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However, oral semaglutide (Rybelsus) increases thyroxine exposure and requires thyroid function monitoring when used with levothyroxine, with careful attention to timing of administration

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Important safety considerations include: Risk of acute pancreatitis: urgent medical review needed for severe, persistent abdominal pain (with or without back pain) Gallbladder disorders: seek medical advice for symptoms of gallstones (right upper abdominal pain, nausea) Diabetic retinopathy complications: particularly with semaglutide in those with pre-existing retinopathy Hypoglycaemia: risk is low unless combined with insulin or sulfonylureas, which may require dose adjustment Reports of mood changes and suicidal ideation in patients taking GLP-1 receptor agonists are being monitored by regulatory authorities

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