Editorial note: This article covers documented side effects of GLP-1 receptor agonists and Novi's published cancellation and refund policy. It is educational, not medical advice. Side effects vary among individuals, and any patient experiencing symptoms should communicate directly with their prescriber. Compounded medications are not FDA-approved finished drugs.
Two facts about a compounded GLP-1 telehealth subscription are worth knowing in the same breath. First: GLP-1 medications work in part because they cause gastrointestinal side effects — that's the mechanism, slowed gastric emptying and altered appetite signaling, doing its job. Second: once Novi dispenses a prescription, refunds aren't available, regardless of whether the patient tolerates the medication.
Those two facts intersect for prospective patients. The decision to start treatment is also a financial commitment to the 3-month subscription window, with limited exit pathways for tolerability reasons. This article covers what side effects to actually expect from the medications Novi prescribes, what Novi's clinical safety mechanics look like, and exactly what the cancellation and refund terms say.
The Side Effect Profile of GLP-1 Medications — What's Actually Documented
The published clinical trial data and post-marketing surveillance for semaglutide and tirzepatide describe a fairly consistent side effect profile across studied populations. The 2026 systematic review aggregating 22 randomized controlled trials across 41,757 individuals reported the following frequency ranges for GLP-1 receptor agonists versus placebo:
Nausea — 14% to 28% of trial participants on GLP-1 medications, versus 5% to 10% on placebo. This is the most commonly reported side effect across the class and tends to be most pronounced in the first weeks of treatment and during dose escalation.
Vomiting — 6% to 12% on GLP-1 medications versus 2% to 4% on placebo. Less common than nausea but a significant minority experience it, particularly at higher doses.
Diarrhea — 8% to 20% versus 4% to 7%. Highly variable across trials and individuals.
Constipation — Reported in clinical trials at meaningful frequency. Often results from slowed gastric and intestinal motility, which is part of the medication's mechanism.
Decreased appetite — This is, technically, the desired effect. It also represents a significant change from baseline that some patients find uncomfortable, particularly if it interferes with adequate hydration or nutrition.
For context: the trials of brand-name tirzepatide and brand-name semaglutide found that, despite these effects, the risk of pancreatitis and serious adverse events remained comparable to placebo. The class is not characterized by a high rate of severe events. It is characterized by a high rate of moderate gastrointestinal effects, particularly during titration.
One interesting comparative finding from preclinical research: dual GLP-1/GIP agonists like tirzepatide may be associated with somewhat fewer gastrointestinal adverse events than equipotent doses of pure GLP-1 agonists like semaglutide, with similar weight-loss effects. The clinical implication for individual patients is uncertain — both molecules have substantial side effect rates in real-world use.
Serious Risks and Contraindications
The contraindication list for GLP-1 receptor agonists includes specific conditions that any reputable prescribing process screens for.
Personal or family history of medullary thyroid carcinoma. Personal or family history of multiple endocrine neoplasia syndrome type 2 (MEN2). Personal history of pancreatitis. Severe gastroparesis or other significant gastrointestinal disorders. Pregnancy or active attempts to conceive. Active gallbladder disease. Severe renal impairment.
Some of these are absolute contraindications (medullary thyroid carcinoma history, MEN2). Others are relative — risks to be weighed by a prescribing clinician against potential benefit.
Less common but documented serious risks include acute pancreatitis, gallbladder disease (cholelithiasis, cholecystitis), acute kidney injury (often related to dehydration from severe nausea/vomiting), and rare reports of intestinal obstruction or ileus. The FDA's adverse event reporting system has captured these signals across both brand-name and compounded GLP-1 products.
The agency's reporting on compounded versions specifically, as of early 2025: more than 455 adverse event reports for compounded semaglutide and more than 320 for compounded tirzepatide. Many involved dosing errors from patients drawing incorrect amounts from multidose vials — a delivery format more common in compounded preparations than in brand-name pen injectors. Some required hospitalization. The dosing-error pattern factored into the FDA's regulatory posture leading to the April 30, 2026 503B exclusion proposal. We cover the regulatory mechanics in more depth in our Novi compounded vs brand analysis.
