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This side effect can start soon after you begin taking the medication or after many years of treatment

However, patients should be advised to report symptoms suggestive of liver injury, including: Persistent nausea or vomiting unrelated to expected GI side effects Right upper quadrant abdominal pain (which may also indicate gallbladder disease, a known risk with GLP-1 therapy) Jaundice (yellowing of skin or eyes) Dark urine or pale stools Unexplained fatigue or malaise Clinicians should maintain a low threshold for investigating these symptoms with comprehensive liver function tests, including ALT, AST, alkaline phosphatase, bilirubin, albumin, and INR/prothrombin time

Even though there are studies showing an effective and safe reduction of glycaemic parameters with initial combination therapies with DPP-4 inhibitors, initial combinations are not generally recommended in the new treatment recommendations (7072, 7685)

Withhold HALAVEN in patients who experience Grade 3 or 4 peripheral neuropathy until resolution to Grade 2 or less