Aim Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), including semaglutide, are increasingly prescribed for type 2 diabetes and weight management. A possible association with acute pancreatitis remains controversial. This study evaluated the incidence, presentation, and outcomes of acute pancreatitis in patients receiving semaglutide. Methods A retrospective observational study was performed at a tertiary referral centre between January 2020 and December 2024. Adult patients presenting with acute pancreatitis while actively receiving semaglutide were identified using hospital coding and pharmacy records. Diagnosis required revised Atlanta criteria. Patients with alternative dominant aetiologies, including gallstone disease with obstruction, alcohol misuse, hypertriglyceridaemia, or pancreatic malignancy, were excluded. Demographic data, semaglutide exposure, disease severity, management, and outcomes were analysed descriptively. Results Forty-one patients receiving semaglutide presented with acute pancreatitis; 26 met inclusion criteria. Mean age was 52.6 years, and 61.5% were female. Semaglutide was prescribed for type 2 diabetes in 65.4% and weight loss in 34.6%. Median duration of therapy prior to presentation was 5.2 months. Pancreatitis was mild in 76.9% and moderately severe in 23.1%; no severe or necrotising cases occurred. Median length of stay was 4 days. Two patients required intensive care admission, and no patients required surgical intervention. Semaglutide was ceased in all cases. No recurrent pancreatitis or mortality occurred during median follow-up of 9 months. Conclusion Acute pancreatitis temporally associated with semaglutide use was uncommon and predominantly mild, with favourable outcomes following drug cessation. Clinicians should consider medication-related pancreatitis in patients without traditional risk factors. Larger prospective studies are required to clarify causality and risk stratification.