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Rare but serious risks include pancreatitis, gallbladder disease, and a thyroid C-cell tumor risk based on rodent studies (semaglutide carries a boxed warning and is contraindicated in patients with personal or family history of medullary thyroid carcinoma or MEN2)

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Our calculations indicate no thermodynamic stability for the P (R) -MA adduct while for the P (S) -MA adduct ΔG is −7.4 kcal/mol compared to that of the reactants (Fig