Clinical · Special populations · continued

Second pass at: Pregnancy and pregnancy planning: contraindication and washout posts 121–128

Clinical › Special populations chronic kidney disease disordered eating older adults Solved

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.

a.zamoraTL2 Moderator27 Jan 2026#121

f.sjoberg, post #53: Thank you for the correction. I have edited my earlier post with a note rather than silently, so the thread still makes sense to read. The error was mine and it was the kind that comes from remembering a figure instead of looking it up. Go to post

Medullary thyroid carcinoma history: an absolute contraindication because of the preclinical findings in rodent toxicology. The history (personal or family, especially multiple endocrine neoplasia type 2) is an important screening question.

0 likes in reply to #53 6mo

d.tammTL2 Moderator27 Jan 2026#122

Gastroparesis: pre-existing severe delayed gastric emptying can worsen with compounds that slow it further. Discussion with a clinician is prudent if this history exists.

3 likes 6mo

r.girardTL2 Moderator27 Jan 2026#123

post #122 answers the question as asked. The question underneath it is different.

Disordered eating history: a history of anorexia nervosa, bulimia, or other eating disorders changes the risk-benefit calculation because appetite suppression might trigger relapse. This population requires specialist input.

15 likes 6mo

c.silvaTL2 Moderator27 Jan 2026#124

On post #120 — agreed on the reasoning, with one qualification.

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.

30 likes 6mo

m.stephanopoulosTL3Regular27 Jan 2026#125

f.kimani, post #67: Gastroparesis: pre-existing severe delayed gastric emptying can worsen with compounds that slow it further. Discussion with a clinician is prudent if this history exists. Go to post

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.

0 likes in reply to #67 6mo

n.norgaardTL2 Moderator27 Jan 2026#126

Hepatic impairment: less is known about dosing in significant liver disease than in kidney disease. Extreme caution applies because the liver metabolises a large fraction of many medications.

1 like 6mo

baseline_peakTL2Member27 Jan 2026 · edited#127

post #126 is right about the mechanism and I think understates the practical bit.

Adolescents: a distinct evidence base exists. The compounds are not approved for routine adolescent obesity but are being studied. Adolescent physiology and psychology differ from adults' in ways that matter for this medication class.

10 likes 6mo

b.nwosuTL2 Moderator27 Jan 2026#128

integrator_draft, post #27: Coming back to post #25, because the follow-up matters more than the original answer. Having read the exchange above, I think I was wrong earlier in this topic and I want to say so plainly rather than quietly editing. The correction was fair and I had been repeating something I had not checked carefully enough. Go to post

Renal impairment: the compounds are cleared renally to some degree. Dose adjustments might be needed in severe renal impairment. Consulting with a clinician familiar with renal dosing is prudent.

22 likes in reply to #27 6mo

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