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Additional fatigue is most likely due to a sudden decrease in food intake and blood sugar as the medicine reduces your appetite

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References Alahmari, L

Serious but rare adverse effects include: Acute pancreatitis (patients should be advised to seek immediate medical attention for severe, persistent abdominal pain) Gallbladder disease, including cholecystitis and cholelithiasis Acute kidney injury, particularly in the context of dehydration from gastrointestinal side effects Hypoglycaemia, especially when used alongside other glucose-lowering medications Thyroid C-cell tumours (observed in rodent studies