Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. Symptoms included malaise, myalgias, respiratory distress, somnolence, dizziness, changes in heart rate/rhythm, and abdominal pain. Laboratory abnormalities included elevated blood lactate levels, anion gap acidosis, increased lactate/pyruvate ratio; and metformin plasma levels generally >5 mcg/mL. In more than 20,000 patient-years exposure to metformin in clinical trials, there were no reports of lactic acidosis. Reported cases have occurred primarily in diabetic patients with significant renal insufficiency, including both intrinsic renal disease and renal hypoperfusion, often in the setting of multiple concomitant medical/surgical problems and multiple concomitant medications.

Risk factors include renal impairment, concomitant use of certain drugs, age ≥65 years old, radiological studies with contrast, surgery and other procedures, hypoxic states, excessive alcohol intake, and hepatic impairment. Lactic acidosis is a medical emergency and requires immediate treatment in the hospital.

Before using metformin, tell your healthcare provider about your medical history, especially if you have:

• kidney disease
• heart disease or congestive heart failure
• liver disease
• metabolic acidosis or diabetic ketoacidosis
• high ketone levels in your blood or urine
• you use insulin or other diabetes medications

Talk to your healthcare provider if you are planning to become pregnant or if pregnant or breastfeeding. Avoid alcohol while taking this medication. Talk to your healthcare provider about discontinuing metformin prior to a surgical procedure or an iodinated contrast imaging procedure. Stop metformin and notify your healthcare provider immediately if you have an illness with severe diarrhea and/or vomiting resulting in dehydration.

Many people experience no side effects while taking metformin. The most common side effects of metformin include:

• diarrhea
• nausea/vomiting
• upset stomach (gas, bloating, and stomach cramps)

These symptoms may subside after the body adjusts to the medication. Taking your medicine with the evening meal can help reduce these side effects.

Additional but rare side effects include:

• low blood sugar (hypoglycemia)
• feeling cold
• unusual muscle pain
• dizziness
• slow or irregular heart rate
• trouble breathing
• metallic taste
• changes to nails on fingers and toes
• Low b12 levels

As with other medications, metformin can interact with alcohol and certain medications, including angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, corticosteroids, hormone replacement therapy and estrogens, oral contraceptives, carbonic anhydrase inhibitors, nifedipine, thiazides or furosemide and other diuretics, phenothiazines, phenytoin, nicotinic acid (niacin), multidrug and toxin extrusion inhibitors, sympathomimetics, calcium channel blockers, isoniazid (antibiotic for tuberculosis), insulin and glyburide or other medications for diabetes, and medications for thyroid disease.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information.

To report suspected adverse reactions to metformin contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

Bupropion may cause psychiatric disorders, including suicidal thinking and behavior, hallucinations, confusion, paranoia, irrational fears and manic episodes (for people with undiagnosed bipolar disorder). The medicine could also cause high blood pressure, fast irregular heart beats, seizures, acute angle-closure glaucoma, and death. You should not stop taking bupropion abruptly or without consulting your healthcare provider.

Tell your healthcare provider about your medical history, especially if you have any of the following conditions in which case you should NOT take bupropion:

• seizure disorder
• anorexia
• Bulimia
• use of an MAOI (monoamine oxidase inhibitor) such as Nardil®, Parnate® or Marplan® in the past 14 days
• severe head injury
• withdrawal from benzodiazepine or alcohol intoxication.

This drug may make you dizzy or drowsy or impair your judgment. Please do not drive, operate heavy machinery, or perform any hazardous task until the effects of bupropion are known to you. For anyone taking diabetes medications, please have a discussion with your prescribing clinician prior to taking bupropion as your diabetes medications may need to be adjusted as you lose weight. You should wear medical identification stating that you are taking this drug so that appropriate treatment can be given in a medical emergency.

Tell your healthcare provider right away if you experience anxiety, dry mouth, irregular heartbeats, irritability or other mental depression or other mood or mental changes or suicidal thoughts, restlessness, shaking, trouble sleeping, buzzing or ringing in ears, skin hives, rashes or itching, confusion, fainting, hyperventilation, hallucinations, seizures, trouble concentrating, lightheadedness, chest discomfort, sweating, headaches, impulsivity or unusual tiredness.

DO NOT take bupropion if you are planning to become pregnant or if pregnant or breastfeeding.

Many people experience no side effects while taking bupropion. Some of the most common side effects (but not extremely frequent) are:

• difficulty sleeping
• headaches or migraines
• nausea or vomiting
• constipation
• excessive sweating
• dizziness
• weight loss
• decrease in appetite
• blurred vision
• dry mouth
• nervousness
• agitation or other mental changes
• tremors
• fast heart rate

Additional side effects include:

• change in sense of taste
• drowsiness
• frequent need to urinate
• sore throat
• unusual feeling of well-being

These symptoms may subside after the body adjusts to the medication.

As with other medications, bupropion can interact with alcohol and certain prescription and non-prescription medications and herbal products, including monoamine oxidase (MAO) inhibitors (like isocarboxazid, linezolid, phenelzine, selegiline, tranylcypromine), dopaminergic medications (drugs that increase dopamine levels in your system like levodopa and amantadine), drugs that affect the central nervous system (CNS) like antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicines, medicine for depression, medicine for anxiety, antipsychotics, theophylline, systemic corticosteroids, prescription pain medicine or narcotics, medicine for attention deficit and hyperactivity disorder, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information.

