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Semaglutide must not be given to people with a personal or family history of multiple endocrine neoplasia syndrome type 2 (MEN 2) or medullary thyroid carcinoma (MTC)

If reflux has been managed with medication, attempt a gradual step-down after 4 to 6 weeks at maintenance

For patients on compounded GLP-1 medications from PlexusDxincluding compounded semaglutide, tirzepatide, or our Microdose GLP-1 Protocolgenetic predispositions in peptide pathways can inform symptom expectations and medication compatibility

Supplement with a high-quality multivitamin, additional B12 (especially if not using a methylcobalamin-enhanced formulation ), vitamin D, and magnesium