Dr.NephBHM_UK said:Steady state is the thing most people miss.
Bookmarking. The distinction being drawn above is the one nobody else makes.
From the other side of the consultation, briefly.
Gallbladder warning for gallbladder risk: rapid weight loss increases gallstone risk regardless of method. GLP-1 patients have a ~2-3% incidence of gallbladder events in clinical trials.
Symptoms to watch for: pain in upper right abdomen after fatty meals, nausea after eating, pain radiating to right shoulder. I had my gallbladder out at month 5 — it was full of stones. My surgeon said it's very common in significant weight loss patients.
PharmD_Rodriguez said:Albumin binding above 99% is the whole reason weekly dosing works, and it is also why the trough matters more than the peak.
I will push back on the "any working dose is fine" framing. The maintenance evidence sits overwhelmingly at the top studied dose, and the extension data shows regain tracking dose reduction rather than tracking stopping. Holding low is reasonable; pretending it is evidentially equivalent is not.
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View ResultsPharmacoVig_BOS said:The gallbladder signal is real and it is mostly the weight loss, not the drug.
Gallbladder ultrasound monitoring on gallbladder risk: given the known gallstone risk with rapid weight loss, my doctor orders gallbladder ultrasound every 6 months:
Baseline: normal, no stones or sludge
Month 6: small amount of biliary sludge, no stones
Month 12: sludge resolved, gallbladder normal
Ursodeoxycholic acid (Ursodiol) 300mg BID was prescribed prophylactically from the start. This reduces gallstone formation during rapid weight loss by ~60% per the available data. Ask your doctor about prophylactic ursodiol if you're losing weight rapidly.
Moderator note: the sourcing question belongs in the vendor section and has been split out. Thread quality here is what the rules are for. Keep it up.