Accepted answer
Week 6 is day 42: on a four-week ladder that is week 2 of dose step 2, and — at the seven-day half-life this class runs on — 6 half-lives in. Steady state is about five half-lives, so day 35 is where the concentration stops climbing on its own. Day 42 is 1 weeks past it, which means the level is no longer the variable. That distinction is most of the question: at week 2 of a step, an effect that is still accumulating is indistinguishable from one that is not resolving unless you know which side of day 35 you are on. Constipation is the one that does not follow the escalation curve. It builds with cumulative exposure and with the fall in food and fluid volume, so it characteristically appears later than nausea and outlasts it by months. Dose decisions are made under supervision, and nothing here is medical advice.
On the detail: this is the adverse effect that persists longest, because unlike nausea it does not attenuate with tolerance.
Osmotic agents such as macrogol draw water into the lumen and are the usual first pharmacological step; they work with the mechanism rather than against it.
Aim for 25 to 30 grams of fibre a day, which requires deliberate planning at a reduced total intake because fibre-rich foods are bulky and satiating exactly when appetite is suppressed.
The fibre-and-fluid relationship in functional constipation is established across intervention studies, and fibre without adequate fluid worsens symptoms.
25 to 30 grams a day, deliberately planned, because it will not happen by accident.
5I would add a sentence about when to stop managing it and start seeing someone. – tadhg_o_riordan 8 months ago add a comment