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More serious but rare adverse effects include: Pancreatitis : Seek immediate medical attention if you experience severe, persistent abdominal pain radiating to the back, particularly if accompanied by vomiting Diabetic retinopathy complications : The SmPC notes that rapid improvement in glucose control has been associated with temporary worsening of diabetic retinopathy, particularly in patients with pre-existing retinopathy and those on insulin [1] [18] Acute kidney injury : Particularly in the context of severe dehydration from gastrointestinal side effects Gallbladder disease : Rapid weight loss may increase the risk of gallstones Thyroid considerations : Semaglutide has been associated with thyroid C-cell tumours in rodent studies, though the relevance to humans remains uncertain

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It is also why splitting the dose, in theory, creates only modest changes in the overall drug exposure curve rather than dramatic ones