Side effects are common, mostly GI, dose-dependent, and largely resolve. Knowing what's normal vs concerning is the difference between successful therapy and unnecessary discontinuation.
Common (>10%)
- Nausea — peaks within 1–2 wks of each dose step, then declines
- Constipation — slowed GI transit
- Diarrhea — some patients, especially early
- Decreased appetite — this is the mechanism; ensure adequate protein
- Vomiting — less common; concerning if persistent
- Heartburn / reflux — delayed emptying can worsen GERD
Call your prescriber
- Severe persistent abdominal pain (especially radiating to back) — possible pancreatitis. Stop, evaluate urgently.
- Severe vomiting with inability to keep liquids — dehydration/AKI risk.
- Severe constipation with bloating and no flatus — possible ileus.
- RUQ pain with fever — possible gallbladder disease.
- Vision changes — report.
- Severe depression or suicidal thoughts — report regardless.
Managing nausea
- Smaller, more frequent meals.
- Avoid greasy/fatty foods, alcohol, very sweet foods during titration.
- Eat slowly. Hydrate consistently.
- Bland foods during titration weeks.
- Ondansetron prn if needed; ask prescriber.
- Slow the titration if needed.
The 'GLP-1 face'
Rapid weight loss from any cause produces facial volume loss. Remedy: slow weight loss rate, adequate protein, volumizing treatments once weight stabilizes.
Muscle loss
~70:30 fat:lean ratio without intervention. Resistance training + protein (1.6–2.0 g/kg target weight) shifts favorably. See muscle preservation.