Pregnancy as an absolute contraindication

Pregnancy as an absolute contraindication — setting out what I have, and where I think it stops being reliable.

Asking about a population rather than about a person.

The published trials in this class mostly enrolled a fairly specific group, and the questions here frequently come from people well outside it. I would like to understand what the honest position is when someone falls outside the studied population: not "it is fine" and not "there is no data", but what the reasoning actually looks like.

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.

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

I read post #3 twice before replying, because I had assumed the opposite.

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

This follows post #3 rather than contradicting it.

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.

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.

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.

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.

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.

Coming back to post #10, 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.

post #12 answers the question as asked. The question underneath it is different.

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.

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.