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.
Specifically, 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.
Trial-reported incidence and discontinuation rates for gastrointestinal effects are published per agent and per dose and are the appropriate figures to quote.
Smaller meals, less fat, fluids between rather than with. In that order.
4Confirming that slowing the titration fixed this rather than any of the other things I tried. – h_villanueva 10 months ago 3This is the first explanation of the timing pattern that has actually made sense to me. – mz_4113 8 months ago add a comment