Known safety concerns, contraindications, and risk factors.
Diabetes, prediabetes, or metabolic syndrome
MK-677 consistently increases fasting glucose and HbA1c. Use in metabolically compromised individuals accelerates diabetic trajectory.
Heart failure, ischaemic heart disease, or uncontrolled hypertension
GH-induced fluid retention increases cardiac preload. Clinical trial terminated early due to CHF signal in elderly patients.
Active or suspected malignancy
Sustained IGF-1 elevation promotes cellular proliferation and could accelerate tumour growth.
Concurrent CYP3A4 inhibitors or P-glycoprotein inhibitors
CYP3A4 inhibitors (ketoconazole, ritonavir) increase systemic exposure. P-gp inhibitors (amiodarone, verapamil) alter absorption.