Revisiting: Absolute versus relative contraindications

Revisiting: Absolute versus relative contraindications Writing it up because I had to work it out twice and would rather nobody else did.

I was wrong about Absolute versus relative contraindications in a thread last spring and I would like to correct it publicly rather than quietly.

The error was in the units, which changed the conclusion by an order of magnitude. Setting out the corrected version, and the way I now check for that class of mistake.

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.

Reading the contraindications section of the actual product information takes two minutes and answers most questions asked here.

The reasoning is more useful than the number, which is why I have shown it.

Narrowing the opening post, because the general version has more than one answer.

Research-use-only material has no labelling and therefore no contraindications listed, which is not the same as having none.

That is what the documentation says. What happens in practice is usually close.

Where a contraindication is relative rather than absolute, the reasoning usually appears in the assessment report rather than the labelling.

Interaction-based contraindications are compound-pair specific and are the ones most often generalised incorrectly.

Right — I had this wrong and I am glad to have read it before it mattered.

The section of the product information covering special warnings is usually longer and more useful than the contraindications list itself.

This follows post #9 rather than contradicting it.

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.

Where I would look next, rather than where I would stop.

If you are new and reading this thread for the answer to Absolute versus relative contraindications: the answer is conditional, the conditions are in the third reply, and the rest of the thread is worth skipping.

Post #9 put the caveat in the right place and I want to underline it.

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.

That is the practical version. The rigorous version is longer and says the same thing.

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.

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.