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Common GI side effects (affecting more than 1 in 10 people) according to the SmPC: Nausea : The most frequent side effect, reported in approximately 44% of patients in clinical trials, usually most pronounced during the first few weeks and with dose increases Diarrhoea : Affects roughly 30% of users, typically mild to moderate and transient Vomiting : Occurs in about 24% of patients, often associated with eating too quickly or consuming large portions Constipation : Reported in approximately 24% of users, which may require dietary modification or occasional laxative use Abdominal pain or discomfort : Affects around 20% of patients, usually described as cramping or bloating Dyspepsia and reflux : Indigestion and heartburn occur in approximately 9% of users Less common but significant GI effects : Delayed gastric emptying : Whilst this is the intended pharmacological effect, in some cases it can cause persistent nausea, vomiting, and inability to tolerate food Pancreatitis : Has been reported in clinical trials and post-marketing

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The impressive weight loss outcomes of the poly-agonists suggest additive or synergistic effects