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Semaglutide or Tirzepatide

What do these medications treat?

These medications were originally designed to treat diabetes, however patients taking them were found to have significant weight loss.

How do they work?

Both medications are GLP-1 agonists. The GLP-1 receptor is noted for controlling appetite and caloric intake.

Who is a candidate?

These medications are recommended by the FDA for individuals with a BMI of 30 or higher, or above 28 with a weight related co-morbidity.

If my BMI is less than 28 can I still receive these medications?

Yes, if approved by your care provider these medications can be taken off label similar to other off label uses of various other medications and treatments.

I am already taking diabetic medicines, what should I do?

It is recommended to carefully watch blood sugar in patients with Type II diabetes taking insulin or other insulin secretagogues.

I have diabetes type I. Can I take these medications?

These medications are not recommended in patients with Type I diabetes.

How are these medications administered?

These medications are subcutaneous injections performed weekly. It is recommended that they be given at the same time on the same day each week.

Can I do my own injections?

Yes, we can teach you how to do your injections at home if you prefer. In this case we will see you monthly for a follow-up and provide you with a month supply.

Can my follow-ups be virtual?

Yes. If you prefer to do virtual follow-ups we can arrange that.

I don’t like needles, can I still receive these medications?

Semaglutide has an oral form. The effectiveness of this oral medication compared to the injections is unknown.

What if I miss a dose?

It is recommended to take the next dose as soon as possible if missed. If missed more than a few days, you may need to reduce your dose and restart your taper.

What is the recommended dosing?

It is recommended to start at the lowest dose and increase dosing every four weeks. For Semaglutide the maintenance dose is recommended to be 2.4 mg weekly. For Tirzepatide the initial goals is 15 mg per dose but may be increased if weight loss is not achieved.

What are the long-term effects?

The long-term effects of these medications are unknown.

What happens if I stop taking the medications?

Significant rebound weight gain has been noticed in some patients who have stopped taking these medications. It may be necessary to stay on these medications long term to prevent secondary weight gain.

Who should not take these medications?

  1. These medications have been shown to cause Thyroid C-cell tumors including Medullary Thyroid Carcinoma in animal studies. It is NOT recommended in patients with a history of Medullary Thyroid Carcinoma or a family or personal history of Multiple Endocrine Neoplasia Syndrome type II (MEN 2).
  2. If you are scheduled for surgery, you will need to stop this medication one week before general anesthesia. This may result in you having to restart dosing at initial levels.
  3. Any known sensitivity to these products or their ingredients.

What are the cautions?

  1. Pancreatitis: Has been reported in clinical trials. Discontinue promptly if pancreatitis is suspected. It is not recommended to take these medications if you have had a personal history of pancreatitis.
  2. Hypoglycemia with Concomitant Use of Insulin Secretagogues or Insulin: Concomitant use with an insulin secretagogue or insulin may increase the risk of hypoglycemia, including severe hypoglycemia. Reducing dose of insulin secretagogue or insulin may be necessary.
  3. Hypersensitivity Reactions: Hypersensitivity reactions have been reported. Discontinue these medications if suspected.
  4. Acute Kidney Injury: Monitor renal function in patients with renal impairment reporting severe adverse gastrointestinal reactions.
  5. Severe Gastrointestinal Disease: Use may be associated with gastrointestinal adverse reactions, sometimes severe. Has not been studied in patients with severe gastrointestinal disease and is not recommended in these patients.
  6. Diabetic Retinopathy Complications in Patients with a History of Diabetic Retinopathy: Has not been studied in patients with non-proliferative diabetic retinopathy requiring acute therapy, proliferative diabetic retinopathy, or diabetic macular edema. Monitor patients with a history of diabetic retinopathy for progression.
  7. Acute Gallbladder Disease: Has occurred in clinical trials. If cholelithiasis is suspected, gallbladder studies and clinical follow-up are indicated.
  8. Constipation: Some patients have developed severe constipation.

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