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Like other GLP-1 receptor agonists, oral semaglutide also carries a black box warning for potential risk of thyroid C-cell tumors and a contraindication for use in patients with a personal or family history of medullary thyroid cancer or in patients with multiple endocrine neoplasia syndrome type 2

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Low cortisol levels have also been associated with an increase in oxidative stress and a decrease in glutathione levels, further impairing detoxification