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Serious but rare risks requiring immediate medical attention (call 999 or go to A&E if severe) include: Severe, persistent abdominal pain (potential pancreatitis) Signs of gallbladder problems (pain in upper right abdomen, fever, yellowing of skin or eyes) Chest pain, severe palpitations, or shortness of breath Severe mood changes or psychotic symptoms (more commonly associated with stimulants) Signs of severe dehydration or acute kidney injury Patients with pre-existing conditions require particular caution, including those with cardiovascular disease, history of pancreatitis, gallbladder disease, eating disorders, psychiatric conditions, or substance use history

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Maintenance dose adjustments may be necessary in several scenarios

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3 The pharmacokinetic feasibility gate: exposure, half-life, and the accumulation requirement The central determinant of whether an orally administered peptide achieves therapeutic systemic exposure is not the sophistication of the delivery platform, but the relationship among absorption rate, elimination half-life, and dosing interval