Introduction
This is an information leaflet providing an overview of your treatment with tirzepatide (Mounjaro®). It tells you what it is, how to take it and possible side effects. This leaflet also includes frequently asked questions. However, if you have questions that are not covered within this leaflet then please do not hesitate to contact the Specialist Weight Management team.
In the leaflet we will refer to the medication as tirzepatide which is its generic name (Mounjaro® is a brand name).
What is tirzepatide and what should I expect?
Tirzepatide is a dual agonist for GLP-1 (Glucagon-Like Peptide-1 Receptor Agonist) and GIP (Glucose-dependent Insulinotropic Polypeptide). It mimics the two hormones that are released naturally in our gastrointestinal tract when we consume foods.
The GLP-1 hormone slows down stomach emptying, which makes you feel fuller for longer. It also targets the brain, helping to limit hunger and food cravings. GIP works in a similar way. The two together have a more powerful effect on metabolism, fat utilisation, and appetite than drugs that target GLP-1 alone. When taking tirzepatide with a reduced calorie meal plan and increased physical activities, around a 20% reduction in body weight, on average, can be achieved.
How often do you take tirzepatide?
Tirzepatide is a weekly injection, and it is licensed for the treatment of type 2 diabetes as well as for weight management.
The starting dose of tirzepatide is 2.5mg once weekly, which can be gradually increased to a maximum dose of 15mg once weekly over 20 weeks or more. Some people may not need to go up to the higher doses to get the full effect of the drug. Any side effects that you experience and your rate of weight loss will be assessed at every appointment.
What are the possible side effects from tirzepatide?
As with any medication, there are potential side effects associated with tirzepatide.
|
THE MOST COMMON SIDE EFFECTS OF TIRZEPATIDE |
RARE, SERIOUS SIDE EFFECTS OF TIRZEPATIDE |
|
Diarrhoea Flatulence Constipation Heartburn/Acid Reflux Stomach pain Feeling bloated Nausea Vomiting Fatigue Dizziness Headaches Hair loss |
Increased heart rate Kidney problems/Kidney failure Gallstones Acute pancreatitis Severe stomach pains Allergic reactions Depression or suicidal thoughts Tumours, including thyroid cancer For those with diabetes: Increased risk of low blood glucose levels (hypoglycaemia) Changes to vision |
While you are unlikely to develop any serious or long-term side effects from taking tirzepatide, it is important that you understand the potential risks beforehand. For most people taking this medication, the benefits outweigh the potential risks. Being overweight increases your likelihood of developing serious health conditions, so striving to get your weight down to a healthy range is vital.
Tirzepatide might not be the right treatment for you if you have a history of problems with your pancreas, or kidney problems or significant mental health issues.
Pregnancy and breastfeeding
Tirzepatide is not recommended if you are pregnant or planning to get pregnant, as it might harm your unborn baby. You should stop using tirzepatide if you become pregnant, or for at least a month before you plan to become pregnant. It is uncertain whether tirzepatide passes into breast milk and so it is not recommended for use when you are breastfeeding or if you plan to breastfeed.
Contraception
If you are starting tirzepatide or switching to tirzepatide from any other GLP-1 agonist then you should use a barrier method of contraception (such as a condom) for four weeks after starting/the switch, and for four weeks after any increases in dose, while also continuing any oral contraception. Alternatively, you may wish to consider changing to a non-oral method of contraception whilst using tirzepatide. Please discuss this further with either your practice nurse or the Specialist Weight Management Team.
How long does it take for tirzepatide to start working?
Tirzepatide starts working right after you inject your first dose. However, it might take several weeks or months before you notice a decrease in appetite or any weight loss.
Mild side effects of tirzepatide tend to be most noticeable right after an injection, lasting anywhere from a few days to a few weeks. As your body adjusts to the medication, side effects tend to diminish. However, if your symptoms persist, you should discuss this further with the Specialist Weight Management Team.
How can I manage the side effects?
It is important to keep a track of any symptoms you might be experiencing when taking tirzepatide, from mild symptoms to the more serious ones. Please contact the Specialist Weight Management team to discuss any symptoms you have that worry you.
Here are some helpful tips to help you manage the most common side effects:
Headaches
Headaches are one of the most common side effects of taking tirzepatide. They can be caused by dehydration, low blood glucose levels or your body just getting used to the change in hormones. If you are experiencing headaches alongside vomiting and diarrhoea, it is likely you are dehydrated. Make sure you rehydrate your body by drinking plenty of fluids and use rehydration sachets if necessary. You might wish to take a painkiller should your headache be bothering you.
Nausea or vomiting
Nausea and vomiting are also very common side effects. This is because tirzepatide works by slowing down the emptying of your stomach, which can result in an upset stomach whilst your body gets used to it. To help with nausea and vomiting try to:
- eat bland, low-fat foods such as crackers or toast
- eat foods that contain water such as soups
- eat slowly
- eat mindfully and stop when you are feeling full
- not lie down after eating
- get some fresh air
If this does not work, you should contact the Specialist Weight Management Team. You might need an anti-sickness medication to help ease your symptoms.
