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The combination carries GI side effects from semaglutide (nausea, vomiting, diarrhea) plus potential naltrexone-related symptoms (dizziness, headache, insomnia) and requires liver monitoring because naltrexone can elevate enzymes

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CrossRef Cardiac Autonomic Neuropathy in Type 1 and 2 Diabetes: Epidemiology, Pathophysiology, and Management Scott Williams, Siddig Abdel Raheim, Muhammad Ilyas Khan, Umme Rubab, Prathap Kanagala, Sizheng Steven Zhao, Anne Marshall, Emily Brown, Uazman Alam Clinical Therapeutics.2022

The initial application may briefly increase sensitivity before the desensitizing effect kicks in