Adverse symptom escalation guide

Escalation ladder at a glance

Symptoms requiring 999 or A&E (emergency)

• Difficulty breathing, swelling of face / throat / tongue — possible anaphylaxis.
• Loss of consciousness or near-loss.
• Severe chest pain.
• Severe persistent abdominal pain that doesn’t settle in a couple of hours — possible pancreatitis or other acute abdomen.
• Vomiting blood; black, tarry stools; significant per-rectum bleeding.
• Sudden severe headache, vision change, weakness on one side.
• Severe hypoglycaemia not responding to fast-acting carbohydrate.
• Active suicidal ideation with intent or means.

Symptoms requiring NHS 111 (urgent)

• Persistent vomiting unable to keep down fluids for more than 24 hours.
• Right-upper-quadrant pain — possible gallbladder; see GLP-1 gallbladder risk.
• Moderate but persistent abdominal pain — assess for pancreatitis; see GLP-1 pancreatitis.
• Significant new fatigue with sweating, shaking, or confusion (possible hypoglycaemia, especially if on insulin or sulfonylureas).
• Fever >38°C with severe symptoms following an injection (possible injection-site infection or systemic reaction).
• Unable to pass urine, or significantly reduced urine output (dehydration / kidney concern).
• Mental-health symptoms that are new, severe, or worsening.

Use 111 online or call 111. Have the medicine name, dose, and start date to hand.

Symptoms to contact your prescriber about (same week)

• Side effects that are persistent and affecting daily life but not severe.
• Side effects that don’t settle as expected at a stable dose.
• Side effects that recur predictably at each dose escalation and need a plan (slower titration, antiemetic, dose hold).
• Injection-site reactions that are persistent or worsening.
• New onset of symptoms unrelated to the GI side-effect picture.
• Concerns about whether the medicine is still appropriate for you.

Use the contact route your clinic specifies. Email creates a paper trail; phone is faster.

Symptoms to self-manage (with Yellow Card)

• Mild nausea responding to titration and diet adjustments.
• Mild constipation responding to fluid, fibre, and OTC laxatives.
• Mild fatigue or headache in the first week of a dose step.
• Transient injection-site redness.

All of these still warrant a Yellow Card report — even mild side effects feed the pharmacovigilance signal. See Yellow Card guide.

Reporting in parallel

Whatever level of escalation, also report the side effect to MHRA via Yellow Card. The two systems serve different purposes — the NHS / your prescriber for your individual care; Yellow Card for the population-level safety picture.

If you suspect the medicine was counterfeit

The escalation ladder above still applies for symptoms. In parallel: don’t inject any more of it, photograph everything, and report via the GOV.UK report-a-problem form and Yellow Card. See what to do if your pen looks wrong.

What to record

• What the symptom is and when it started.
• Severity and trajectory (getting worse / stable / improving).
• Medicine, dose, last injection date, total time on medicine.
• Other medicines and supplements you’re taking.
• What you’ve done so far and what helped.
• Photographs of injection sites if relevant.