To report suspected adverse reactions to Bupropion contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

DO NOT take naltrexone if you are taking ANY opioids or opiate drugs or if you are dependent on opioids or using methadone or buprenorphine, or if you are in opioid withdrawal. If you take opioids/opiates right after stopping naltrexone you may be more sensitive to them (and require lower doses) - which poses a risk of overdose. Please talk to your provider before initiating any amount of opioids/opiates after stopping naltrexone. Do not take this medication if you have a sensitivity to it or any of its components.

Before using naltrexone, tell your healthcare provider about your medical history, especially if you have:

• kidney disease
• liver disease (as it may cause liver dysfunction or hepatitis)
• depression/suicidality
• current or recent (7-14 days) use of any type of opioid or opiate drugs

This drug may make you dizzy or drowsy or impair your judgment. Please do not drive, operate heavy machinery, or perform any hazardous task until the effects of naltrexone are known to you. For anyone taking diabetes medications, please have a discussion with your prescribing clinician prior to taking naltrexone as your diabetes medications may need to be adjusted as you lose weight. You should wear medical identification stating that you are taking this drug so that appropriate treatment can be given in a medical emergency.

Tell your healthcare provider right away if you experience severe stomach or abdominal pain changes in vision, eye pain, burning or swollen eyes, chest pain, confusion, discomfort while urinating or frequent urination, fever, hallucinations or seeing, hearing, or feeling things that are not there, itching, mental depression or other mood or mental changes or suicidality, ringing or buzzing in the ears, shortness of breath, swelling of the face, feet, or lower legs or weight gain.

DO NOT take naltrexone if you are planning to become pregnant or if pregnant or breastfeeding.

Many people experience no side effects while taking naltrexone. Some of the most common side effects (but not extremely frequent) are:

• fatigue or low energy
• difficulty sleeping
• nervousness and anxiety
• headache
• nausea or vomiting
• joint and muscle pain
• stomach cramps or pain

Additional side effects include:

• loss of appetite
• diarrhea or constipation
• increased energy
• increased thirst
• dizziness
• skin rash
• sexual problems in males
• chills
• runny nose
• irritability or feeling down

These symptoms may subside after the body adjusts to the medication.

As with other medications, naltrexone can interact with certain prescription and non-prescription medications and herbal products, including dextromethorphan, diarrhea medication, disulfiram, opioid pain or cough relievers (such as codeine) and thioridazine.
Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information.

To report suspected adverse reactions to naltrexone contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

Before using topiramate, tell your healthcare provider about your medical history, especially if you have:

• narrow angle glaucoma and nearsightedness
• kidney problems, such as kidney stones
• liver problems
• depression or thoughts of suicide
• lung or breathing problems
• metabolic acidosis
• high blood ammonia levels
• long-term diarrhea
• low body temperature
• a diet high in fat and low in carbohydrates, aka a ketogenic diet
• brittle bones

Topiramate may cause some people to sweat less. It is recommended to avoid alcohol and stay well hydrated while taking this medication.This drug may make you dizzy or drowsy or impair your judgment. Please do not drive, operate heavy machinery, or perform any hazardous task until the effects of topiramate are known to you. For anyone taking diabetes medications, please have a discussion with your prescribing clinician prior to taking topiramate as your diabetes medications may need to be adjusted as you lose weight.

Topiramate may also cause birth defects (particularly there is a risk of cleft lip and/or palate and low birth weight). Topiramate may cause breakthrough bleeding. DO NOT take topiramate if you are planning to become pregnant or if pregnant or breastfeeding.

Many people experience no side effects while taking topiramate. Some of the most common side effects (but not extremely frequent) are:

• anorexia
• weight loss
• dizziness
• fatigue or drowsiness
• difficulty with concentration and psychomotor slowing
• speech difficulty
• nervousness
• tingling or prickling sensations
• abnormal vision
• fever

Additional side effects include:

• difficulty with memory
• changes in taste
• diarrhea
• numbness
• nausea
• abdominal pain
• upper respiratory tract infection
• hair loss
• changes in mood/suicidal thoughts

These symptoms may subside after the body adjusts to the medication.

As with other medications, topiramate can interact with alcohol, marijuana and certain medications, including antiepileptic drugs, CNS depressants, oral contraceptives, lithium, other carbonic anhydrase inhibitors, hydrochlorothiazide, pioglitazone and amitriptyline. Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information.

To report suspected adverse reactions to topiramate contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

DO NOT take zonisamide if you have an allergy to sulfa drugs. A potentially fatal reaction can occur including a life threatening skin rash or a blood cell condition.

Before using zonisamide, tell your healthcare provider about your medical history, especially if you have:

• kidney disease
• liver disease
• long-term diarrhea
• lung or breathing problems
• metabolic acidosis or diabetic ketoacidosis
• high ketone levels in your blood or urine
• you use insulin or other diabetes medications
• history of psychiatric disorders or suicidal thoughts
  

Talk to your healthcare provider if you are planning to become pregnant or if pregnant or breastfeeding. Avoid alcohol and stay well hydrated while taking this medication. Do not drive, operate heavy machinery or perform any hazardous task until the effects of this medication are known to you. Tell your healthcare provider right away if you experience eye pain, changes in vision, eye swelling or redness, yellowing of the eyes, confusion, difficulty concentrating, suicidal thoughts, memory problems, trouble thinking clearly, agitation, irritability, speech problems, decreased sweating, sudden flank pain, painful urination, dark urine, increased fatigue, skin rash, faintness, easy bruising, irregular or fast heartbeat, bone pain, rapid breathing, dizziness, or stomach pain that is severe or that lasts more than a few days.

