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Some people experience more pronounced gastrointestinal side effects as the dose increases, which is why titration matters

This is due to an excessive amount of calcified black tartar accumulated under the gum tissue, which may result in the black appearance near the gums, but the gums themselves do not have discoloration

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To keep patients safe and outcomes strong, consider the following clinical best practices: Start low, go slow on dosing Monitor for GI symptoms, especially early on Revisit mental health and vision concerns routinely Avoid use in patients with thyroid cancer history Stay alert for signs of pancreatitis or gallbladder issues Smart oversight matters