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Seek urgent medical attention (A&E or call 999) if you experience: Severe, persistent vomiting preventing fluid intake for more than 24 hours, risking dehydration Signs of severe dehydration extreme thirst, dark urine, dizziness, confusion, rapid heartbeat Severe abdominal pain , particularly if constant, sharp, or accompanied by fever Symptoms of pancreatitis intense upper abdominal pain radiating to the back, with nausea and vomiting Allergic reactions facial swelling, difficulty breathing, widespread rash, or rapid pulse Contact NHS 111 or seek same-day GP review if: Right upper abdominal pain with or without fever, which could indicate gallbladder problems (a known risk with GLP-1 medications, particularly during weight loss) New or worsening visual symptoms GLP-1 medications, particularly semaglutide, may temporarily worsen diabetic retinopathy in some patients Severe headaches that differ from your usual pattern and are concerning you You experience significant weight loss beyond expected therapeutic effects, or inability to maintain adequate nutrition Persistent fatigue severely impacts daily functioning and does not improve with rest Contact your GP or prescribing clinician within 24-48 hours if: Flu-like symptoms persist beyond the expected titration phase without improvement or worsen over time You develop new or worsening symptoms not previously experienced You have concerns about medication interactions with other prescribed or over-the-counter medicines Symptoms are significantly affecting your quality of life or ability to continue treatment Routine follow-up considerations: NICE guidance recommends regular monitoring for patients on GLP-1 therapy, typically including: HbA1c and weight measurements at 3-6 month intervals for diabetes management Renal function tests may be performed if there are concerns about dehydration, as this can affect kidney function Review of side effects and treatment response to determine whether continuation is appropriate Important safety notes: If you develop actual flu or COVID-19 symptoms (fever, cough, body aches) whilst taking GLP-1 medications, contact your healthcare provider for guidance

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