Gastrointestinal adverse events occur in 55.3% of participants treated with survodutide, are dose-related, and lead to treatment discontinuation in 15.9% of cases, with most discontinuations occurring during the first 6 weeks of rapid dose escalation, suggesting that a slower titration regimen may improve tolerability.

Survodutide activates two types of receptors in the body: GLP-1 receptors and glucagon receptors. Activating GLP-1 receptors slows down how fast the stomach empties food into the intestines and makes the brain feel less hungry. Activating glucagon receptors also relaxes the stomach and intestines, slowing digestion. When these effects are too strong, especially at high doses, they cause nausea, vomiting, and diarrhea because food moves too slowly and digestive signals get mixed up. The body can get used to these effects if the dose is increased slowly, so fewer people have bad stomach problems.