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The FDA also required a black box warning on Victozas label due to concerns about thyroid tumors in animal studies, which has remained a central issue in safety discussions

Peripheral Neuropathy: Grade 3 peripheral neuropathy occurred in 8% of patients with mBC (Grade 4=0.4%) and 22% developed a new or worsening neuropathy that had not recovered within a median follow-up duration of 269 days (range 25-662 days)

This makes oral supplements less effective for individuals with: Pernicious Anemia: An autoimmune condition where the body can't produce intrinsic factor

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PMID 15652195 Mahler HC, Friess W, Grauschopf U, Kiese S