Semaglutide (Ozempic, Wegovy, Rybelsus):

• • Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist.
  • It is available under different brand names: Ozempic and Wegovy for injectable forms, and Rybelsus for an oral tablet.
  • FDA-approved indications include chronic weight management in adults with obesity or overweight, alongside lifestyle modifications.
  • It works by mimicking the action of GLP-1, which helps regulate insulin secretion in response to meals, slows gastric emptying, and reduces appetite.

Tirzepatide (Mounjaro, Zepbound):

• • • Tirzepatide is a dual agonist of both GLP-1 and glucose-dependent insulinotropic peptide (GIP) receptors.
    • It is available under the brand names Mounjaro and Zepbound.
    • Similar to semaglutide, tirzepatide is used for weight management in adults with obesity or overweight.
    • The dual agonism of GLP-1 and GIP is thought to provide additional benefits in weight reduction compared to GLP-1 agonists alone.

Both semaglutide and tirzepatide are FDA-approved for weight management when used in conjunction with a reduced-calorie diet and increased physical activity. They are effective in helping individuals lose weight by reducing appetite, slowing digestion, and improving insulin sensitivity.

It's important to note that while Wegovy (semaglutide) and Zepbound (tirzepatide) are FDA-approved and commercially available, other forms or variations of these medications obtained from compounded pharmacies are considered "off-label" uses. Compounded medications are prepared by pharmacies but are not FDA-approved in the same way as commercially available drugs. Therefore, they may be used under specific circumstances as prescribed by healthcare providers, but their use differs from the approved indications of the branded products.

Semaglutide and tirzepatide are FDA-Approved for individuals with a BMI of 30 kg/m² or higher and for those with a BMI of 27 kg/m² or higher who have at least one weight-related health condition (such as type 2 diabetes, high blood pressure, or high cholesterol). (Off-Label Use) is for patients who aim to lose more than 10 pounds and have found it challenging to do so through diet and exercise alone. Patients should have attempted weight loss through lifestyle modifications (such as diet and exercise) before considering semaglutide or tirzepatide assisted weight loss.

Semaglutide and tirzepatide are not suitable for certain individuals due to specific medical conditions or circumstances. Here are the groups who are generally not considered candidates for these medications:

1. Type 1 Diabetes:
2. History of Pancreatitis:
3. Medullary Thyroid Carcinoma (MTC):
4. Multiple Endocrine Neoplasia Syndrome Type 2 (MEN 2):
5. Diabetic Retinopathy:
6. Gallbladder Disease:
7. Severe Kidney Disease:
8. Gastrointestinal Issues: Conditions such as gastroparesis (delayed gastric emptying) and ileus (intestinal blockage) are contraindications due to the gastrointestinal effects of these medications, which can exacerbate these conditions.
9. Pregnancy and Lactation: due to potential risks to the fetus or infant.
10. Oral Birth Control Effectiveness: use of GLP-1 or GIP agonists like semaglutide or tirzepatide may affect the efficacy of oral contraceptives. Alternative contraceptive methods should be considered in women of reproductive age using these medications.

These contraindications highlight the importance of careful medical evaluation and consideration of individual health conditions before initiating treatment with semaglutide or tirzepatide. It is the patient responsibility to disclose any past or current medical condition as well as any past or current family history to the healthcare providers to avoid and complications.

On average, weight loss with semaglutide can range from 13.2 to 22 pounds.

Typically, weight loss with tirzepatide ranges from 15.4 to 28.6 pounds.

These ranges are based on clinical studies and individual responses may vary. Tirzepatide may offer slightly more weight loss in some individuals but can also be associated with more gastrointestinal side effects, especially at higher doses.

Both semaglutide and tirzepatide are administered via subcutaneous injection, typically in the stomach, back of the arm, or thigh. The injection process is generally simple and relatively painless. Alternating injection sites is recommended to minimize any potential local side effects such as irritation or discomfort.

Exercise is still important even when using semaglutide or tirzepatide for weight loss. Focus on a combination of aerobic exercises (like walking) and resistance exercises (such as weightlifting, using resistance bands, or bodyweight exercises like squats and push-ups). Exercise helps preserve muscle mass, which is crucial for overall health and metabolic rate, especially during weight loss efforts.