Many people experience no side effects while taking zonisamide. The most common side effects of zonisamide include:

• dizziness and lightheadedness
• fatigue and drowsiness
• language and speech difficulty
• metallic taste
• nausea

Other possible side effects include:

• trouble sleeping
• lack of coordination
• loss of appetite and weight loss
• diarrhea
• double vision
• mood changes such as depression or irritability
• difficulty concentrating

These symptoms may subside after your body adjusts to the medication.

As with other medications, zonisamide can interact with certain medications, including carbonic anhydrase inhibitors (such as acetazolamide), orlistat (if using zonisamide for a seizure disorder), phenobarbital, primidone, rifamycins, glucocorticoids, and St. John's wort.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information. Do not stop taking this medication without consulting your healthcare provider because some conditions may become worse when the drug is suddenly stopped.

To report suspected adverse reactions to zonisamide contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

GLP-1s are contraindicated in individuals with a history of medullary thyroid carcinoma, a family history of such, or in patients with multiple endocrine neoplasia syndrome type 2. Do not take them if you have ever had thyroid cancer. In studies with rodents, GLP-1s caused thyroid tumors, including thyroid cancer; it is not known if they will cause thyroid tumors or cancer in humans. Please notify your doctor ASAP if you develop trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath. 

If you experience a medical emergency, call 911 or go to the nearest emergency room.

Tell your healthcare provider about your medical history prior to taking Mounjaro®.

Avoid alcohol while taking this medication. If you’re taking diabetes medications, please discuss this with your prescribing doctor before starting Mounjaro®, as your diabetes medications may need to be adjusted as you lose weight.

Females of reproductive potential should use adequate contraception while taking this medication. It is advised to use a non-oral contraceptive method (instead of oral contraceptive) or, if using oral contraception- add a barrier method of contraception 4 weeks after initiation and 4 weeks after dose escalation. 

Do not take this medication if pregnant, trying to get pregnant or breastfeeding. If you plan to become pregnant, this medication needs to be stopped at least 2 months before trying. This medication may cause fetal harm.

Notify your doctor if you have kidney, liver, or pancreas problems.

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

Stop using Mounjaro® and get medical help right away if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; or very rapid heartbeat.

Serious hypersensitivity reactions (e.g., anaphylaxis and angioedema) have been reported. Discontinue Mounjaro® if suspected and promptly seek medical advice.

Please contact your doctor ASAP and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea and/or vomiting resulting in dehydration-  it is important to stay well hydrated and drink plenty of fluids while on this medication 
• Kidney problems/kidney failure - vomiting, nausea, diarrhea can cause dehydration and kidney issues and make kidney problems worse in individuals who have pre-existing kidney conditions; may sometimes lead to the need for hemodialysis 
• Thyroid C-Cell Tumor: Trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath (see black box warning below)
• Pancreatitis: Severe pain in your abdomen or back that will not go away 
• Acute gallbladder disease - Pain in the middle or right upper stomach, fever, white parts of your eyes turn yellow or skin turns yellow, nausea/vomiting. If gallstones or inflammation of the gallbladder is suspected further studies are needed.
• Hepatitis/Elevated liver enzymes/Jaundice
• Diabetic retinopathy problems: Changes in vision in those with type II diabetes, particularly vision problems may worsen in those with a history of diabetic retinopathy 
• Severe gastrointestinal disease - may cause gastrointestinal disease; do not use if you have a history of severe gastrointestinal disease 
• Signs of low blood sugar (for example, dizziness, weakness, shakiness, jitteriness, headache, anxiety/mood changes, rapid heartbeat, confusion, slurred speech, sweating, or lightheadedness). While this is rare with GLP-1s, if it occurs, please seek in-person care immediately. If you have these symptoms, try having liquid or food containing sugar (around 15-20 grams) —drinking juice, having regular soda, or eating some hard candies right away, as this will help raise your blood sugar quickly. If taken with insulin or an insulin secretagogue (ie sulfonylurea) it is best to talk to your healthcare provider about possibly lowering the dose of these medications to lower the risk of hypoglycemia. 
• Increasing heart rate
• Worsening depression, behavior changes, or suicidality
• Note: Never share the Mounjaro® pen with other people

Many people experience no side effects. Some of the most common or potential side effects include:

• Nausea
• Constipation
• Vomiting
• Diarrhea
• Abdominal Pain
• Headache
• Indigestion 
• Injection site reactions
• Dizziness
• Back pain
• Increased Lipase or Amylase 
• Altered taste
• Nasopharyngitis (common cold)
• Passing Gas
• Bloating
• Belching
• Gastroenteritis
• Decreased appetite 
• Fatigue
• Gastroesophageal reflux disease
• Low blood sugar (hypoglycemia) in those with type II diabetes
• Upset stomach

These symptoms often subside as your body adjusts to the medications. Please notify your provider if side effects persist. For a complete list of side effects, review the medication packaging inserts.

