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Stop using semaglutide and call your healthcare provider immediately if you have severe stomach or abdomen pain that will not go away, with or without vomiting

To support semaglutides effects and reduce digestive side effects, focus on prebiotic fibers and resistant starches, low glycemic foods, and lean proteins at each meal

[10] [11] The risk with metformin alone is lower but still requires monitoring P-glycoprotein (P-gp) and CYP3A4 substrates : Berberine may inhibit these important drug transporters and enzymes, potentially affecting levels of medicines with a narrow therapeutic index, including: Immunosuppressants (ciclosporin, tacrolimus) Direct oral anticoagulants (DOACs) and warfarin Digoxin Some statins (particularly simvastatin, atorvastatin) Anticoagulants and antiplatelet drugs : Theoretical increased bleeding risk Antihypertensive medications : Possible additive blood pressure-lowering effects When to seek medical advice : Persistent or severe gastrointestinal symptoms Signs of hypoglycaemia (shakiness, sweating, confusion, rapid heartbeat) Unexplained fatigue or jaundice (yellowing of skin or eyes) Any unusual symptoms after starting berberine Seek urgent medical help for severe hypoglycaemia (confusion, seizures, loss of consciousness) or signs of severe allergic reaction (difficulty breathing, swelling of face/throat)

Specifically, semaglutide should be avoided or approached cautiously in the following cases : Medullary Thyroid Carcinoma (MTC) or MEN 2 : Individuals with personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) should avoid semaglutide