Mounjaro

Mounjaro – Tirzepatide

Name

• Generic: Tirzepatide
• Brand: Mounjaro
• Other Names: None known

Classification

• Class: Dual GIP and GLP-1 receptor agonist
• Mechanism: Mimics incretin hormones to enhance insulin secretion, reduce glucagon, slow gastric emptying, and reduce appetite

Indications

• Type 2 Diabetes Mellitus (T2DM)
• Obesity (approved in US, under review elsewhere)
• Weight management (off-label in some regions)

Dose

• Starting Dose: 2.5 mg SC once weekly (not for glycaemic control, titration only)
• Maintenance: 5 mg–15 mg SC once weekly
• Titration: Increase in 2.5 mg steps every 4 weeks based on tolerability
• Max Dose: 15 mg weekly

Side Effects

• Common:
  • Nausea, diarrhoea, vomiting
  • Constipation
  • Decreased appetite
• Less Common:
  • Abdominal pain, fatigue, dyspepsia
• Rare but Serious:
  • Pancreatitis
  • Acute kidney injury (from dehydration)
  • Thyroid C-cell tumours (rodent data)
  • Severe GI symptoms

Interactions

• May delay absorption of oral drugs
• Increased risk of hypoglycaemia with insulin or sulfonylureas
• Avoid with other GLP-1 agonists
• Enhanced effects with DPP-4 inhibitors not recommended

Warnings

• Thyroid C-cell tumour risk (boxed warning)
• Pancreatitis risk
• Risk of severe GI adverse effects
• Hypoglycaemia when combined with insulin or sulfonylureas

Cautions

• History of pancreatitis
• Severe GI disease (e.g., gastroparesis)
• Personal/family history of medullary thyroid carcinoma
• Dehydration risk in elderly or renally impaired

Pregnancy

• Not recommended; insufficient data
• Avoid use unless benefit justifies risk
• Stop at least 1 month before planned conception

Hepatic

• No dose adjustment needed
• Use with caution in severe hepatic impairment

Renal

• No dose adjustment required
• Monitor renal function if GI symptoms are severe

Contraindications

• Personal/family history of medullary thyroid carcinoma (MTC)
• Multiple endocrine neoplasia syndrome type 2 (MEN 2)
• Hypersensitivity to tirzepatide or formulation

Counselling

• Inject subcutaneously once weekly (same day/time)
• Can be taken with or without food
• Rotate injection sites (abdomen, thigh, upper arm)
• May cause nausea initially—usually improves over time
• Report symptoms of pancreatitis or thyroid tumour
• Store in fridge; can be kept at room temp for up to 21 days

Monitoring

• HbA1c (every 3–6 months)
• Weight
• Blood glucose (esp. if on insulin)
• Renal function (in dehydration or GI side effects)
• Symptoms of thyroid cancer
• Amylase/lipase (if pancreatitis suspected)

Use in Pregnancy

• Avoid use; discontinue at least 1 month prior to conception
• Insufficient human data available

Use in Children

• Not approved in children <18 years

Use in Elderly

• No specific dose adjustment
• Monitor for GI side effects, dehydration, and renal function

Costs, Brands, Manufacturer

Brand	Manufacturer	Approx. Cost (USD/month)
Mounjaro	Eli Lilly	$1,050–$1,200

❓ FAQs – Mounjaro (Tirzepatide)

1. How fast does Mounjaro work?
   – Initial weight loss and blood glucose effects may appear in weeks; full effect over months.
2. Can Mounjaro be used for weight loss alone?
   – Approved for obesity in the US; not yet in all countries. Off-label use exists.
3. What if I miss a dose?
   – Take within 4 days of missed dose. If more than 4 days, skip and resume on next scheduled day.
4. Does it cause hypoglycaemia?
   – Not alone, but risk increases when combined with insulin or sulfonylureas.
5. Can I take it with metformin?
   – Yes. Often used together in T2DM management.
6. Is nausea common?
   – Yes, especially in early weeks. Usually subsides as the body adjusts.
7. Can I drink alcohol while on Mounjaro?
   – Best to limit alcohol due to increased risk of GI issues and hypoglycaemia.
8. How is it different from Ozempic or Wegovy?
   – Mounjaro activates both GIP and GLP-1 receptors; others only target GLP-1.
9. Do I need blood tests before starting?
   – Baseline renal and liver function, HbA1c; thyroid exams if history indicates.
10. Will I gain weight if I stop Mounjaro?
    – Possible rebound weight gain if lifestyle changes aren’t maintained post-discontinuation.