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Red flag symptoms requiring urgent assessment include: Severe abdominal pain or distension that is progressive or unrelieved Nausea and vomiting, particularly if unable to tolerate oral intake Inability to pass gas or persistent vomiting (possible signs of obstruction) Rectal bleeding or black, tarry stools suggesting gastrointestinal bleeding Unintentional weight loss beyond expected therapeutic effects Fever accompanying constipation, which may indicate infection or inflammation Signs of dehydration (extreme thirst, dry mouth, dizziness, dark urine) Patients with pre-existing gastrointestinal conditionsincluding inflammatory bowel disease, previous bowel obstruction, or diverticular diseaseshould have lower thresholds for seeking medical advice
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Important safety considerations include a boxed warning for risk of thyroid C-cell tumors (contraindicated in patients with personal/family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2), and risks of pancreatitis, gallbladder disease, acute kidney injury with dehydration, and diabetic retinopathy complications with semaglutide
