Common

• Nausea, vomiting, diarrhoea, constipation and reduced appetite — worse at higher doses.^[1]Titrate up slowly from a low dose and eat smaller, blander meals; the gut effects usually ease over the first weeks.^[1]
• A substantial share of the weight lost is lean mass, not fat — trial data put it at roughly a quarter to a third of total weight lost without resistance training and adequate protein.^[1]Keep resistance training and protein intake high throughout, and avoid aggressive dose escalation.^[1]

Serious

• Pancreatitis — severe, persistent abdominal pain.^[1]Stop and seek medical care; do not restart without advice.^[1]
• Gallbladder disease.^[1]
• Low blood sugar, mainly when combined with insulin or a sulfonylurea.^[1]Have those doses adjusted by a clinician.^[1]
• Boxed warning: thyroid C-cell tumours (seen in rodents).^[1]