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Individuals with pre-existing liver disease, hepatitis B or C, acetaminophen-induced liver injury history, or conditions causing glutathione depletion face substantially elevated overdose risk at standard doses

Pathophysiology of Secondary Polycythemia Secondary polycythemia (D75.1) reflects an appropriate physiological response to chronic hypoxia (COPD, OSA, cyanotic heart disease, high altitude) or inappropriate EPO overproduction (renal cell carcinoma, hepatocellular carcinoma, cerebellar hemangioblastoma)

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If you already have delayed gastric emptying, adding a long-acting amylin analog on top of that could create problematic levels of GI stasis