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Wernicke encephalopathy, a life-threatening complication of thiamine deficiency characterized by ophthalmoparesis, ataxia, confusion, and nystagmus 60,61 , has been reported in patients using semaglutide 62

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Muscle cramps during GLP-1 therapy are typically caused by indirect factors including electrolyte depletion (especially magnesium and potassium) from gastrointestinal side effects, dehydration from reduced fluid intake or vomiting/diarrhea, rapid weight loss with some lean mass reduction, and increased physical activity exceeding current conditioning levels