Side-effect tracking is observational data for sharing with your provider — not a self-diagnosis tool. Symptom severity that exceeds the patterns described here, or any new severe symptom (severe abdominal pain, persistent vomiting, signs of dehydration, rash, or breathing problems), is a reason to stop the medication and contact your provider, not log it and continue.
If you're three weeks into a Semaglutide ramp and feeling worse than last week, the question that matters is: is this the dose escalation taking effect, or is the medication not working for me? Without a written record, the question is unanswerable — memory of side-effect severity from week to week is unreliable.
This post lays out a 13-symptom tracking framework. It's the same framework the iOS app uses — derived from the most-cited adverse events on the FDA-approved labels for Wegovy® and Mounjaro®, plus the practitioner-reported patterns for the major research peptides.
The 13 symptoms
These cover ~95% of what users actually report on peptide protocols:
GI cluster (most common)
- Nausea — the hallmark of GLP-1 ramps. Worst in the first 5–7 days after each dose increase.
- Vomiting — less common than nausea but tracked separately because it's a stop-the-medication threshold.
- Diarrhea — most common with the GLP-1 family during early weeks.
- Constipation — the other side of GLP-1 GI changes; often alternates with diarrhea.
- Abdominal pain — distinguish from cramps. Sudden severe abdominal pain is a contact-provider symptom (rare pancreatitis risk).
- Acid reflux / heartburn — slowed gastric emptying delays stomach contents from clearing.
Energy and mood
- Fatigue — typical in week 1 of any GLP-1 step. Should settle within 5–7 days.
- Insomnia or vivid dreams — common with growth-hormone peptides (Ipamorelin, CJC-1295, Sermorelin).
- Mood changes — track both directions (low mood, irritability, euphoria) since some peptides modulate this.
Physical
- Headache — common in the first week of any new peptide. Distinct from migraine.
- Injection-site reaction — local redness, swelling, or soreness at the injection point. Distinguish from infection (spreading redness, warmth, pus → contact provider).
- Tingling or numbness in extremities — specifically tracked because it's a known GHRP side effect.
Body composition
- Rapid weight change — track weekly weight regardless of direction. Rapid loss with muscle-mass concern is a reason to increase protein intake; rapid gain on a GLP-1 protocol suggests the dose may not be working as expected.
Severity scale
The simplest scale that produces useful patterns over weeks:
| Score | Meaning |
|---|---|
| 0 | None — symptom not present |
| 1 | Mild — noticed but didn't change behavior |
| 2 | Moderate — noticed, mildly disruptive |
| 3 | Severe — disrupted daily activity, considered stopping |
| Stop | Reached "stop and call provider" threshold |
Logging on a 0–3 scale (rather than free-text) is what makes the data comparable across weeks. Free-text journals look thorough but produce no usable trend.
When to log
The two patterns that work:
- End of day, every day. 60 seconds. Open the log, score the 13 symptoms, save. Best for high-fidelity tracking.
- Day after a dose change. For protocols where you only inject once a week, daily logging is overkill; logging the 24-hour post-dose window captures the relevant data.
The iOS app supports both — a daily widget for whichever pattern fits.
Reading the trend — the patterns that matter
Three patterns emerge from a few weeks of consistent logging.
Pattern A — early peak, settling tail
Most common. Severity peaks in the first 5–7 days after a dose change, then drops back to baseline over the next 2 weeks.
Week 1 step: ▆▆▅▄▃▂▁
Week 2: ▁▁▁▁▁▁▁
Week 3: ▁▁▁▁▁▁▁
Week 4: ▁▁▁▁▁▁▁
Signal: body adapting normally. Advance to next dose-step on schedule.
Pattern B — sustained moderate
Severity stays at 2/3 for the entire phase rather than tapering.
Week 1 step: ▃▃▃▃▃▃▃
Week 2: ▃▃▃▃▃▃▃
Week 3: ▃▃▃▃▃▃▃
Week 4: ▃▃▃▃▃▃▃
Signal: body not adapting. Don't advance — hold this dose for an extra 2–4 weeks. Bring the data to your provider; they may choose to stay at this dose long-term.
Pattern C — escalating
Severity grows over weeks at the same dose.
Week 1 step: ▂▂▂▂▂▂▂
Week 2: ▃▃▃▃▃▃▃
Week 3: ▄▄▄▄▄▄▄
Week 4: ▅▅▅▅▅▅▅
Signal: something is wrong. Stop and contact provider. Possible causes: vial degradation, accumulating side-effect that will worsen further, immune-style reaction.
What this framework is for
This isn't a diagnostic tool. It's a structured record for two purposes:
- Decisions during the protocol — pattern A says advance, pattern B says hold, pattern C says stop. The decisions need data.
- Conversations with your provider — handing them four weeks of structured 0–3 scores per symptom is dramatically more useful than "I felt kinda bad some days." It compresses 28 data points into a chart they can read in 10 seconds.
The iOS app exports the timeline to a doctor-ready PDF for exactly this purpose. Get the app.
What's NOT in the 13
Tracking everything is the same as tracking nothing — the noise overwhelms the signal. The 13 above cover ~95% of reported peptide side effects. Other symptoms specific to your case (a chronic condition, a comorbidity, a medication interaction) belong in a separate "context" field rather than the daily score grid.
If you have a symptom not on the list that's recurring and seems peptide-related, log it as free text alongside the 13. Don't try to fit it into one of the 13 just to keep the format clean.
When to stop entirely (not just hold)
| Symptom | Threshold for stop |
|---|---|
| Severe abdominal pain | Single occurrence, regardless of severity |
| Persistent vomiting | Unable to keep liquid down for 12+ hours |
| Signs of dehydration | Reduced urination, dry mouth, dizziness on standing |
| Allergic-style reaction | Hives, swelling, breathing difficulty — always |
| Rapid heart rate or chest pressure | At rest, sustained |
| New-onset jaundice | Yellow skin or eyes |
| Sudden severe headache | Worst-of-life style |
Any of those — stop the medication, contact your provider, and don't debate it with internet sources.
Related reading
- How to titrate Semaglutide safely — phase-by-phase side-effect timeline for the canonical GLP-1 ramp
- Peptide cycling: when to take breaks — pattern B (sustained moderate) often signals cycle break
- Tirzepatide vs Semaglutide: dosing math — comparison of the two side-effect profiles
- Resources page — DailyMed sources for the FDA-approved labels these patterns derive from
References
- DailyMed: Wegovy — Semaglutide adverse-event reference
- DailyMed: Mounjaro — Tirzepatide adverse-event reference
- PubMed: GLP-1 side-effect timeline — academic literature