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much lower at community doses Vomiting up to 36% at high doses Diarrhea 23-26% Constipation 17-19% Fatigue 11-13% Pancreatitis risk trials flagged severe abdominal pain for discontinuation and evaluation Gallbladder issues rapid weight loss increases gallstone risk Thyroid C-cell tumors same boxed warning as semaglutide (animal studies) GI side effects were more intense than semaglutide in trial data due to the dual mechanism