Personal or family history of medullary thyroid carcinoma — what changed since posts 31–60
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
post #31 is right about the mechanism and I think understates the practical bit.
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.
Pregnancy: these compounds are not approved for pregnancy. The potential risks outweigh potential benefits. Planning windows and washout (several months) are the standard approach.
Practical note that does not fit anywhere else. Whatever you conclude from this topic, write down what you did and when. The single most useful thing in your own records is not any individual result; it is that they are dated and consecutive.
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.
Coming back to post #35, because the follow-up matters more than the original answer.
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.
Picking up post #35: that is the part I would want checked first.
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.
Worth separating two things that post #35 runs together.
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.
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.
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.
Severe renal impairment (eGFR <15): these compounds are renally cleared and accumulate in severe kidney disease. Risk-benefit is unfavourable without dose adjustment.
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.
Pregnancy: these compounds are not approved for pregnancy. The potential risks outweigh potential benefits. Planning windows and washout (several months) are the standard approach.
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.
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.
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.
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.
Picking up post #49: 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.
Collapsed as off-topic by two members at trust level 3 or above
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.
Severe renal impairment (eGFR <15): these compounds are renally cleared and accumulate in severe kidney disease. Risk-benefit is unfavourable without dose adjustment.
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.
This follows post #53 rather than contradicting it.
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.
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.
Practical note that does not fit anywhere else. Whatever you conclude from this topic, write down what you did and when. The single most useful thing in your own records is not any individual result; it is that they are dated and consecutive.
Severe hepatic impairment: less is known than for kidney disease. Extreme caution or contraindication depending on the specific degree of impairment.