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Call your prescriber within 24 hours if: Vomiting occurs more than three times in a single day You cannot keep down water or oral rehydration solution for 12 or more hours Vomiting persists for more than 48 hours at the same dose without improvement You are taking oral medications (birth control pills, levothyroxine, antiepileptics) that depend on GI absorption, because repeated vomiting can reduce their effectiveness [6] You develop new or worsening heartburn, which may indicate gastroparesis or gastroesophageal reflux worsened by delayed emptying The Endocrine Society's 2024 clinical practice guideline on pharmacological management of obesity recommends that clinicians "consider dose reduction or temporary discontinuation of GLP-1 receptor agonists in patients with persistent gastrointestinal intolerance rather than abrupt cessation" [7]