As with other medications, Mounjaro® can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of hypoglycemia is increased when combined with insulin or insulin secretagogues such as sulfonylureas. Mounjaro® delays gastric emptying and may impact the absorption of oral medications. If you are on thyroid hormone medication, prior to starting Mounjaro®, please review the timing of taking your thyroid hormone medication with the doctor who prescribes it as it may need to be adjusted.The drug levels of medications with narrow therapeutic windows (ie warfarin) should be monitored closely while on Mounjaro®. 

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information. 

To report suspected adverse reactions to Mounjaro® contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

GLP-1s are contraindicated in individuals with a history of medullary thyroid carcinoma, a family history of such, or in patients with multiple endocrine neoplasia syndrome type 2. Do not take them if you have ever had thyroid cancer. In studies with rodents, GLP-1s caused thyroid tumors, including thyroid cancer; it is not known if they will cause thyroid tumors or cancer in humans. Please notify your doctor ASAP if you develop trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath. 

If you experience a medical emergency, call 911 or go to the nearest emergency room.

Tell your healthcare provider about your medical history prior to taking Ozempic®.

Avoid alcohol while taking this medication. If you’re taking diabetes medications, please discuss this with your prescribing doctor before starting Ozempic®, as your diabetes medications may need to be adjusted as you lose weight.

Use adequate contraception while taking this medication. Do not take this medication if pregnant, trying to get pregnant or breastfeeding. If you plan to become pregnant, this medication needs to be stopped at least 2 months before trying. This medication may cause fetal harm.

Notify your doctor if you have kidney, liver, or pancreas problems.

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

Stop using Ozempic® and get medical help right away if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; or very rapid heartbeat.

Serious hypersensitivity reactions (e.g., anaphylaxis and angioedema) have been reported. Discontinue Ozempic® if suspected and promptly seek medical advice.

Please contact your doctor ASAP and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea and/or vomiting resulting in dehydration-  it is important to stay well hydrated and drink plenty of fluids while on this medication 
• Kidney problems/kidney failure - vomiting, nausea, diarrhea can cause dehydration and kidney issues and make kidney problems worse in individuals who have pre-existing kidney conditions; may sometimes lead to the need for hemodialysis 
• Thyroid C-Cell Tumor: Trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath (see black box warning below)
• Pancreatitis: Severe pain in your abdomen or back that will not go away 
• Acute gallbladder disease - Pain in the middle or right upper stomach, fever, white parts of your eyes turn yellow or skin turns yellow, nausea/vomiting. If gallstones or inflammation of the gallbladder is suspected further studies are needed.
• Hepatitis/Elevated liver enzymes/Jaundice
• Diabetic retinopathy problems: Changes in vision in those with type II diabetes, particularly vision problems may worsen in those with a history of diabetic retinopathy 
• Severe gastrointestinal disease - may cause gastrointestinal disease; do not use if you have a history of severe gastrointestinal disease 
• Signs of low blood sugar (for example, dizziness, weakness, shakiness, jitteriness, headache, anxiety/mood changes, rapid heartbeat, confusion, slurred speech, sweating, or lightheadedness). While this is rare with GLP-1s, if it occurs, please seek in-person care immediately. If you have these symptoms, try having liquid or food containing sugar (around 15-20 grams) —drinking juice, having regular soda, or eating some hard candies right away, as this will help raise your blood sugar quickly. If taken with insulin or an insulin secretagogue (ie sulfonylurea) it is best to talk to your healthcare provider about possibly lowering the dose of these medications to lower the risk of hypoglycemia. 
• Increasing heart rate
• Worsening depression, behavior changes, or suicidality
• Never share the Ozempic® pen with other people

Many people experience no side effects. Some of the most common or potential side effects include:

• Nausea
• Constipation
• Vomiting
• Diarrhea
• Abdominal Pain
• Headache
• Indigestion 
• Injection site reactions
• Dizziness
• Back pain
• Increased Lipase or Amylase 
• Altered taste
• Nasopharyngitis (common cold)
• Passing Gas
• Bloating
• Belching
• Gastroenteritis
• Decreased appetite 
• Fatigue
• Gastroesophageal reflux disease
• Low blood sugar (hypoglycemia) in those with type II diabetes
• Upset stomach

These symptoms often subside as your body adjusts to the medications. Please notify your provider if side effects persist. For a complete list of side effects, review the medication packaging inserts.

As with other medications, Ozempic® can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of hypoglycemia is increased when combined with insulin or insulin secretagogues such as sulfonylureas. Ozempic® delays gastric emptying and may impact the absorption of oral medications. If you are on thyroid hormone medication, prior to starting Ozempic®, please review the timing of taking your thyroid hormone medication with the doctor who prescribes it as it may need to be adjusted. The drug levels of medications with narrow therapeutic windows (ie warfarin) should be monitored closely while on Ozempic®.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information. 

To report suspected adverse reactions to Ozempic® contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

GLP-1s are contraindicated in individuals with a history of medullary thyroid carcinoma, a family history of such, or in patients with multiple endocrine neoplasia syndrome type 2. Do not take them if you have ever had thyroid cancer. In studies with rodents, GLP-1s caused thyroid tumors, including thyroid cancer; it is not known if they will cause thyroid tumors or cancer in humans. Please notify your doctor ASAP if you develop trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath. 