How Novi's Screening Process Works
Per Novi's published intake description, the medical questionnaire collects current weight and BMI, medical history, existing medications, prior weight-loss efforts, and lifestyle context. A US-licensed clinician reviews the submission. If the clinician determines additional information is needed, a virtual visit may be scheduled. If the clinician determines treatment is medically appropriate, a prescription is issued.
The platform's published clinical team — including Daniel Funsch, MD; Michael Wasef, MD; Takashi Nakamura, MD; and several nurse practitioners — reviews intakes and conducts virtual consultations. Novi states that providers retain the authority to deny treatment for any reason consistent with their clinical judgment, including potential misuse risk.
The honest read on telehealth eligibility screening generally — Novi included — is that it's only as thorough as the patient's disclosure. The intake questionnaire format is well-suited to identifying named contraindications when patients accurately report family history and existing conditions. It is less able to identify subclinical issues that might emerge in an in-person physical examination. Novi's published telehealth consent acknowledges this — explicitly noting that telehealth providers rely primarily on patient-reported data rather than in-person physical exams.
For patients with uncertain medical histories, complex medication regimens, or known cardiovascular or endocrine concerns, the right diligence is to discuss the prospective treatment with an existing primary care or specialty physician before completing a telehealth intake. The telehealth platform isn't designed to replace that consultation — it's designed to handle the prescribing pathway after eligibility is reasonably established.
What Side Effects Look Like in Practice — and What to Do About Them
Most patients on a GLP-1 medication experience some form of gastrointestinal effect during the first weeks. The standard clinical approach to minimize this is gradual dose titration — starting at the lowest effective dose, holding for several weeks, and stepping up only if tolerated. Novi's published process aligns with this approach.
Practical management strategies for common effects, all of which a patient should discuss with their prescriber rather than self-direct:
For nausea: smaller, more frequent meals; avoiding very fatty or rich foods, especially during titration; staying hydrated; eating slowly. If nausea is severe or persistent, the prescriber may delay a planned dose increase.
For constipation: adequate fluid intake, fiber-rich foods, gentle physical activity. The mechanism here is the same gastric-motility effect that causes the appetite suppression, so this is a frequent companion symptom. For comparison context on a non-pharmaceutical approach to GLP-1 mechanism that produces some similar side effects, see the analysis at our gelatin trick side effects coverage.
For dizziness or low blood sugar (more relevant for patients with diabetes or those taking other glucose-lowering medications): communicate immediately with the prescriber; avoid driving or operating machinery if symptoms are present.
For severe abdominal pain (especially radiating to the back, with vomiting): treat as a potential pancreatitis warning sign. Stop the medication and seek immediate medical evaluation. Do not wait for a telehealth appointment for severe abdominal symptoms.
The Cancellation and Refund Terms — In Detail
This is where Novi's published terms become specific in ways that matter for tolerability decisions.
The 3-month minimum commitment is contractual. Per the published Terms of Service: the first month plus the next two months are charged at time of purchase and are non-refundable, unless a provider determines that treatment is not medically appropriate before any prescription is dispensed. After that point, the published terms do not provide a refund mechanism.
To stop further charges after the 3-month commitment is completed, cancellation must be submitted at least 15 days before the next monthly processing date. Cancellation can be made by emailing support@joinnovi.com or through the patient dashboard.
Once a prescription is dispensed or shipped, that prescription cannot be returned or refunded under any condition listed in the published terms. The terms further state: “False credit card disputes will be aggressively defended and customers who attempt to dispute charges to circumvent the 3-month commitment will be sent to collections and/or have further legal action pursued.”
What this means in practice for a patient experiencing significant side effects in month one of a 3-month commitment:
Communicating with the prescriber to discuss dose adjustment, alternative medications, or temporary holds is the available pathway within the platform. Discontinuing the medication doesn't, by itself, end the financial commitment to the remaining months. Whether and how Novi's clinical team handles tolerability-based discontinuation requests in practice — including whether unused future months can be paused, refunded, or applied to a different course — is a question prospective patients should clarify with support@joinnovi.com before signing up. The published terms describe a strict commitment structure; the operational practice may include flexibility that isn't documented.
