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These medications are contraindicated in patients with personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2

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When to call your provider Within 3-5 days: No bowel movement for 5+ days despite using Miralax or other osmotic laxative Severe abdominal pain or distension Inability to pass gas Vomiting, especially if it tastes or smells fecal Within 1-2 weeks: Constipation not improving after 2 weeks of consistent dietary changes plus Miralax Blood in stool (bright red or dark/tarry) Severe pain during bowel movements Unintended weight loss beyond expected from the medication At your next scheduled visit: Mild persistent constipation that's manageable but bothersome Questions about whether to escalate dose given current constipation Interest in prescription motility agents The threshold for calling is lower if you have a history of bowel obstruction, diverticulitis, inflammatory bowel disease, or prior abdominal surgery