• Magnesium: Taking magnesium at night is recommended to help mitigate potential constipation, which can be a side effect of semaglutide or tirzepatide.
• Vitamin D: This vitamin is beneficial for reducing insulin resistance and supporting mood.
• Electrolytes: Adding electrolytes to water or soft drinks helps maintain proper hydration and electrolyte balance, which is important during weight loss and while on these medications.
• Vitamin B12: It can help boost energy and may alleviate nausea associated with semaglutide. If B12 is already included in compounded semaglutide, additional supplementation may not be necessary.

These supplements can support overall health and help manage potential side effects while undergoing treatment with semaglutide or tirzepatide. Always consult with your healthcare provider before starting.

Research indicates that after discontinuing semaglutide or tirzepatide, individuals tend to regain a significant portion of the weight they lost. One study suggested that after one-year post-treatment, people regained about two-thirds of the weight lost during treatment. To maintain weight loss achieved with these medications, long-term changes in diet and physical activity are essential. Adopting healthier eating habits and continuing regular exercise can help sustain weight loss efforts.

Patients are often prescribed semaglutide or tirzepatide for a duration of 12 weeks initially. This period allows for assessment of how well the medication is tolerated and the initial response in terms of weight loss.  If during these 12 weeks the patient tolerates the medication well but has not yet achieved their desired weight loss goal, treatment can be continued beyond the initial 12 weeks. This extension allows for further weight loss to be achieved.

Patients have the flexibility to stop taking semaglutide or tirzepatide at any time, regardless of whether they have completed the initial 12 weeks or continued beyond that period. There is typically no need to gradually reduce the dose when stopping these medications. Once treatment is discontinued, the body naturally metabolizes and clears the remaining drug over time.

Responses to semaglutide or tirzepatide can vary widely among individuals. Some may achieve their weight loss goals within the initial 12 weeks, while others may require longer treatment periods to reach their targets. It's important for patients to discuss their progress and any concerns with their healthcare provider throughout treatment. Providers can adjust the treatment plan based on individual responses, side effects, and overall health considerations.

Before and during treatment with semaglutide or tirzepatide for weight loss, healthcare providers typically recommend specific blood tests to monitor various aspects of your health. Here are the commonly required tests:

1. Hgb A1C (Glycated Hemoglobin): measures your average blood sugar levels over the past 2-3 months.
2. CMP (Comprehensive Metabolic Panel): Measures blood sugar levels, electrolytes, kidney and liver finctions.
3. TSH (Thyroid Stimulating Hormone) with Free T4 evaluate thyroid function, which is important as thyroid disorders can affect metabolism.
4. Lipid Panel measures total Cholesterol, LDL "bad", and  HDL "good" cholesterol, as well as triglycerides

These tests should ideally be conducted within 6 months before starting semaglutide or tirzepatide. They provide baseline information about your health status and help healthcare providers assess any pre-existing conditions that may affect treatment decisions. During Treatment: Periodic monitoring of your kidney functions may be recommended to detect any changes in health that may require adjustments to your treatment plan.

Before starting treatment with semaglutide or tirzepatide, it's important to disclose certain information and be aware of potential side effects.

Allergies and Medication Disclosure:

• Inform your healthcare provider about any allergies you have, especially to semaglutide, tirzepatide, or similar medications in the GLP-1 receptor agonist or GIP receptor agonist groups.
• Provide a complete list of all medications (prescription and over-the-counter), as well as supplements you are currently taking. This information helps prevent potential interactions and ensures safe prescribing.

Mental Health Warning: treatment with semaglutide or tirzepatide may affect mental health. Individuals may experience symptoms of depression or become suicidal. It's crucial to monitor for these symptoms and contact your doctor immediately if you or your family notice any changes in mood or behavior.

Common side effects include constipation, nausea, vomiting, diarrhea, abdominal pain, heartburn, and burping. These symptoms are generally mild to moderate in severity.

