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There are clear contraindications based on the trial exclusion criteria and the known risks of this drug class

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GLP-1 medications can deplete magnesium through multiple pathways

Hegedus L, Moses AC, Zdravkovic M, Le TT, Daniels GH

The STEP trial program provides the most detailed fatigue data of any GLP-1: STEP-1: ~11% fatigue at 2.4mg STEP-3: 12.8% the highest rate, in the trial combining semaglutide with intensive behavioral therapy (suggesting that aggressive lifestyle changes compound drug-induced fatigue) STEP-8: 9.5% semaglutide vs 4.7% liraglutide vs 0% placebo direct evidence that semaglutide causes more fatigue than the older GLP-1 A pooled meta-analysis of 50 semaglutide trials found a relative risk of 4.23 for asthenia (95% CI 1.34-13.36) with I=0%. That means the meta-analysis did not detect between-study heterogeneity at its available resolution