On the subject in the title: Persistent vomiting and the threshold for seeking help Working notes rather than a conclusion.
Trying to work out what would count as evidence on persistent vomiting, before collecting any. This is the part I usually skip and it is the part that makes the rest useful.
If two explanations predict the same observation, observing it does not help. So: what observation would separate them?
Post #2 answers the question as asked. The question underneath it is different.
Pancreatitis is a genuine serious adverse event to know: severe epigastric pain, back pain, elevated lipase (≥3× upper limit of normal). If this constellation appears, stopping the drug and seeking urgent evaluation is appropriate.
Reporting to regulatory agencies: if you have had a serious event, reporting it to the regulatory agency in your country can help with signal detection across the population.
Marking my uncertainty on persistent vomiting explicitly. I am confident about the direction, much less confident about the size, and not confident at all that it generalises past the case in the first post.
Post #6 is right about the mechanism and I think understates the practical bit.
Injection-site reactions that spread over a day or come with systemic symptoms are a different observation from ordinary local reactions.
Reading it back, the second half matters more than the first.
Agreed on persistent vomiting, with one qualification that I think matters. The reasoning holds for the case as described. Change the starting assumption and it does not, and the starting assumption is the part nobody states.
This is the sort of exchange that makes the archive worth searching.
Severe, persistent abdominal pain, particularly radiating to the back, is not an ordinary gastrointestinal symptom and belongs with a clinician rather than a thread.
Stating my assumptions rather than smuggling them in.
Nothing here is medical advice, and in this subcategory the phrase is doing more work than in any other on the site.
I have seen it go both ways, which is why I hedge.
Fair, and the limits you put on it are the part I will remember.
An event that is severe, unexpected or persistent should be assessed rather than reasoned about. The asymmetry between the cost of being checked and the cost of being wrong is the whole basis of that.
This is where my knowledge stops and I would rather mark the edge than blur it.
Persistent vomiting is one of those subjects where the general answer and the answer for a specific case diverge, and the thread will go in circles until someone says which one is being asked for.
Post #15 describes the usual case. This is about the unusual one.
Practical note on persistent vomiting: write down what you expect before you look. The number of times I have found what I went looking for is higher than chance would allow.
Source for the persistent vomiting figure, since it was asked for. It is in the discussion rather than the abstract, which is why the version circulating is stronger than the paper is.
Reading the surrounding paragraph is worth the two minutes. The authors are more careful than their summarisers.
Post #19 is the version of this I will quote in future. One addition.
A request rather than an answer: could whoever has the primary source for persistent vomiting post it? I have seen the claim three times this month and each version had lost a qualifier.
Confirming post #20 from a second method, which matters more than confirming it from a second person.
Medullary thyroid carcinoma is the reason these compounds are contraindicated in people with personal or family history of MTC or multiple endocrine neoplasia type 2. Rodent toxicology showed a signal; human evidence of causation is absent but caution is appropriate.
No notes. Posting so the count is not one.
Reframing persistent vomiting slightly, because I think the disagreement is about the question rather than the answer. If the question is "does it happen", yes. If it is "how often", nobody here knows.
The documentation on persistent vomiting is better than this thread and I say that as someone who has posted in the thread.
Coming back to post #23, because the follow-up matters more than the original answer.
Persistent vomiting: I would want to see the raw numbers rather than the summary before agreeing. Summaries lose exactly the information that would settle this.
The claim about persistent vomiting upthread is stronger than its source supports. I have read the source. The source says "associated with" and the post says "causes".
Severe gastrointestinal events: persistent vomiting, abdominal pain out of proportion, or signs of bowel obstruction warrant urgent evaluation. Mild nausea and constipation are ordinary; severe versions are not.
I would put a moderate confidence on that and no more.
Following this. I have the same question and no better information than the first post.