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However, at higher doses, niacinamide can cause: Mild GI upset (which could theoretically compound semaglutide GI effects) Easy bruising or increased bleeding from wounds Liver enzyme elevations at very high doses (typically above 3 grams daily, far exceeding injectable doses) The 2 mg per injection dose is so low relative to studied therapeutic ranges that these side effects are essentially irrelevant for the compounded formulation