If you experience a medical emergency, call 911 or go to the nearest emergency room.

Tell your healthcare provider about your medical history prior to taking Rybelsus®.

Avoid alcohol while taking this medication. If you’re taking diabetes medications, please discuss this with your prescribing doctor before starting Rybelsus®, as your diabetes medications may need to be adjusted as you lose weight.

Use adequate contraception while taking this medication. Do not take this medication if pregnant, trying to get pregnant or breastfeeding. If you plan to become pregnant, this medication needs to be stopped at least 2 months before trying. This medication may cause fetal harm.

Notify your doctor if you have kidney, liver, or pancreas problems.

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

Stop using Rybelsus® and get medical help right away if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; or very rapid heartbeat.

Serious hypersensitivity reactions (e.g., anaphylaxis and angioedema) have been reported. Discontinue Rybelsus® if suspected and promptly seek medical advice.

Please contact your doctor ASAP and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea and/or vomiting resulting in dehydration-  it is important to stay well hydrated and drink plenty of fluids while on this medication 
• Kidney problems/kidney failure - vomiting, nausea, diarrhea can cause dehydration and kidney issues and make kidney problems worse in individuals who have pre-existing kidney conditions; may sometimes lead to the need for hemodialysis 
• Thyroid C-Cell Tumor: Trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath (see black box warning below)
• Pancreatitis: Severe pain in your abdomen or back that will not go away 
• Acute gallbladder disease - Pain in the middle or right upper stomach, fever, white parts of your eyes turn yellow or skin turns yellow, nausea/vomiting. If gallstones or inflammation of the gallbladder is suspected further studies are needed.
• Hepatitis/Elevated liver enzymes/Jaundice
• Diabetic retinopathy problems: Changes in vision in those with type II diabetes, particularly vision problems may worsen in those with a history of diabetic retinopathy 
• Severe gastrointestinal disease - may cause gastrointestinal disease; do not use if you have a history of severe gastrointestinal disease 
• Signs of low blood sugar (for example, dizziness, weakness, shakiness, jitteriness, headache, anxiety/mood changes, rapid heartbeat, confusion, slurred speech, sweating, or lightheadedness). While this is rare with GLP-1s, if it occurs, please seek in-person care immediately. If you have these symptoms, try having liquid or food containing sugar (around 15-20 grams) —drinking juice, having regular soda, or eating some hard candies right away, as this will help raise your blood sugar quickly. If taken with insulin or an insulin secretagogue (ie sulfonylurea) it is best to talk to your healthcare provider about possibly lowering the dose of these medications to lower the risk of hypoglycemia. 
• Increasing heart rate
• Worsening depression, behavior changes, or suicidality

Many people experience no side effects. Some of the most common or potential side effects include:

• Nausea
• Constipation
• Vomiting
• Diarrhea
• Abdominal Pain
• Headache
• Indigestion 
• Dizziness
• Back pain
• Increased Lipase or Amylase 
• Altered taste
• Nasopharyngitis (common cold)
• Passing Gas
• Bloating
• Belching
• Gastroenteritis
• Decreased appetite 
• Fatigue
• Gastroesophageal reflux disease
• Low blood sugar (hypoglycemia) in those with type II diabetes
• Upset stomach

These symptoms often subside as your body adjusts to the medications. Please notify your provider if side effects persist. For a complete list of side effects, review the medication packaging inserts.

As with other medications, Rybelsus® can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of hypoglycemia is increased when combined with insulin or insulin secretagogues such as sulfonylureas. Rybelsus® delays gastric emptying and may impact the absorption of oral medications. If you are on thyroid hormone medication, prior to starting Rybelsus®, please review the timing of taking your thyroid hormone medication with the doctor who prescribes it as it may need to be adjusted. The drug levels of medications with narrow therapeutic windows (ie warfarin) should be monitored closely while on Rybelsus®.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information. 

To report suspected adverse reactions to Rybelsus® contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

GLP-1s are contraindicated in individuals with a history of medullary thyroid carcinoma, a family history of such, or in patients with multiple endocrine neoplasia syndrome type 2. Do not take them if you have ever had thyroid cancer. In studies with rodents, GLP-1s caused thyroid tumors, including thyroid cancer; it is not known if they will cause thyroid tumors or cancer in humans. Please notify your doctor ASAP if you develop trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath. 

If you experience a medical emergency, call 911 or go to the nearest emergency room.

Tell your healthcare provider about your medical history prior to taking Saxenda®.

Avoid alcohol while taking this medication. If you’re taking diabetes medications, please discuss this with your prescribing doctor before starting Saxenda®, as your diabetes medications may need to be adjusted as you lose weight.

Use adequate contraception while taking this medication. Do not take this medication if pregnant, trying to get pregnant or breastfeeding. If you plan to become pregnant, this medication needs to be stopped at least 2 months before trying. This medication may cause fetal harm.

Notify your doctor if you have kidney, liver, or pancreas problems.

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

Stop using Saxenda® and get medical help right away if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; or very rapid heartbeat.

Serious hypersensitivity reactions (e.g., anaphylaxis and angioedema) have been reported. Discontinue Saxenda® if suspected and promptly seek medical advice.

