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Nausea (most common, typically dose-dependent and transient) Diarrhea or constipation during dose escalation Vomiting, especially when starting or increasing dose Reduced appetite and early satiety Injection site reactions (redness, bruising) Fatigue, particularly in early weeks Rare: Pancreatitis discontinue immediately with severe abdominal pain Rare: Thyroid C-cell effects (contraindicated with MEN2 or thyroid cancer history) Small-molecule NNMT inhibitor often discussed with metabolic protocols