diff --git a/src/lib/medications/courses.ts b/src/lib/medications/courses.ts
index f7c82c468..c4646e017 100644
--- a/src/lib/medications/courses.ts
+++ b/src/lib/medications/courses.ts
@@ -178,8 +178,41 @@ export async function createCourse(
       args.userId,
       args.medicationId,
     );
+    // A medication without course rows is not empty history. With no window
+    // at all it has been taken continuously since creation and is running
+    // now, so a course cannot be added beside it (it ends its course first,
+    // "End course" writes one). With a window the rows never recorded (a
+    // file restored past the backfill), that window is its first course and
+    // is materialised before the new one is checked against it. Either way
+    // nothing the person already recorded can be cut off by the projection.
+    let existing: { startsOn: Date; endsOn: Date | null }[] = courses;
+    if (courses.length === 0) {
+      if (medication.startsOn === null && medication.endsOn === null) {
+        throw new CourseWriteError("currentOpen");
+      }
+      const implicit = windowAsCourse(
+        medication.startsOn,
+        medication.endsOn,
+        undefined,
+        medication.createdAt,
+        args.timeZone,
+      );
+      refuseIfInvalid(
+        [implicit, { startsOn: args.startsOn, endsOn: args.endsOn }],
+        todayKey,
+        medication.oneShot,
+      );
+      await tx.medicationCourse.create({
+        data: {
+          medicationId: args.medicationId,
+          userId: args.userId,
+          ...implicit,
+        },
+      });
+      existing = [implicit];
+    }
     refuseIfInvalid(
-      [...courses, { startsOn: args.startsOn, endsOn: args.endsOn }],
+      [...existing, { startsOn: args.startsOn, endsOn: args.endsOn }],
       todayKey,
       medication.oneShot,
     );
diff --git a/tests/integration/medication-courses.test.ts b/tests/integration/medication-courses.test.ts
index 88cddfc83..54fd4190d 100644
--- a/tests/integration/medication-courses.test.ts
+++ b/tests/integration/medication-courses.test.ts
@@ -275,6 +275,39 @@ describe("course writes keep the projection", () => {
     });
   });
 
+  it("never lets a first course cut off a chronic medication's history", async () => {
+    // Taken continuously since creation: no window, no course row. A course
+    // added beside it would project the medication into ending.
+    const chronic = await makeMedication({});
+    const refused = await postCourse(chronic.id, {
+      startsOn: "2026-03-01",
+      endsOn: "2026-03-31",
+    });
+    expect(refused.status).toBe(422);
+    expect((await refused.json()).meta.errorCode).toBe(
+      "medications.course.currentOpen",
+    );
+    expect(await courses(chronic.id)).toEqual([]);
+    expect(await window(chronic.id)).toEqual({ startsOn: null, endsOn: null });
+
+    // A window the rows never recorded (written past the course writer, as
+    // an older restore could) becomes the first course before the new one.
+    const legacy = await makeMedication({});
+    await getPrismaClient().medication.update({
+      where: { id: legacy.id },
+      data: { startsOn: D("2026-01-10"), endsOn: D("2026-01-20") },
+    });
+    const added = await postCourse(legacy.id, {
+      startsOn: "2026-03-01",
+      endsOn: "2026-03-05",
+    });
+    expect(added.status).toBe(201);
+    expect(await courses(legacy.id)).toEqual([
+      ["2026-01-10", "2026-01-20"],
+      ["2026-03-01", "2026-03-05"],
+    ]);
+  });
+
   it("lets the medication's own PUT edit the latest course", async () => {
     const med = await makeMedication({
       startsOn: "2026-03-01",