Diarrhoea
One of the most important things to do if you are experiencing diarrhoea is to stay hydrated. Dehydration can be a serious risk, so we recommend drinking lots of water and using rehydration sachets to help manage diarrhoea. Should you be struggling with diarrhoea then please contact the Specialist Weight Management Team. We might be able to recommend some medication to ease it.
Constipation
If you find that you are constipated, please make sure that you are eating a balanced diet with plenty of fibre and that you stay well hydrated. Regular exercise, even a daily walk, can help to keep things moving whilst burning off some calories. Please speak to the Specialist Weight Management Team who will be able to advise you on remedies that work. You might need a laxative but there are different types of laxatives, including ones that stimulate your bowel and stool softeners, so we might need to ask you more about your symptoms before we recommend the best treatment for you.
Flatulence & bloating
Flatulence and bloating can be reduced by eating a balanced diet, eating little and often, and making sure you are active.
You might want to avoid foods that are known for causing flatulence, for example brussels sprouts and cabbage. Cutting down on fizzy drinks will help reduce the gas in your body. Sitting upright after meals can also prevent these gastrointestinal side effects. Peppermint tea can help to settle your stomach.
Heartburn
Heartburn and acid reflux can be caused by the way tirzepatide affects your digestive system. Cutting down on caffeine and eating less spicy or fatty foods can help ease symptoms. There are many treatments to help manage reflux. Over the counter medications such as Gaviscon or Rennie can help to neutralise your excess stomach acid, keeping it from irritating your food pipe, which prevents symptoms. Your GP can also prescribe medications to help manage acid reflux.
Fatigue
Feeling weak or tired is common in patients taking tirzepatide. This is probably due to consuming fewer calories, giving your body less energy than it is used to working with. Eating little and often, as well as having a healthy balanced diet, can give your body more energy and sustain it throughout the day.
Dizziness
Dizziness can occur if blood glucose levels get too low. Occasionally dizziness is caused by something as simple as not eating enough and this can be a common problem when tirzepatide reduces your appetite. We advise that you do not operate heavy machinery should you be experiencing these dizzy spells. Eating regularly can help to reduce dizziness. We also recommend you stay well hydrated by drinking plenty of water. Please also discuss your symptoms with the Specialist Weight Management Team. If you have diabetes, we might need to review your blood glucose levels. If you have been losing lots of weight, we might need to review your blood pressure and adjust any medication you are on.
Tirzepatide is labelled with a black triangle. This means it is new and being monitored very closely. If you do get any side effects with tirzepatide, whether they are listed in the patient information leaflet or not, please report these via the Yellow Card Scheme.
Please make sure you read the patient information leaflet carefully before starting treatment.
FREQUENTLY ASKED QUESTIONS
The Specialist Weight Management team will provide you with your first prescription when you attend your ‘New Start’ appointment. We will also ask you to confirm the name and address of your preferred pharmacy as thereafter the prescription will be couriered to your named pharmacy once your overall health and any side effects have been reviewed in clinic. You will then have to collect your medication from your pharmacy.
Please contact the Specialist Weight Management team. We might need to lower the dose of tirzepatide to manage your side effects or we might need to stop or pause the medication.
If you develop severe stomach pain with or without persistent vomiting this might be a sign of pancreatitis, and you need to contact the Specialist Weight Management team immediately. If the pain occurs out of hours, please call 111 for advice.
If you experience a severe rash, swelling of your face, lips, tongue or throat; a very rapid heartbeat or trouble breathing or swallowing, please seek immediate medical attention as this could be life-threatening.
In animal studies, tirzepatide has been shown to cause thyroid C-cell tumours in rats. This has not been demonstrated in humans, but tirzepatide is not recommended for people with a history or family history of thyroid cancer.
There is no proven link between tirzepatide and changes in mood. However, you may experience an indirect effect on your mental health due to, for example, rapid weight loss, physical side effects and fluctuations in your blood sugars. Please contact the Specialist Weight Management team if you feel that your mood is affected whilst you receive treatment with tirzepatide.
You will inject tirzepatide once a week using an injection pen called a KwikPen.
The starting dose is 2.5mg once weekly for the first four weeks and this will increase every four weeks until you reach the most effective dose for you (maximum dose is 15mg once weekly).
You will receive a new injection pen for each dose step, and each injection pen contains all four doses of each step (e.g. the first contains all four doses of 2.5mg, then the next contains all four doses of 5mg, and so on). Be careful not to throw away or lose your pen until all four doses have been given.
The box that contains the tirzepatide does not contain any needles. Your first prescription will include a box of 100 needles. Always use a new needle for each injection and remove it after use (we will show you how to do this).
| Week | Dose |
|---|---|
| Week Week 1-4 | Dose 2.5mg once weekly |
| Week Week 5-8 | Dose 5mg once weekly |
| Week Week 9-12 | Dose 7.5mg once weekly |
| Week Week 13-16 | Dose 10mg once weekly |
| Week Week 17-20 | Dose 12.5mg once weekly |
| Week Week 21+ | Dose 15mg once weekly |
The best places to inject are around your tummy, your thighs or upper arms.
