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Johns Wort can accelerate clearance and diminish efficacy, whereas inhibitors like ketoconazole, clarithromycin, certain protease inhibitors, or excessive grapefruit intake may elevate serum estradiol and increase adverse-event risk

Common Side Effects Water retention & flushing: Mild water retention, headaches or transient flushing can occur

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Much of the supporting research summarized in peer-reviewed literature relies on animal studies, such as GLP-1 receptor-knockout mice and rodent injection trials, rather than large-scale human trials, and peptide-based drugs overall are described as rarely used in real-world patient care because of lingering questions about safety, effectiveness, and inadequate insurance coverage