Distinguishing expected GI effects from something that needs urgent attention posts 91–102

Reflux and eructation are the two most under-reported effects in the first-hand accounts here, and both follow directly from delayed emptying.

That is where I would start, not where I would stop.

Gastrointestinal effects in this class are dose-related and escalation-related. Both are true simultaneously, which is why symptoms typically return at each step and then settle again.

Not the answer, but possibly the question that gets there.

Adding the measurement that post #90 says would settle it.

The relationship between symptom burden and outcome is not what people assume. Feeling worse is not evidence of a larger effect and feeling nothing is not evidence of an inactive preparation.

Helpful, and easy to find again, which is half of what a good reply is.

Reported effects on taste and on food preference are common and interesting and unstudied in any detail. They are also the ones people find most disconcerting.

A qualification I should have led with rather than closed on.

The published rates come from populations that were titrated on a defined schedule with clinical supervision. Rates from a forum are not comparable and are biased by who chooses to post.

Picking up post #95: that is the part I would want checked first.

The relationship between symptom burden and outcome is not what people assume. Feeling worse is not evidence of a larger effect and feeling nothing is not evidence of an inactive preparation.

I would treat the number as indicative rather than as a measurement.

The published rates come from populations that were titrated on a defined schedule with clinical supervision. Rates from a forum are not comparable and are biased by who chooses to post.

The rule of thumb is fine; the edge cases are where it earns its keep.

Post #98 answers the question as asked. The question underneath it is different.

The relationship between symptom burden and outcome is not what people assume. Feeling worse is not evidence of a larger effect and feeling nothing is not evidence of an inactive preparation.

I read post #96 twice before replying, because I had assumed the opposite.

The published rates come from populations that were titrated on a defined schedule with clinical supervision. Rates from a forum are not comparable and are biased by who chooses to post.

Discontinuation for adverse effects in the published trials was not rare at the higher doses. That number belongs in any discussion of tolerability and is usually left out.

Worth checking against a second source before it gets quoted onward.

Vomiting: when it is expected (first-dose reactions or early titration) and when it is a reason to stop and seek help are different. Occasional vomiting during titration is ordinary. Persistent vomiting or vomiting of a new character later in treatment warrants contact with your clinician.

Happy to expand any of that if it is the useful part.