Please contact your doctor ASAP and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea and/or vomiting resulting in dehydration-  it is important to stay well hydrated and drink plenty of fluids while on this medication 
• Kidney problems/kidney failure - vomiting, nausea, diarrhea can cause dehydration and kidney issues and make kidney problems worse in individuals who have pre-existing kidney conditions; may sometimes lead to the need for hemodialysis 
• Thyroid C-Cell Tumor: Trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath (see black box warning below)
• Pancreatitis: Severe pain in your abdomen or back that will not go away 
• Acute gallbladder disease - Pain in the middle or right upper stomach, fever, white parts of your eyes turn yellow or skin turns yellow, nausea/vomiting. If gallstones or inflammation of the gallbladder is suspected further studies are needed.
• Hepatitis/Elevated liver enzymes/Jaundice
• Diabetic retinopathy problems: Changes in vision in those with type II diabetes, particularly vision problems may worsen in those with a history of diabetic retinopathy 
• Severe gastrointestinal disease - may cause gastrointestinal disease; do not use if you have a history of severe gastrointestinal disease 
• Signs of low blood sugar (for example, dizziness, weakness, shakiness, jitteriness, headache, anxiety/mood changes, rapid heartbeat, confusion, slurred speech, sweating, or lightheadedness). While this is rare with GLP-1s, if it occurs, please seek in-person care immediately. If you have these symptoms, try having liquid or food containing sugar (around 15-20 grams) —drinking juice, having regular soda, or eating some hard candies right away, as this will help raise your blood sugar quickly. If taken with insulin or an insulin secretagogue (ie sulfonylurea) it is best to talk to your healthcare provider about possibly lowering the dose of these medications to lower the risk of hypoglycemia. 
• Increasing heart rate
• Worsening depression, behavior changes, or suicidality
• Note: Never share the Saxenda® pen with other people

Many people experience no side effects. Some of the most common or potential side effects include:

• Nausea
• Constipation
• Vomiting
• Diarrhea
• Abdominal Pain
• Headache
• Indigestion 
• Injection site reactions
• Dizziness
• Back pain
• Increased Lipase or Amylase 
• Altered taste
• Nasopharyngitis (common cold)
• Passing Gas
• Bloating
• Belching
• Gastroenteritis
• Decreased appetite 
• Fatigue
• Gastroesophageal reflux disease
• Low blood sugar (hypoglycemia) in those with type II diabetes
• Upset stomach

These symptoms often subside as your body adjusts to the medications. Please notify your provider if side effects persist. For a complete list of side effects, review the medication packaging inserts.

As with other medications, Saxenda® can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of hypoglycemia is increased when combined with insulin or insulin secretagogues such as sulfonylureas. Saxenda® delays gastric emptying and may impact the absorption of oral medications. If you are on thyroid hormone medication, prior to starting Saxenda®, please review the timing of taking your thyroid hormone medication with the doctor who prescribes it as it may need to be adjusted.The drug levels of medications with narrow therapeutic windows (ie warfarin) should be monitored closely while on Saxenda®.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information. 

To report suspected adverse reactions to Saxenda® contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

GLP-1s are contraindicated in individuals with a history of medullary thyroid carcinoma, a family history of such, or in patients with multiple endocrine neoplasia syndrome type 2. Do not take them if you have ever had thyroid cancer. In studies with rodents, GLP-1s caused thyroid tumors, including thyroid cancer; it is not known if they will cause thyroid tumors or cancer in humans. Please notify your doctor ASAP if you develop trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath. 

If you experience a medical emergency, call 911 or go to the nearest emergency room.

Tell your healthcare provider about your medical history prior to taking Trulicity®.

Avoid alcohol while taking this medication. If you’re taking diabetes medications, please discuss this with your prescribing doctor before starting Trulicity®, as your diabetes medications may need to be adjusted as you lose weight.

Use adequate contraception while taking this medication. Do not take this medication if pregnant, trying to get pregnant or breastfeeding. If you plan to become pregnant, this medication needs to be stopped at least 2 months before trying. This medication may cause fetal harm.

Notify your doctor if you have kidney, liver, or pancreas problems.

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

Stop using Trulicity® and get medical help right away if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; or very rapid heartbeat.

Serious hypersensitivity reactions (e.g., anaphylaxis and angioedema) have been reported. Discontinue Trulicity® if suspected and promptly seek medical advice.

Please contact your doctor ASAP and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea and/or vomiting resulting in dehydration-  it is important to stay well hydrated and drink plenty of fluids while on this medication 
• Kidney problems/kidney failure - vomiting, nausea, diarrhea can cause dehydration and kidney issues and make kidney problems worse in individuals who have pre-existing kidney conditions; may sometimes lead to the need for hemodialysis 
• Thyroid C-Cell Tumor: Trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath (see black box warning below)
• Pancreatitis: Severe pain in your abdomen or back that will not go away 
• Acute gallbladder disease - Pain in the middle or right upper stomach, fever, white parts of your eyes turn yellow or skin turns yellow, nausea/vomiting. If gallstones or inflammation of the gallbladder is suspected further studies are needed.
• Hepatitis/Elevated liver enzymes/Jaundice
• Diabetic retinopathy problems: Changes in vision in those with type II diabetes, particularly vision problems may worsen in those with a history of diabetic retinopathy 
• Severe gastrointestinal disease - may cause gastrointestinal disease; do not use if you have a history of severe gastrointestinal disease 
• Signs of low blood sugar (for example, dizziness, weakness, shakiness, jitteriness, headache, anxiety/mood changes, rapid heartbeat, confusion, slurred speech, sweating, or lightheadedness). While this is rare with GLP-1s, if it occurs, please seek in-person care immediately. If you have these symptoms, try having liquid or food containing sugar (around 15-20 grams) —drinking juice, having regular soda, or eating some hard candies right away, as this will help raise your blood sugar quickly. If taken with insulin or an insulin secretagogue (ie sulfonylurea) it is best to talk to your healthcare provider about possibly lowering the dose of these medications to lower the risk of hypoglycemia. 
• Increasing heart rate
• Worsening depression, behavior changes, or suicidality
• Note: Never share the Trulicity® pen with other people

