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For renal impairment, although most GLP-1 agents have minimal renal clearance, impaired kidney function increases the risk of adverse events such as dehydration from vomiting or decreased drug clearance in polypharmacy

MHRA-licensed alternatives for weight management including semaglutide (Wegovy), liraglutide (Saxenda), orlistat, and tirzepatide (Mounjaro) have well-characterised safety profiles and NICE eligibility criteria

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Unlike the consistent inhibition seen with GLP-1 analogues, Ex-4 has shown variable effects on adipogenic differentiation

People with absorption disorders, older adults, individuals following strict vegan diets and those with certain medical conditions may be at increased risk