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ForumsSide Effects & ManagementDay 3 on sema and I feel like death warmed over — need advice

Day 3 on sema and I feel like death warmed over — need advice

roxy_nash Sat, Aug 16, 2025 at 7:33 AM 50 replies 2,150 viewsPage 1 of 10
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roxy_nash
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Nashville, TN
Aug 16, 2025 at 7:33 AM#1

Nausea arrived on day two of each dose step, lasted about four days, and disappeared entirely by the second week — until the step where it did not.

Trial-level incidence runs roughly 20 to 25% for nausea at the higher dose tiers and 12 to 17% for diarrhoea, with most events mild to moderate and concentrated in the weeks after each escalation.

So the question, as narrowly as I can put it: whether holding at a lower dose for longer actually reduces total side-effect burden or just spreads it out.

Practical detail welcome, however dull — the duller the better.

15 10josh_phd_bmore, roxy_nash, tony_orlando and 12 others
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Dr.SurgeonPGH
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Aug 16, 2025 at 7:40 AM#2

This one has a reasonably settled answer, so here it is. The line between titrate-through and stop is not severity, it is trajectory and what else is present. Nausea that peaks and improves within a week is the expected pattern. Nausea that is escalating, or that comes with severe upper-abdominal pain radiating to the back, or that prevents fluids for more than a day, is a different conversation and belongs with a clinician the same day.

Ask again with the specifics and you will get a better answer than this one.

Last edited: Aug 16, 2025 at 10:40 AM
14 9TomTeleRx, DoseLogDan, SleepFixSam and 11 others
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tammy_FL
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Aug 16, 2025 at 7:47 AM#3
Dr.SurgeonPGH said:
The line between titrate-through and stop is not severity, it is trajectory and what else is present.

Agreeing with Dr.SurgeonPGH, and the qualification matters more than the agreement. The meal advice is right and incomplete without the hydration point. People stop drinking because drinking makes them feel full, then attribute dehydration symptoms to the drug.

13 8kevin_tulsa, Dr.PainCLE, mike_mealprep and 10 others
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TomTeleRx
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Aug 16, 2025 at 7:54 AM#4
roxy_nash said:
Nausea arrived on day two of each dose step, lasted about four days, and disappeared entirely by the second week — until the step where it did not.

This matches mine closely enough to be worth saying so. The practical protocol is dull and it works: smaller meals, stop eating at the first sign of fullness rather than at the end of the plate, drop the fat fraction of meals in the two days after dosing, and do not lie down straight after eating. Most of what people call unmanageable nausea is a meal-size and meal-composition problem interacting with a stomach that is emptying slowly.

12 7HPLC_Greg, LibrarianMeg, bri_stats and 9 others
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Dr.GutHealth
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Aug 16, 2025 at 8:32 AM#5

From the other side of the consultation, briefly. Take it one variable at a time. Almost every unanswerable question in these threads is unanswerable because three things changed in the same fortnight, and no amount of subsequent argument can untangle them after the fact.

11 6MikeKY_noInsulin, Dr.RaviCardio, jennifer_SEA and 8 others
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