Nausea incidence by dose tier — STEP and SURMOUNT meta-analysis

Something nobody mentions — peppermint. Peppermint oil capsules (enteric-coated so they don't dissolve in your stomach) helped me more than ginger honestly. I take one before each meal.

Also B6 (pyridoxine) 25 mg twice daily. It's what they give pregnant women for morning sickness and the mechanism is surprisingly similar to GLP-1 nausea.

Good point on B6. The combination of doxylamine + pyridoxine (sold as Diclegis/Bonjesta for pregnancy nausea) does have some off-label use in GLP-1 patients. The evidence is anecdotal but the safety profile is well-established.

One caution on peppermint: it relaxes the lower esophageal sphincter, so if you're also experiencing reflux (common on GLP-1s), peppermint can make that worse. Pick your battles.

5 months in and my nausea trick is stupid simple — I eat a handful of plain saltine crackers 20 minutes before any real meal. Something about having a little starch base in there prevents the worst of it. Also I switched to injecting in my thigh instead of my belly and swear the nausea is milder, though that might be placebo.

For what it's worth, the STEP trials showed nausea was dose-dependent and time-limited for most participants:

• Median onset: within first 8-12 days of starting or increasing dose
• Median duration per episode: 3-5 days
• Resolution without intervention: ~70% of cases by week 20
• Discontinuation due to nausea specifically: only about 3-4% of trial participants

So statistically, the odds are strongly in your favor that it resolves. The people who post about nausea are self-selecting — the 56% on sema who never experienced significant nausea aren't posting about it.

Great contributions everyone. Pinning a summary at the top:

The Nausea Toolkit:

1. Ginger capsules 250 mg QID or ginger tea
2. Smaller, more frequent meals
3. Avoid high-fat foods 48h post-injection
4. Evening injection timing
5. B6 (pyridoxine) 25 mg BID
6. Saltines or bland starch before meals
7. Slow sips of electrolyte drinks
8. Talk to your prescriber about ondansetron if severe
9. SLOW YOUR TITRATION if needed

Red flag: if you can't keep fluids down for 4+ hours, contact your provider or go to urgent care. Dehydration can cause serious complications.