The edition · Clinical Pharmacology
What GLP-1 drugs take from muscle, and dosing antimicrobials through the filter
A large meta-analysis finds GLP-1 receptor agonists trim lean mass without harming bone or joints, antimicrobial dosing in continuous renal replacement remains an evidence gap, a premixed vancomycin product is recalled, and pharmacogenomic testing needs choosing with care.
The edition in brief
Today's clinical pharmacology edition leads with a meta-analysis of 60 studies and over 1.2 million people showing GLP-1 receptor agonists reduce lean body mass (standardised mean difference about -0.5), mainly with liraglutide and semaglutide, while showing no effect on bone density, fractures or osteoarthritis symptoms; the loss appears to track weight loss and its functional significance is uncertain. A scoping review maps why antimicrobial dosing in continuous renal replacement therapy remains guesswork and argues for individualised, monitored dosing. A Class II recall of a premixed vancomycin product for manufacturing deviations is a supply issue, not a drug-safety signal. A pearl covers AUC-guided vancomycin monitoring. The edition closes on a call to standardise pharmacogenomic testing, with practical criteria for choosing a laboratory and knowing what a panel reports, so that prescribing decisions rest on complete, reliable results.
GLP-1 agonists trim lean mass, but spare bone and joints
When prescribing GLP-1 receptor agonists, protect muscle with resistance exercise and protein, especially in frail patients; bone and joints appear unaffected.
Antimicrobial dosing in continuous renal replacement is still guesswork
Do not assume standard antimicrobial doses in patients on CRRT; account for CRRT settings and drug properties and use therapeutic drug monitoring where possible.
A premixed vancomycin product is under Class II recall
Reconcile stock for the recalled premixed vancomycin lots and confirm an alternative preparation is available.
Dose serious vancomycin by AUC, not trough alone
Use AUC-guided vancomycin monitoring with a loading dose for serious infection, rather than trough-only dosing.
Choose pharmacogenomic testing deliberately, not blindly
Treat the choice of pharmacogenomic laboratory and panel scope as part of the prescribing decision, and interpret results against recognised guidance.
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