Many people experience no side effects. Some of the most common or potential side effects include:

• Nausea
• Constipation
• Vomiting
• Diarrhea
• Abdominal Pain
• Headache
• Indigestion 
• Injection site reactions
• Dizziness
• Back pain
• Increased Lipase or Amylase 
• Altered taste
• Nasopharyngitis (common cold)
• Passing Gas
• Bloating
• Belching
• Gastroenteritis
• Decreased appetite 
• Fatigue
• Gastroesophageal reflux disease
• Low blood sugar (hypoglycemia) in those with type II diabetes
• Upset stomach

These symptoms often subside as your body adjusts to the medications. Please notify your provider if side effects persist. For a complete list of side effects, review the medication packaging inserts.

As with other medications, Trulicity® can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of hypoglycemia is increased when combined with insulin or insulin secretagogues such as sulfonylureas. Trulicity® delays gastric emptying and may impact the absorption of oral medications. If you are on thyroid hormone medication, prior to starting Trulicity®, please review the timing of taking your thyroid hormone medication with the doctor who prescribes it as it may need to be adjusted.The drug levels of medications with narrow therapeutic windows (ie warfarin) should be monitored closely while on Trulicity®. 

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information. 

To report suspected adverse reactions to Trulicity® contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

GLP-1s are contraindicated in individuals with a history of medullary thyroid carcinoma, a family history of such, or in patients with multiple endocrine neoplasia syndrome type 2. Do not take them if you have ever had thyroid cancer. In studies with rodents, GLP-1s caused thyroid tumors, including thyroid cancer; it is not known if they will cause thyroid tumors or cancer in humans. Please notify your doctor ASAP if you develop trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath. 

If you experience a medical emergency, call 911 or go to the nearest emergency room.

Tell your healthcare provider about your medical history prior to taking Victoza®.

Avoid alcohol while taking this medication. If you’re taking diabetes medications, please discuss this with your prescribing doctor before starting Victoza®, as your diabetes medications may need to be adjusted as you lose weight.

Use adequate contraception while taking this medication. Do not take this medication if pregnant, trying to get pregnant or breastfeeding. If you plan to become pregnant, this medication needs to be stopped at least 2 months before trying. This medication may cause fetal harm.

Notify your doctor if you have kidney, liver, or pancreas problems.

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

Stop using Victoza® and get medical help right away if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; or very rapid heartbeat.

Serious hypersensitivity reactions (e.g., anaphylaxis and angioedema) have been reported. Discontinue Victoza® if suspected and promptly seek medical advice.

Please contact your doctor ASAP and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea and/or vomiting resulting in dehydration-  it is important to stay well hydrated and drink plenty of fluids while on this medication 
• Kidney problems/kidney failure - vomiting, nausea, diarrhea can cause dehydration and kidney issues and make kidney problems worse in individuals who have pre-existing kidney conditions; may sometimes lead to the need for hemodialysis 
• Thyroid C-Cell Tumor: Trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath (see black box warning below)
• Pancreatitis: Severe pain in your abdomen or back that will not go away 
• Acute gallbladder disease - Pain in the middle or right upper stomach, fever, white parts of your eyes turn yellow or skin turns yellow, nausea/vomiting. If gallstones or inflammation of the gallbladder is suspected further studies are needed.
• Hepatitis/Elevated liver enzymes/Jaundice
• Diabetic retinopathy problems: Changes in vision in those with type II diabetes, particularly vision problems may worsen in those with a history of diabetic retinopathy 
• Severe gastrointestinal disease - may cause gastrointestinal disease; do not use if you have a history of severe gastrointestinal disease 
• Signs of low blood sugar (for example, dizziness, weakness, shakiness, jitteriness, headache, anxiety/mood changes, rapid heartbeat, confusion, slurred speech, sweating, or lightheadedness). While this is rare with GLP-1s, if it occurs, please seek in-person care immediately. If you have these symptoms, try having liquid or food containing sugar (around 15-20 grams) —drinking juice, having regular soda, or eating some hard candies right away, as this will help raise your blood sugar quickly. If taken with insulin or an insulin secretagogue (ie sulfonylurea) it is best to talk to your healthcare provider about possibly lowering the dose of these medications to lower the risk of hypoglycemia. 
• Increasing heart rate
• Worsening depression, behavior changes, or suicidality
• Never share the Victoza® pen with other people 

Many people experience no side effects. Some of the most common or potential side effects include:

• Nausea
• Constipation
• Vomiting
• Diarrhea
• Abdominal Pain
• Headache
• Indigestion 
• Injection site reactions
• Dizziness
• Back pain
• Increased Lipase or Amylase 
• Altered taste
• Nasopharyngitis (common cold)
• Passing Gas
• Bloating
• Belching
• Gastroenteritis
• Decreased appetite 
• Fatigue
• Gastroesophageal reflux disease
• Low blood sugar (hypoglycemia) in those with type II diabetes
• Upset stomach

These symptoms often subside as your body adjusts to the medications. Please notify your provider if side effects persist. For a complete list of side effects, review the medication packaging inserts.

