Q: My doctor prescribed Ozempic for Type 2 diabetes. I got the dose up to 0.5 milligrams after several weeks. Then I began to have severe nausea and constipation.

I lowered the dose back to 0.25 but experienced the same symptoms. I had to stop taking Ozempic. The nausea, loss of appetite and constipation I had developed all resolved about a week or two after discontinuing Ozempic.

I lost about 20 pounds, but the side effects were intolerable. How can anyone tolerate higher doses of this drug?

A: People are highly variable in their reaction to drugs like semaglutide (Ozempic, Wegovy). We have heard from many people who experienced minor discomfort from these medications. But a few, like you, could not tolerate them.

One woman wrote that Ozempic caused nausea and vomiting for an entire week, leading to abnormal blood tests. Another had nausea so severe she felt she was in the first trimester of pregnancy although she was 75. Like you, when she raised the dose to 0.5 milligrams she had intolerable side effects.

While you had constipation, others have experienced diarrhea. A few readers found that the “intestinal apocalypse” they experienced was too intense to stay on the drug.

Q: I cured my toenail fungus with 40% urea. After applying it and covering the nail daily for two weeks, the affected portion peeled off, leaving only the healthy area. I am surprised that there is not more information about this.

A: Dermatologists have long utilized 40% urea applications to treat nail fungus. We would discourage self-treatment with such a high concentration of urea. That’s because this compound can lead to the destruction of the nail. It often falls off, which can be alarming.

Used under medical supervision, however, 40% urea appears to enhance the effectiveness of topical antifungal creams (Journal of Foot and Ankle Research, April 11, 2019). Dermatologists may use it as a pretreatment before photodynamic therapy (Archives of Dermatological Research, May 2023).

Q: I’ve had weird tingling in my feet that has been diagnosed as idiopathic peripheral neuropathy. I’m not diabetic, and nobody seems to know why I got this or what to do about it.

A blood test showed that my level of B6 was 10 times higher than normal, but nobody seemed to think that was relevant. Then a doctor friend of mine sent me an article about vitamin B6 causing peripheral neuropathy. The usual source is supplementation. After that, I found corroborating evidence.

I know people who have developed this condition. They should look at the supplements they are taking to see if they are getting too much vitamin B6 — and then stop taking it! It seems the bad effects may be reversible.

A: Scientists have known for decades that excess vitamin B6 from supplements could harm the nervous system. This was associated with prolonged intake of doses of 50 milligrams/day or more. The Food and Nutrition Board has established a tolerable upper limit of 100 milligrams of vitamin B6 for adults.

More recently, nutrition experts have found that vitamin B6 supplements at much lower levels can cause neuropathy (Drug Safety, September 2018). But the vitamin dose isn’t always linked to the blood levels of the patients. Even a multivitamin may be too much for some (Journal of Nutrition, Health & Aging, July-August 2007).

Foods such as chickpeas, tuna, salmon and chicken breast are ways to get the vitamin B6 you need.

In their column, Joe and Teresa Graedon answer letters from readers. Send questions to them via www.peoplespharmacy.com.