I don’t think my nausea /cramping response to the Nuzyra has changed at all after taking it for a year. If I premeditate with the Zofran half an hour before taking it I rarely have an issue though. At least that's my impression. I never skip the Zofran. But once in awhile it doesn’t work for some reason. Maybe I don’t get the timing just right, or my stomach is more or less empty than usual, or who knows. Then I’m in for at least an hour of incapacitating and miserable GI stuff.