High-dose GLP-1 stacking significantly slows gastric transit, which compounds constipation risk - especially if you're adding anything that slows motility independently. The bowel regimen approach that surgical teams use (senna + MOM combination) is relevant preventively at 15mg+ even outside the opioid context. If the persistent hunger at that dose level is real, the question is also whether an actual serum level check would confirm the pharmacokinetic reality of stacking two GLP-1s.