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Beyond the absolute contraindications, several situations call for heightened caution in the class framing and are firmly a clinicians domain: a history of pancreatitis or symptomatic gallstones, significant gastrointestinal motility disorders (such as gastroparesis, which slowed gastric emptying can worsen), diabetic retinopathy that is not stabilized, severe renal impairment where dehydration from GI side effects raises risk, and any concurrent use of insulin or a sulfonylurea, where the additive glucose-lowering can produce hypoglycemia

Like smoking, alcohol consumption also leads to oxidative damage by activating cytochromes and other reactive oxygen species

Whether a proportional or threshold anti-inflammatory effect exists at microdose levels remains an open question