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The revelation came from Jill Furman, director of CDERs Office of Compliance, during the 2025 Enforcement, Litigation, and Compliance Conference, where she addressed enforcement trends and compliance priorities
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The reason for this is that the initial wave of drug-induced hepatocellular destruction is followed by a robust innate immune response, in which invading inflammatory cells release toxic oxidants and cause a second wave of destruction
A 2023 case series in Annals of Pharmacotherapy described INR instability in three patients within 6 to 10 weeks of starting semaglutide, requiring warfarin dose adjustments [6]
Instead of advancing from 1.0 mg to 1.7 mg at week 9 as the standard protocol specifies, your provider may extend the 1.0 mg phase for an additional 4 to 8 weeks until GI symptoms stabilize
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