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UNC School of Medicine highlights this in its Phase 3b trial data

Two subjects discontinued before trial completion: one subject randomised to OW s.c

These calcium-regulatory effects also contribute to inhibiting pulmonary vein (PV) automaticity: as a primary trigger of atrial fibrillation, PVs are modulated by GLP-1RAs, which affect PV electrical activity, ionic properties, and intracellular calcium homeostasis to suppress PV automaticity (143)

Common adverse effects include nausea and vomiting, as well as increased hazards of gastroparesis and small bowel obstruction

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Despite widespread use, there have been no published reports of serum enzyme elevations or clinically apparent liver injury attributable to alpha lipoic acid given in conventional doses