You should always remember to rotate where you inject tirzepatide. This will reduce soreness and bruising at your injection sites.
Tirzepatide can be taken at any time of the day with or without food. Time of day will not make a difference as to whether or not you will experience any side effects from the medication.
There is limited information about the effects of alcohol while taking tirzepatide, but it might worsen some of the side effects.
Alcohol and tirzepatide are both known to lower your blood glucose levels. If you combine both alcohol and tirzepatide, you might experience light-headedness and dizziness. If you get dizziness with tirzepatide, you should limit your alcohol intake so that it does not heighten your side effects.
Staying hydrated is important and it is worth noting that weight loss injections can suppress not just hunger but also thirst. It is recommended that you drink two to three litres of water or sugar-free drinks daily while taking tirzepatide. Adequate fluid intake will help reduce common side effects such as nausea, diarrhoea, constipation, vomiting and fatigue.
It is not essential to take vitamin supplements whilst on tirzepatide, but we do recommend that you take a daily A-Z multivitamin (we do not recommend a particular brand). The reason for this recommendation is that tirzepatide may result in you eating less, and an A-Z multivitamin can help bridge any nutritional gaps in your diet.
If you take too much tirzepatide, you might have severe nausea, severe vomiting and seriously low blood glucose levels. Please contact the Specialist Weight Management team if you have taken too much. Tirzepatide is available in six different dose strengths and after you start the medication your dose will be increased gradually until you reach the full dose. This is to minimise side effects. Be sure to contact the Specialist Weight Management team if there are any side effects that bother you or that do not go away.
A regular schedule for your injection is important. It should always be taken on the same day each week.
If you forget to inject a dose:
- If it is four days or less since you should have injected tirzepatide, use it as soon as you remember. Then inject your next dose as usual on your scheduled day.
- If it is more than four days since you should have injected tirzepatide, skip the missed dose. Then inject your next dose as usual on your next scheduled day. Do not take a double dose to make up for a forgotten dose. The minimum time between two doses must be at least three days.
If unsure, please contact the Specialist Weight Management team for advice on this.
Tirzepatide stays in the body for 25-30 days after the last dose so you might still experience side effects for some time despite having stopped taking it. Side effects should go away within four to five weeks of stopping tirzepatide. Please also note that your hunger might increase, and your weight loss might slow down when you stop taking tirzepatide.
Tirzepatide is unlikely to affect your ability to drive and use machines. Some patients might feel dizzy when taking tirzepatide mainly during the first three months of treatment. If you feel dizzy you should not drive or operate machines until you feel better. If you need any further information, talk to the Specialist Weight Management team.
You may take tirzepatide with you if you are flying. It is very important that you place it in your carry-on luggage, and not in your checked suitcase. The reason for this is that the temperature in the cargo hold can drop below freezing which may destroy the medication. Please let us know if you need to travel by air so that we can send you a letter for the security staff at the airport.
Do not use this medicine after the expiry date, which is stated on the pen label and carton after ‘EXP’. The expiry date refers to the last day of that month.
Tirzepatide should be stored in a fridge (2°C to 8°C) away from the cooling element, ideally towards the front of the fridge or in the fridge door. Once opened you can keep the pen for up to 30 days when stored at a temperature below 30°C. You can also continue to store it in the fridge away from the cooling element.
Do not use this medicine if you notice that the solution is not clear and colourless. Do not dispose of tirzepatide and the empty pens in the household waste; they should be disposed of in your sharps bin. If you leave your pens outside the fridge for longer than 30 days, please get in touch with the Specialist Weight Management team.
You should receive a sharps bin with your first prescription of tirzepatide.
When full, the box can be collected for disposal by your local council. Please see your local council website for more information.
Do not stop using this medicine without talking to your consultant or Specialist Weight Management team.
Yes, if necessary, you can change the day of your weekly injection of this medicine as long as it has been at least three days since your last injection. After selecting a new dosing day, continue with once-a-week dosing.
If the tirzepatide pen dose counter stops before you reach your prescribed dose, there is not enough tirzepatide left for a full dose. Please contact the Specialist Weight Management team if this happens.
You will need to contact the Specialist Weight Management team.
You must always inform your surgeon and anaesthetist that you are taking tirzepatide if you need to have surgery and you must follow their guidance. You also need to inform the Specialist Weight Management team before or soon after urgent or planned surgery so we can help you restart tirzepatide in a safe way.
Please let the Specialist Weight Management team know if you change address. If you change your GP we need to ensure you are still funded for this medication and will liaise on your behalf with the local NHS Integrated Care Board (ICB) who fund the medication. It is important we know of this change as soon possible so that it does not interfere with your treatment plan and we invoice the correct ICB for your medication.
Contacting the Specialist Weight Management Team:
By email:
By telephone:
01223 348 124 (answer machine).
Please leave a message with your name, Hospital Number (MRN) and date of birth and we will return your call as soon as possible.
By MyChart:
We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device.
More information is available on our website.
We are smoke-free
Smoking is not allowed anywhere on the hospital campus. For advice and support in quitting, contact your GP or the free NHS stop smoking helpline on 0800 169 0 169.
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