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Before starting either medication , inform your healthcare provider about: All current medications, including over-the-counter medicines and supplements Any history of kidney stones, metabolic acidosis, or kidney disease (relevant for topiramate) History of pancreatitis, gallbladder disease, thyroid disease, or diabetic retinopathy (relevant for semaglutide) Mental health conditions, as topiramate can affect mood and cognition Pregnancy plans or possibility of pregnancy, as both medications have significant implications for pregnancy Contact your GP or prescriber urgently if you experience: Severe or persistent nausea and vomiting that prevents adequate fluid or food intake Signs of dehydration : decreased urination, dizziness, dry mouth, or confusion Visual disturbances , particularly sudden onset, which may indicate acute angle-closure glaucoma (rare with topiramate) or diabetic retinopathy worsening (with semaglutide) Severe abdominal pain , especially radiating to the back, which could indicate pancreatitis Right upper quadrant pain, fever, or yellowing of skin/eyes , which could indicate gallbladder disease (risk with semaglutide) Flank pain or urinary symptoms , which might indicate kidney stones (risk with topiramate) Cognitive changes , including confusion, difficulty concentrating, or memory problems Mood changes , including depression or suicidal thoughts Excessive weight loss or nutritional concerns Pregnancy or suspected pregnancy while taking either medication Routine monitoring should include regular weight checks, blood pressure, assessment of side effects, review of medication effectiveness, and periodic blood tests including renal function, serum bicarbonate (for topiramate), and glycaemic markers if applicable