For the financial breakdown of what the 3-month commitment looks like in dollar terms, see our Novi cost analysis.
The Telehealth Consent Document and What It Acknowledges
Novi's published Medical Consent describes the limitations of telehealth in clear language. It acknowledges that, in rare cases, transmitted information may be insufficient for appropriate medical decision-making, that delays in evaluation could occur due to equipment failures, that security protocols could fail in very rare instances, and that lack of complete medical records may result in adverse drug interactions or judgment errors.
The consent also confirms that the platform does not replace emergency medical services. The Terms of Service repeat this in capital letters: “WE ARE NOT A REPLACEMENT FOR EMERGENCY MEDICAL SERVICES. IF YOU HAVE A MEDICAL EMERGENCY SEEK EMERGENCY MEDICAL CARE IMMEDIATELY IN-PERSON OR DIAL 911 OR YOUR LOCAL EMERGENCY NUMBER.”
This is standard for compliant telehealth platforms and reflects the actual scope of what telehealth can and cannot do. It also points to a real evaluation criterion: the right candidate for any compounded-GLP-1 telehealth program is a patient whose general health status is well-characterized through existing in-person medical care, who can independently recognize when symptoms exceed the telehealth scope, and who has appropriate in-person medical resources for situations that arise outside that scope.
Insurance, Medical Records, and HIPAA
Novi states that all prescriptions are cash-pay. Insurance reimbursement may be available for branded GLP-1 medications, but compounded options are positioned as the affordable cash-pay alternative. The platform is not enrolled as a participating provider in Medicare, Medicaid, or other federal or state healthcare programs.
Patient information is treated under HIPAA. Novi's Notice of Privacy Practices describes standard HIPAA-permissible uses for treatment, payment, and healthcare operations. Patients have the right to access their records, request amendments, request restrictions on disclosures, and file complaints with the platform's Compliance and Privacy Officer or with the U.S. Department of Health and Human Services Office for Civil Rights. The HIPAA contact line published in Novi's privacy practices is (844) 357-3601.
SMS messaging is opt-in. Per the published policy, mobile information is not shared with third parties for advertising purposes. Patients can opt out of SMS at any time by replying STOP.
The Honest-Broker Read on Novi's Safety and Cancellation Mechanics
Novi's published clinical screening process is consistent with standard telehealth-prescribing operations for the compounded GLP-1 category. The platform's terms are transparent about what telehealth can and cannot do. The contraindication screening relies on patient self-disclosure, which is true for the entire telehealth category.
The cancellation and refund mechanics are stricter than what some patients might assume from the marketing. The “cancel anytime” framing on the homepage is technically accurate — the cancellation request can be submitted anytime — but the contractual obligation to three months of payments isn't reversible based on tolerability or response to the medication. That structure isn't unusual in the compounded-GLP-1 telehealth category, but it should be understood explicitly before signing up.
For prospective Novi patients with a clean medical history and reasonable comfort with the GLP-1 side effect profile: the platform's clinical and policy structure is functional, transparent, and within category norms. For patients whose tolerance for side effects is uncertain, or who would want a one-month trial before committing financially, Novi's structure isn't a fit. We compare Novi's policies head-to-head with other compounded-GLP-1 platforms in our Novi vs SynergyRx vs TeleHealth Med comparison.
For the full editorial breakdown of what to evaluate before any compounded-GLP-1 commitment, see the core Novi review.
Bottom Line
The side effect profile of the medications Novi prescribes is well-documented and substantial — particularly during the first weeks of treatment and during dose escalation. The vast majority of side effects are gastrointestinal and self-limiting. A minority are more serious and require immediate clinical attention. The intake screening, like all telehealth screening, is only as thorough as the patient's disclosure of medical history.
The cancellation and refund terms are strict. The 3-month commitment is binding once treatment begins and a prescription is dispensed. The mechanism for managing intolerability is communication with the prescriber for dose adjustment, not discontinuation with refund. Patients who don't want that structure should evaluate platforms with different commitment terms.
Read the terms before signing. Ask the questions before paying. The platforms that answer cleanly are the ones running the program seriously.