Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are important therapeutic options for obesity and type 2 diabetes mellitus. Despite their increasing use, safety concerns remain, and pharmacy students' knowledge of their adverse effects is unclear. This study evaluated pharmacy students' knowledge and attitudes regarding GLP-1 RA adverse effects in obesity management. A cross-sectional questionnaire-based study was conducted among undergraduate Doctor of Pharmacy (Pharm.D.) students (1st-7th year) at Umm Al-Qura University, Saudi Arabia, between November and December 2025. A newly developed questionnaire, reviewed by two experts and pilot-tested among 10 students, assessed 17 knowledge and five attitude items covering indications, mechanisms, adverse effects, and clinical scenarios. Of 1,118 eligible students, 296 completed the survey (response rate: 26.5%). Descriptive statistics and multivariable regression analyses were performed using RStudio (version 2024.9.1.394). Among participants (63.9% male), the mean knowledge score was 7.6 ± 4.0/17. Most agreed that adverse effects significantly impact clinical use (59.4%) and supported further education on less common side effects (61.1%). Nausea was the most frequently recognized adverse effect (59.1%), whereas thyroid C-cell tumors observed in rodent studies (25.0%) and diabetic retinopathy complications (36.5%) were less commonly identified. Only 37.2% correctly recognized that hypoglycemia is uncommon with GLP-1 RA monotherapy. Higher knowledge scores were significantly associated with greater confidence in knowledge (OR = 1.11, 95% CI: 1.06-1.17; p < 0.001) and stronger endorsement of further education on less common side effects (OR = 1.11, 95% CI: 1.06-1.18; p < 0.001), whereas gender and academic year were not significant predictors of any attitude item. Pharmacy students demonstrated limited knowledge but generally positive attitudes regarding GLP-1 RA safety. These findings highlight the need to strengthen pharmacovigilance and evidence-based medication safety education within pharmacy curricula to improve clinical preparedness and patient counseling.
