

The part I am sure of is shorter than the part I have written.

7 likes 14mo
KO
k.okaforTL218 May 2025#48

Picking up post #46: that is the part I would want checked first.

Prior hypersensitivity to the product or its excipients is a contraindication that people forget applies to the excipients too.

Adding a source would improve this post and I do not have one to hand.

1 like 14mo
RM
r.marsdenTL3Regular18 May 2025#49

Answering the question post #46 raises rather than the one it answers.

Nothing here is medical advice, and a contraindication question is one where the cost of a wrong forum answer is high.

0 likes 14mo
FF
f.fontaineTL218 May 2025#50

The arithmetic in post #49 is right; the assumption feeding it is the part to check.

Labelling differs between jurisdictions for the same molecule, so quoting a contraindication should say which document it comes from.

Not a conclusion. A place to stand while looking for one.

24 likes 14mo
CS
c.serranoTL218 May 2025#51

Marking my place. If it changes for me I will come back and say so.

0 likes 14mo
B
BBramleyTL3Regular19 May 2025#52

Genuine question rather than a rhetorical one: has anyone here actually observed pregnancy, as opposed to read about it? The thread is long and I cannot tell.

0 likes 14mo
IA
i.amankwahTL219 May 2025#53
bench_notes, post #40: A caution and a contraindication are different levels and the difference is not stylistic. Conflating them makes the labelling sound more restrictive than it is. Go to post

Picking up post #52: that is the part I would want checked first.

A rodent toxicology finding underlying a contraindication is worth understanding, because it explains why the contraindication is narrow rather than broad.

Not the answer, but possibly the question that gets there.

4 likes in reply to #40 14mo
TN
t.nardoneTL3Regular19 May 2025#54
i.amankwah, post #53: Picking up post #52: that is the part I would want checked first. A rodent toxicology finding underlying a contraindication is worth understanding, because it explains why the contraindication is narrow rather than broad. Not the answer, but possibly the question that gets there. Go to post

On post #50 — agreed on the reasoning, with one qualification.

Asking a pharmacist to check a contraindication takes minutes and is more reliable than any thread, including this one.

13 likes in reply to #53 14mo
EM
e.mensaTL219 May 2025#55

The most common error here is treating a trial exclusion criterion as a contraindication. They are different documents with different purposes.

0 likes 14mo
H
HRouhaniTL1Member19 May 2025#56

A rodent toxicology finding underlying a contraindication is worth understanding, because it explains why the contraindication is narrow rather than broad.

It is a small point and it changes the answer, which is an awkward combination.

1 like 14mo
TT
t.tullochTL219 May 2025#57
y.mensah, post #38: Following, with nothing to contribute beyond having asked the same thing elsewhere. Go to post

Labelling differs between jurisdictions for the same molecule, so quoting a contraindication should say which document it comes from.

Somebody will have a better source than mine, and I hope they post it.

7 likes in reply to #38 14mo
VD
vial_deskTL3Regular19 May 2025#58

Post #54 describes the usual case. This is about the unusual one.

Nothing here is medical advice, and a contraindication question is one where the cost of a wrong forum answer is high.

It is worth stating the boring hypothesis before the interesting one.

18 likes 14mo
ST
s.teixeiraTL219 May 2025#59
m.lehtinen, post #1: Pregnancy as an absolute contraindication — setting out what I have, and where I think it stops being reliable. Pregnancy keeps being re-asked here and I think that is because the answer is conditional and the conditions never travel with it. Attempting to write the conditional version down properly. Corrections welcome and expected — I… Go to post

Post #56 answers the question as asked. The question underneath it is different.

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.

0 likes in reply to #1 14mo
H
HHidalgoTL2Member19 May 2025#60

I read post #58 twice before replying, because I had assumed the opposite.

Anyone posting a contraindication claim should include the source. Without one it circulates and hardens.

4 likes 14mo