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Common digestive side effects include: Nausea (12-24% of patients): typically most prominent during dose escalation Diarrhea (12-17% of patients): may alternate with constipation in some individuals Decreased appetite : therapeutic effect but can be uncomfortable Vomiting (6-10% of patients): usually transient and dose-related Constipation (5-11% of patients): paradoxically occurs despite overall slowed transit Abdominal pain or discomfort (6-10% of patients) Dyspepsia and bloating : related to delayed gastric emptying These effects are generally most pronounced during the first 4-8 weeks of treatment and during dose escalation periods