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semaglutide does not require dose adjustment but caution is needed if GI symptoms risk dehydration [2] Serum bicarbonate levels to detect metabolic acidosis, particularly in the first few months of topiramate therapy Blood glucose levels if you have diabetes or prediabetes, as semaglutide affects glycaemic control Cognitive function and mood , given topiramate's neuropsychiatric effects Dose titration and timing : Both medications typically require gradual dose escalation to minimise side effects

Therefore, DPP-4 inhibitors may have pleiotropic effects

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Diem, L