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It is usually well tolerated, but rare serious complications such as VPA-induced hepatotoxicity (VHT) and VPA-induced hyperammonaemic encephalopathy (VHE) may occur in some patients who receive VPA chronically [133]

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The SELECT trial (Semaglutide Effects on Heart Disease and Stroke in Patients With Overweight or Obesity), a phase 3 study involving 17,604 adults with overweight or obesity and pre-existing CVD but no diabetes, revealed that once-weekly subcutaneous semaglutide 2.4 mg reduced the risk of major adverse cardiovascular events by 20% compared with placebo over a mean follow-up of 39.8 months, including cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke [48]

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Clinical Implications and Future Monitoring Needs Although the absolute risk remains low, the findings highlight an important safety consideration for semaglutide prescribing

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