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As the condition advances, the open space in the spinal canal continues to decrease, usually from degenerative spinal changes like: Thickened spinal ligaments Weakened, bulging, or herniated spinal discs Arthritic facet joints and/or spinal bone spurs Eventually, spinal stenosis can lead to nerve impingement as the spinal canal presses on nearby nerves

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Patients should be counseled to report severe abdominal pain immediately Gallbladder disease : Increased risk of cholelithiasis and cholecystitis, likely related to rapid weight loss Hypoglycemia : Risk is low when used alone but increases when combined with insulin or sulfonylureas Thyroid C-cell tumors : Based on rodent studies, these agents carry a boxed warning and are contraindicated in patients with personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 Acute kidney injury : Can occur, particularly with dehydration from gastrointestinal side effects Diabetic retinopathy complications : Semaglutide may worsen diabetic retinopathy in patients with diabetes, particularly with rapid improvement in glucose control Severe gastrointestinal disease : Use with caution in patients with gastroparesis or severe gastrointestinal disease