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Very common (10% of patients) Nausea peaks during titration, typically subsides within 48 weeks at a stable dose Vomiting, diarrhoea, constipation Abdominal pain or discomfort Reduced appetite (this is the therapeutic effect, not an adverse effect) Less common but serious stop and see a doctor Severe, persistent abdominal pain radiating to the back possible pancreatitis Right upper abdomen pain, fever, yellowing possible gallstones / gallbladder disease Persistent neck lump, hoarseness, difficulty swallowing evaluate thyroid Rapid heartbeat, severe dehydration from vomiting Hypoglycaemia when semaglutide is combined with insulin or sulfonylureas What the Indian data shows: a 2025 study of Indian patients found GI side effects are the leading cause of discontinuation, peaking during dose escalation

This was predicted to stabilise the N-terminal -helix (5-18) of the peptide through formation of an intramolecular salt bridge, as observed in a crystal structure of CagriBB fused at the C-terminal end of maltose-binding protein (PDB:7BG0) 2

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The shorter working life of a 50mg vial is part of its advantage over the 100mg presentation, so avoid extending it unnecessarily

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