Obesity Pharmacotherapy
3. Tirzepatide( Mounjaro or Zepound)( mean change in weight: 22.5 %)
a. Patient Selection: i. FDA Indication: 1. Type 2 diabetes indication for > 10 years 2. Obesity indication adults > 18 years 3. Other Considerations a. Consider for patients with i. insulin resistance: acanthosis nigricans, elevated fasting blood glucose levels between 100 and 125 mg / dL, or hemoglobin A1c between 5.7 and 6.4 % ii. poor satiety, food cravings iii. Fatty liver disease iv. OSA ii. CONTRAINDICATIONS: 1. Personal or family history of medullary thyroid carcinoma in patients with Multiple
Endocrine Neoplasia syndrome type 2 iii. USE CAUTION: 1. thyroid c-cell tumors 2. acute gall bladder disease 3. renal impairment 4. serious hypoglycemia 5. suicidal ideation b. To Start Tirzepatide: i. Check Baseline basic metabolic panel to assess kidney function ii. Review warnings with patient and family: gallbladder disease, pancreatitis, nausea, diarrhea, constipation, vomiting, abdominal pain, dyspepsia, headache, dizziness, fatigue: iii. Start Tirzepatide:
1. 2.5 mg subcutaneously once weekly x 4 weeks, then 5 mg weekly x 4 weeks, then 7.5 mg weekly x 4, then 10 mg weekly x4, then 12.5 mg weekly x 4, then 15 mg weekly 2. Dosing Logistics: single-dose pen for subcutaneous dosing in abdomen, thigh or upper arm. Rotate injection sites with each dose. iv. Tirzepatide can be obtained at a discount from www. lilly. com / lillydirect and via discount programs like GoodRx. c. Follow-up: i. Every 1-3 months initially to review side effects and efficacy ii. Check BMP annually to assess kidney function d. Discontinue: i. If BMI continues to increase after 3-4 months of treatment at maximal tolerated dose.
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