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The decline after week 24 does not mean heart rate returns completely to baseline while on treatment

Jul 2016;22(7):490-5

Data extraction and risk of bias assessment Two authors independently completed the literature search, data extraction, and quality evaluation of the included studies according to predetermined criteria

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Seek urgent medical attention (contact 999 or attend A&E) if you experience: Severe, persistent abdominal pain, particularly if accompanied by fever, vomiting, or inability to pass stools or wind Blood in your stools (red blood or black, tarry stools) Signs of severe dehydration: extreme thirst, dark urine, dizziness, confusion, or reduced urine output Persistent vomiting preventing fluid or medication intake Symptoms suggesting pancreatitis: severe upper abdominal pain radiating to the back, often with nausea and vomiting (if pancreatitis is suspected, stop taking your GLP-1 medication immediately) Right upper abdominal pain with fever, yellowing of skin/eyes, dark urine or pale stools (possible gallbladder problems) Contact NHS 111 or your GP within 24-48 hours if: Diarrhoea persists beyond 7 days without improvement You're passing more than 6 loose stools daily Bowel symptoms are significantly impacting your quality of life, work, or daily activities You're unable to maintain adequate nutrition or hydration You develop new symptoms such as unexplained weight loss (beyond expected therapeutic effect), persistent fever, or night sweats Symptoms worsen rather than improve over time Routine review is appropriate if: Mild to moderate symptoms persist but are manageable You're uncertain whether symptoms are medication-related You wish to discuss dose adjustments or alternative management strategies GLP-1 medications are associated with recognised gastrointestinal risks including pancreatitis, gallbladder disease, and rarely, intestinal obstruction

Thus, although at first glance, it appears that plasma drug levels are extremely high, they actually may be closer to those of natural GLP-1 levels after strong stimulation