As with other medications, Victoza® can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of hypoglycemia is increased when combined with insulin or insulin secretagogues such as sulfonylureas. Victoza® delays gastric emptying and may impact the absorption of oral medications. If you are on thyroid hormone medication, prior to starting Victoza®, please review the timing of taking your thyroid hormone medication with the doctor who prescribes it as it may need to be adjusted. The drug levels of medications with narrow therapeutic windows (ie warfarin) should be monitored closely while on Victoza®.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information. 

To report suspected adverse reactions to Victoza® contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

GLP-1s are contraindicated in individuals with a history of medullary thyroid carcinoma, a family history of such, or in patients with multiple endocrine neoplasia syndrome type 2. Do not take them if you have ever had thyroid cancer. In studies with rodents, GLP-1s caused thyroid tumors, including thyroid cancer; it is not known if they will cause thyroid tumors or cancer in humans. Please notify your doctor ASAP if you develop trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath. 

If you experience a medical emergency, call 911 or go to the nearest emergency room.

Tell your healthcare provider about your medical history prior to taking Wegovy®.

Avoid alcohol while taking this medication. If you’re taking diabetes medications, please discuss this with your prescribing doctor before starting Wegovy®, as your diabetes medications may need to be adjusted as you lose weight.

Use adequate contraception while taking this medication. Do not take this medication if pregnant, trying to get pregnant or breastfeeding. If you plan to become pregnant, this medication needs to be stopped at least 2 months before trying. This medication may cause fetal harm.

Notify your doctor if you have kidney, liver, or pancreas problems.

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

Stop using Wegovy® and get medical help right away if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; or very rapid heartbeat.

Serious hypersensitivity reactions (e.g., anaphylaxis and angioedema) have been reported. Discontinue Wegovy® if suspected and promptly seek medical advice.

Please contact your doctor ASAP and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea and/or vomiting resulting in dehydration-  it is important to stay well hydrated and drink plenty of fluids while on this medication 
• Kidney problems/kidney failure - vomiting, nausea, diarrhea can cause dehydration and kidney issues and make kidney problems worse in individuals who have pre-existing kidney conditions; may sometimes lead to the need for hemodialysis 
• Thyroid C-Cell Tumor: Trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath (see black box warning below)
• Pancreatitis: Severe pain in your abdomen or back that will not go away 
• Acute gallbladder disease - Pain in the middle or right upper stomach, fever, white parts of your eyes turn yellow or skin turns yellow, nausea/vomiting. If gallstones or inflammation of the gallbladder is suspected further studies are needed.
• Hepatitis/Elevated liver enzymes/Jaundice
• Diabetic retinopathy problems: Changes in vision in those with type II diabetes, particularly vision problems may worsen in those with a history of diabetic retinopathy 
• Severe gastrointestinal disease - may cause gastrointestinal disease; do not use if you have a history of severe gastrointestinal disease 
• Signs of low blood sugar (for example, dizziness, weakness, shakiness, jitteriness, headache, anxiety/mood changes, rapid heartbeat, confusion, slurred speech, sweating, or lightheadedness). While this is rare with GLP-1s, if it occurs, please seek in-person care immediately. If you have these symptoms, try having liquid or food containing sugar (around 15-20 grams) —drinking juice, having regular soda, or eating some hard candies right away, as this will help raise your blood sugar quickly. If taken with insulin or an insulin secretagogue (ie sulfonylurea) it is best to talk to your healthcare provider about possibly lowering the dose of these medications to lower the risk of hypoglycemia. 
• Increasing heart rate
• Worsening depression, behavior changes, or suicidality
• Never share the Wegovy® pen with other people

Many people experience no side effects. Some of the most common or potential side effects include:

• Nausea
• Constipation
• Vomiting
• Diarrhea
• Abdominal Pain
• Headache
• Indigestion 
• Injection site reactions
• Dizziness
• Back pain
• Increased Lipase or Amylase 
• Altered taste
• Nasopharyngitis (common cold)
• Passing Gas
• Bloating
• Belching
• Gastroenteritis
• Decreased appetite 
• Fatigue
• Gastroesophageal reflux disease
• Low blood sugar (hypoglycemia) in those with type II diabetes
• Upset stomach

These symptoms often subside as your body adjusts to the medications. Please notify your provider if side effects persist. For a complete list of side effects, review the medication packaging inserts.

As with other medications, Wegovy® can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of hypoglycemia is increased when combined with insulin or insulin secretagogues such as sulfonylureas. Wegovy® delays gastric emptying and may impact the absorption of oral medications. If you are on thyroid hormone medication, prior to starting Wegovy®, please review the timing of taking your thyroid hormone medication with the doctor who prescribes it as it may need to be adjusted. The drug levels of medications with narrow therapeutic windows (ie warfarin) should be monitored closely while on Wegovy®.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information. 

To report suspected adverse reactions to Wegovy® contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.