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The Real-World Risks At the same time, combining berberine and semaglutide can: Increase risk of hypoglycemia Intensify GI side effects , enough to disrupt work, training, or travel Raise risk of dehydration and electrolyte imbalance if you are eating and drinking less Complicate other medication regimens through liver-enzyme interactions For that reason, this combo should never be started casually or without medical oversight