Accepted answer
Week 8 is day 56: on a four-week ladder that is week 4 of dose step 2, and — at the seven-day half-life this class runs on — 8 half-lives in. Steady state is about five half-lives, so day 35 is where the concentration stops climbing on its own. Day 56 is 3 weeks past it, which means the level is no longer the variable. That distinction is most of the question: at week 4 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. Early satiety is the mechanism rather than a side effect of it — delayed gastric emptying is the intended pharmacology — so the question the week number helps with is whether it is proportionate, not whether it is expected. Dose decisions are made under supervision, and nothing here is medical advice.
Start with which symptom predominates, because the management diverges sharply even though the mechanism does not.
Symptom prevalence in trials, broadly: nausea a quarter to a half, diarrhoea and constipation each roughly ten to twenty per cent, vomiting rather less, with all rates rising with dose.
Gastrointestinal adverse events, indicative pooled rates
| Event | Active arm | Placebo arm | Timing |
|---|
| Nausea | 40–45 % | 15–20 % | Peaks 1–2 wk after each step |
| Vomiting | 15–25 % | 5–8 % | Follows nausea |
| Diarrhoea | 20–30 % | 10–15 % | Early, variable |
| Constipation | 20–25 % | 8–12 % | Later onset, persistent |
| Discontinuation for GI events | 4–7 % | 1–2 % | Mostly during escalation |
Ranges span agents and doses; read the specific prescribing information for a specific figure.
Concretely, fat is the macronutrient that slows emptying most on its own, so a high-fat meal on top of pharmacologically delayed emptying is the combination that produces the worst episodes.
Dietary fat slowing gastric emptying is basic gastrointestinal physiology and independent of any drug effect.
Nothing here is medical advice.
Smaller meals, less fat, fluids between rather than with. In that order.
edited 24 Jul 2024 by Dr_Nadia_Farsi — added the citation requested in comments
Adding a vote because this deserves more of them. – Dr_Nadia_Farsi 8 months ago I would add a sentence about when to stop managing it and start seeing someone. – teodora_ilic 6 days ago add a comment