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Gastrointestinal effects are the most frequently reported side effects and include: Nausea (1224% of patients): Often most pronounced during treatment initiation and dose escalation, typically improving over time Diarrhea (1323% of patients): May be transient or persistent, requiring dietary modifications Vomiting (611% of patients): Can lead to dehydration if severe or prolonged Constipation (617% of patients): May require increased fiber intake and hydration Abdominal pain or discomfort (610% of patients): Usually mild to moderate in severity Decreased appetite : Therapeutic effect but may be excessive in some individuals These gastrointestinal symptoms generally diminish over several weeks as the body adjusts to the medication

Without sufficient choline, fat accumulates in the liver

For patients concurrently taking metformin, periodic B12 monitoring should be considered , particularly if you have been on metformin for several years or have symptoms of deficiency, in line with MHRA and NICE recommendations

Patt et al