Serious Side Effects:

• Pancreatitis: Symptoms include ongoing upper abdominal pain that may radiate to the back, sometimes accompanied by vomiting. This requires immediate medical attention.
• Allergic Reaction: Signs include rash, itching, swelling of the eyes, face, mouth, tongue, or throat, difficulty breathing, or swallowing. Seek emergency medical help if these symptoms occur.
• Kidney Problems: Symptoms may include decreased urination, swelling of the legs, ankles, or feet. Inform your doctor promptly if you notice these signs.
• Gallbladder Problems: Symptoms include upper stomach pain, yellowing of the skin or eyes, fever, or clay-colored stools. Seek medical attention if you experience these symptoms.
• Hypoglycemia (Low Blood Sugar): Symptoms include dizziness, lightheadedness, sweating, confusion, headache, blurred vision, slurred speech, shakiness, fast heartbeat, anxiety, irritability, mood changes, hunger, weakness, or feeling jittery. It's important to monitor blood sugar levels regularly, especially if you have diabetes.
• Thyroid Tumor/Cancer: While rare, treatment with semaglutide or tirzepatide has been associated with thyroid tumors or cancer. Report any unusual symptoms or findings related to the thyroid to your healthcare provider.

If you experience a serious side effect, you or your doctor can report it to the FDA's MedWatch Adverse Event Reporting program online at http://www.fda.gov/Safety/MedWatch or by phone at 1-800-332-1088.

When there is a national shortage of medications like semaglutide or tirzepatide, they can sometimes be obtained from compounding pharmacies. A compounding pharmacy creates personalized medications for patients by mixing individual ingredients in the exact strength and dosage form required.

Compounding pharmacies must follow strict regulations set by the U.S. Food and Drug Administration (FDA) to ensure the safety and efficacy of the medications they produce.

Keep the medication in its original container to ensure it is properly labeled and stored according to the manufacturer's guidelines.

Store the medication in a place that is out of reach and sight of children to prevent accidental ingestion.

Protect the medication from light and heat to maintain its effectiveness. A cool, dry place is usually ideal.

Follow the storage temperature instructions provided on the medication container. Some medications may need refrigeration, while others should be kept at room temperature.

Do not flush medications down the toilet as this can cause environmental harm.

The best method for disposing of unneeded medications is through a medicine take-back program. These programs are designed to safely dispose of medications to prevent accidental ingestion or misuse.

To learn more, visit FDA's Safe Disposal of Medicines Website: http://goo.gl/c4Rm4p

References

https://www.wegovy.com/?showisi=true&&utm_source=google&utm_medium=cpc&utm_term=wegovy&utm_campaign=1_All_Shared_BR_Wegovy_Core&mkwid=s-dc_pcrid_645289260650_pkw_wegovy_pmt_e_slid__product_&pgrid=146393443618&ptaid=kwd-1296426946962&gad_source=1&gclid=CjwKCAjwkuqvBhAQEiwA65XxQDzkkNXOSbUeS67fFBugkz4to7SdQ21D9RfFf202cHEWlZcnRCRXpxoC7sIQAvD_BwE&gclsrc=aw.ds

https://mounjaro.lilly.com/what-is-mounjaro/patient-stories?gad_source=1&gclid=CjwKCAjwkuqvBhAQEiwA65XxQMq8YPNBNchvWpwlDpGiftQ3sld9n4_lNQ3U-uc4Z1kikxqCZEhlhxoCsbkQAvD_BwE

https://www.drugs.com/medical-answers/tirzepatide-semaglutide-how-compare-3576410/#:~:text=Weight%20loss%20with%20semaglutide%20ranged,side%20effects%20at%20higher%20doses.

https://www.healthline.com/health-news/weight-regain-after-stopping-ozempic#The-keys-to-long-term-weight-loss-maintenance

https://www.goodrx.com/ozempic/what-happens-when-you-stop-taking-ozempic

https://www.fda.gov/news-events/press-announcements/fda-approves-new-medication-chronic-weight-management#:~:text=Today%2C%20the%20U.S.%20Food%20and,weight%2Drelated%20condition%20(such%20as