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.
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Safety · Contraindications · continued
Pregnancy as an absolute contraindication posts 61–90
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.
Collapsed as off-topic by two members at trust level 3 or above
Post #59 is the version of this I will quote in future. One addition.
Having read the whole pregnancy thread before replying: the question in the first post has not actually been answered yet, and three of us have answered a nearby one instead.
Where I would push back on the pregnancy consensus is the confidence, not the direction. The direction looks right. The confidence is borrowed.
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k.ogunleye, post #10: 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. A partial answer, offered because a partial answer beats none. 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.
Pregnancy looks different depending on whether you are reading the primary literature or the summaries of it, and the difference is not in our favour.
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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.
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Answering the question post #63 raises rather than the one it answers.
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.
That is the honest state of it as of this week.
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p.lindqvist, post #4: 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. A guess, clearly labelled as one. 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.
I would want to see it done twice before believing it once.
Post #67 and I disagree about the size of the effect, not about the direction.
Where a contraindication is relative rather than absolute, the reasoning usually appears in the assessment report rather than the labelling.
The short version is the first sentence; the rest is why.
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Asking a pharmacist to check a contraindication takes minutes and is more reliable than any thread, including this one.
Posted with less confidence than the sentence structure implies.
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compounding_ruth, post #68: 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. I would want to see it done twice before believing it once. Go to post
Post #70 is the version of this I will quote in future. One addition.
Severe hepatic impairment: less is known than for kidney disease. Extreme caution or contraindication depending on the specific degree of impairment.
Answering the question post #72 raises rather than the one it answers.
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.
Happy to be corrected if someone holds better data than mine.
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bias_variance, post #64: 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
Nothing to add on the substance. Thank you for taking the question at face value.
h.bhattacharya, post #6: Adding the measurement that post #3 says would settle it. 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. This is the sort of thing that ought to be settled and apparently is not. Go to post
I had written a reply contradicting post #72 and deleted it. Here is what survived.
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.
I would not lead a decision with this, but I would not ignore it either.
Prior hypersensitivity to the product or its excipients is a contraindication that people forget applies to the excipients too.
For what it is worth, the same held on the two occasions I checked.
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e.halonen, post #31: 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. Go to post
Post #76 and I disagree about the size of the effect, not about the direction.
I keep a log for pregnancy specifically because my memory of it turned out to be systematically wrong in one direction. Six weeks of notes cost nothing and settled it.
On post #77 — agreed on the reasoning, with one qualification.
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.
I would treat that as a working assumption and revisit it.
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Collapsed as off-topic by two members at trust level 3 or above
Picking up post #81: 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.
The interesting part of this is the exception, and I do not understand the exception.
GEldridge, post #24: Where a condition appears as a warning rather than a contraindication, the decision is a clinical one rather than a prohibition. Go to post
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.
It took me longer than it should have to see that.
h.bhattacharya, post #6: Adding the measurement that post #3 says would settle it. 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. This is the sort of thing that ought to be settled and apparently is not. 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.
Severe hepatic impairment: less is known than for kidney disease. Extreme caution or contraindication depending on the specific degree of impairment.
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Coming back to post #85, 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.
I am reporting what happened, not recommending it.
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ai.vukovic, post #84: 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. 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.
Written in the hope of being told what I have missed.
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
The version of pregnancy that circulates here is a simplification of a simplification. It is not wrong, but it has lost the conditions under which it holds, and those conditions are where the interesting cases live.