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When used in combination, the majority of the antihyperglycemic agents reduced HbA1c to a lesser extent compared to monotherapy [23]

Furthermore, de Oliveira et al

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The combination Qsymia (phentermine + topiramate) is a separate FDA-approved medication that pairs a low-dose stimulant with an anti-seizure drug but even Qsymia produces less weight loss than semaglutide alone (10% vs 15%)

Sudden fiber increases cause gas and bloating that compound the GLP-1 GI effects