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Inadequate levels of SAM in the liver disrupts VLDL assembly and leads to hepatic accumulation of triglycerides or fatty liver

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Contact your GP or prescribing clinician if you experience: Persistent vomiting lasting more than 24 hours or preventing adequate fluid intake Signs of dehydration including dark urine, dizziness, reduced urination, or extreme thirst Inability to tolerate any food or fluids for more than a day Nausea that significantly interferes with daily activities or quality of life Unexplained weight loss beyond the expected therapeutic effect Symptoms that worsen rather than improve after the first few weeks Seek immediate medical attention (call 999 or attend A&E) if you develop: Severe, persistent abdominal pain , particularly in the upper abdomen, which may radiate to the back this could indicate pancreatitis Severe vomiting with abdominal pain and fever Signs of gallbladder problems including right upper abdominal pain, yellowing of skin or eyes (jaundice), or pale stools Symptoms of allergic reaction such as difficulty breathing, facial swelling, or widespread rash Rapid heartbeat, confusion, or severe weakness suggesting significant dehydration or electrolyte imbalance Difficulty breathing or swallowing related to neck symptoms If you notice a lump in your neck, persistent hoarseness, or difficulty swallowing without acute breathing problems, seek prompt medical advice (but this does not typically require emergency services)

The Endocrine Society's 2015 obesity pharmacotherapy guidelines recommend that "dose escalation be delayed for patients experiencing intolerable adverse events." This applies directly to GLP-1 agents and gives prescribers explicit guideline backing to slow the titration schedule when needed [12]

He can have a higher risk of blood clots