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Warfarin: There have been reports of changes in INR (international normalized ratio) levels in patients taking warfarin concomitantly with semaglutide, suggesting that more frequent monitoring may be necessary

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Potential clinical consequences include: Development of anti-drug antibodies (ADAs) Reduced therapeutic efficacy Altered pharmacokinetics Injection-site reactions or systemic hypersensitivity Regulators therefore place strong emphasis on impurity profiles that could increase immunogenic potential beyond that of the Reference Listed Drug (RLD) Impurity Attributes That Increase Immunogenic Risk Not all impurities pose equal immunogenic concern