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Contraindications and cautions are not well-defined due to limited research, but individuals should exercise particular caution if they have: Active malignancy (theoretical concerns about supporting cancer cell metabolism) Cardiovascular conditions (effects on blood pressure and heart rate are not fully characterised) Pregnancy or breastfeeding (should be avoided due to absence of safety data) Children and adolescents under 18 (should be avoided outside clinical trials) Severe liver or kidney impairment (metabolism and excretion pathways unclear) Quality and governance considerations are significant

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Fatigue on semaglutide can stem from reduced food intake, dehydration, inadequate protein, or insufficient sleep—not necessarily B12 deficiency