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The danger arises only when 20 units delivers more milligrams than your body is adapted to handle

Am J Physiol Gastrointest Liver Physiol 312(6):G666-g680

Rybelsus contains semaglutide like Ozempic and Wegovy, so it shares the same risk profile, while Mounjaro and Zepbound contain tirzepatide and work on additional hormone receptors