Nausea is the big one, especially during dose escalation — it improves for most people within weeks at each dose level. Constipation, diarrhea, fatigue, and reflux are also common. Serious but uncommon: pancreatitis, gallbladder problems, and dehydration-related kidney issues. Anyone with a personal or family history of medullary thyroid cancer or MEN-2 syndrome should not take GLP-1s. Rapid facial volume loss — 'Ozempic face' — is a cosmetic side effect many patients address with dermal fillers or Sculptra.