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For semaglutide, the main concerns include pancreatitis (rare but documented), gallbladder events (including gallstones, particularly during rapid weight loss), and a theoretical concern about medullary thyroid carcinoma based on rodent studies
Hematocrit, reticulocyte count, Vitamin B12, folate and iron levels should be obtained prior to treatment
If oral B12 replacement has been trialled in a person with metformin-associated B12 deficiency, I would suggest that a repeat measurement of B12 levels after 812 weeks is a good time to reassess whether absorption is adequate or whether a switch to intramuscular replacement is required
doi:10.1016/s0022-3476(89)80717-6 [42] Nachtigall D, Nielsen P, Fischer R, Engelhardt R, Gabbe EE
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