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Sheibani M, Shayan M, Khalilzadeh M, Ghasemi M, Dehpour AR (2023) Orexin receptor antagonists in the pathophysiology and treatment of sleep disorders and epilepsy

Weeks 13 through 24 at 7.5-12.5 mg represent the peak weight loss phase for most patients

The mechanism of action can be summarized in the following three stages: reaction with superoxide anion radical to prevent free radical trigger, inhibition of the Fenton reaction to prevent hydroxyl radical generation, and reaction with lipid peroxidation groups to prevent lipid peroxidation

Combine that with people being told they can take the pill whenever means one day they might take it with food, another day on an empty stomach and that can and probably does lead to wild swings in drugs level in the blood, and if research has shown anything consistent with GLP-1 agonists it is that having big spikes and swings in drug levels tend to lead to increased side effects