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And this is where it gets interesting

We confirmed these observations in human islets

Some patients benefit from slower titration schedules: extended time at 0.25 mg or 0.5 mg doses, biweekly rather than weekly increases, or dietary sodium support during early treatment phases

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Seek immediate medical attention if you experience severe or worsening abdominal pain, complete inability to pass stool or gas (possible bowel obstruction), vomiting along with constipation, blood in stool, fever with constipation, or severe abdominal distension

And weight regain after stopping is substantial the drug doesn't change metabolism permanently, it manages appetite while you take it