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Since levothyroxine requires an acidic gastric environment for optimal dissolution and absorption, and its absorption can be affected by the rate of gastric emptying, patients may experience variations in thyroid hormone levels when starting semaglutide therapy

"Nascobal (Cyanocobalamin, USP) Nasal Spray 500 mcg/spray 0.125 mL Rx only" (PDF)

Munipalli B, Strothers S, Rivera F, Malavet P, Mitri G, Abu Dabrh AM, Dawson NL

Efficacy and safety of co-administered once-weekly cagrilintide 24 mg with once-weekly semaglutide 24 mg in type 2 diabetes: a multicentre, randomised, double-blind, active-controlled, phase 2 trial