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Food And Drug Administration, September 30, 2021, Office of the Commissioner

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Seek urgent medical advice (contact your GP or NHS 111) if you experience: Severe or persistent gastrointestinal symptoms : Uncontrolled vomiting, severe abdominal pain, signs of dehydration (dark urine, dizziness, reduced urination), or bloody stools Mental health deterioration : Worsening depression, emergence of suicidal thoughts, severe anxiety, panic attacks, or unusual behavioural changes Possible serotonin syndrome : Agitation, confusion, rapid heartbeat, high fever, muscle stiffness, tremors, or loss of coordination Allergic reactions : Rash, itching, swelling (particularly of face, lips, or throat), severe dizziness, or difficulty breathing Pancreatitis symptoms : Severe upper abdominal pain radiating to the back, nausea, vomiting, and fever Gallbladder problems : Pain in the right upper abdomen, fever, yellowing of skin or eyes (jaundice) Hypoglycaemia (if diabetic): Shakiness, sweating, confusion, or rapid heartbeat, particularly if taking other diabetes medications Signs of hyponatraemia : Headache, confusion, weakness, seizures, or feeling unwell with nausea Contact emergency services (999) immediately if: You experience severe allergic reactions (anaphylaxis) with breathing difficulties You have thoughts of self-harm or suicide You develop symptoms suggesting severe pancreatitis or other acute medical emergencies Routine consultations with your healthcare provider should address: Tolerability of the medication combination and any side effects Weight loss progress and whether targets are being met Mental health status and antidepressant effectiveness Any new medications or supplements you're considering Concerns about appetite, eating patterns, or nutritional intake Pregnancy planning (semaglutide must be stopped at least 2 months before conception) Never discontinue either medication abruptly without medical guidance

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