Lesson One

Robert Fortino, D.O. (email: drrob4tno@aol.com)

Premier Physicians Weight Loss Center, Inc 129 Johnson Road, Unit A3, Turnersville, NJ 08012 856-318-4100

Broad Street Weight Management Center, Inc 1822 South Broad Street, Philadelphia, PA 19145 215-336-8000

What is Tirzepatide?

Tirzepatide is trademarked as Zepbound and Mounjaro, both produced by Lilly Pharmaceuticals.  Tirzepatide is the first dual Agonist: Glucogon-Like Peptide 1 Receptor Agonist and Glucose Dependent Insulinotropic Polypeptide Receptor Agonist, (GLP-1/GIP receptor co-agonist), approved for glycemic control in patients with type 2 diabetes, (T2DM). Tirzepatide has been studied for its weight loss effect in patients with and without diabetes by effecting appetite control and gastric emptying.

GLP-1 and GIP are Incretin Secretory Molecules. GLP-1 is produced in the ileum and colon of your gut.  GIP is produced in the duodenum and jejunum (small intestines) of your gut. Incretins are hormones that help decrease blood glucose levels and improve insulin sensitivity. Effects of GLP-1 and GIP RA’s include glucose control, body weight loss, protection of islet β cells of the pancreas, promotion of islet β cell multiplication with minimal side effects of hypoglycemia.

The GLP-1 receptor is widely distributed on the pancreatic, lungs, kidneys, central nervous system, cardiovascular system, gastrointestinal tract, skin, and the vagus nerves. When activated, the GLP-1 receptor causes multiple biological effects, such as reducing neuroinflammation, promoting nerve growth, improving heart function by improving microvascular function and reducing cardiovascular events by decreasing blood pressure, suppressing appetite, delaying gastric emptying, regulating blood lipid metabolism, and reducing fat deposition as well as activating the metabolism of brown fat.

Obesity, as a chronic recurrent disease, is known to increase the risk of developing T2MD, hypertension, dyslipidemia, CVDs, fatty liver disease, and other diseases, leading to poor quality of life and increased mortality.  Obesity is related to increased appetite, changes in the levels of gastrointestinal hormones, increased fat mass, and disorders of satiety and satiation mechanisms.

Tirzepatide has been shown to reduce body weight in obese patients that are both diabetic and non-diabetic. It was found that Tirzepatide could regulate food preference, as well as reduce food intake and body weight without reducing energy consumption.

Who can take Tirzepatide?

Tirzepatide injection is used along Dr. Fortino’s diet and exercise program to help with weight loss in overweight adults who may also have high blood pressure, diabetes, or high cholesterol.

Who should not take Tirzepatide?

Someone who has thyroid cancer, diabetic retinopathy, history of pancreatitis, kidney failure, stomach motility problems, history of hypoglycemia, pregnancy or planning a pregnancy, breast feeding, a previous allergic reaction to Tirzepatide.

What medications interactions are important to know when using Tirzepatide?

Tirzepatide causes a delay of gastric (stomach) emptying and has the potential to impact the absorption of concomitantly administered oral medications, so caution should be exercised.

Insulin and other Diabetic medications. Dose adjustment to your diabetes medication may need to be made if your blood sugar falls too low. When initiating Semaglutide, monitor blood sugar more aggressively if you are prescribed insulin or other medications for Diabetes (Type 1 or Type 2)

Levothyroxine may interfere with blood glucose control and reduce the effectiveness of Tirzepatide and other diabetic medications. Monitor your blood sugar levels closely. You may need a dose adjustment of your diabetic medications during and after treatment with levothyroxine.

Beta blockers can reduce your ability to detect if your blood sugar is low

How do I take Tirzepatide?

Start at Phase 1:  Tirzepatide is started at 2.5mg subcutaneous injection once weekly for 4 weeks.                 (If you wish to continue this dose the cost is $350)

You may increase your dose to the next Phase if you wish:

Phase 2:  The dose can be increased to 5.0mg subcutaneously once weekly.

The cost for this dose is $550 for the month supply (4 Injections)

Phase 3:  The dose can be increased to 7.5mg subcutaneously once weekly.

The cost for this dose is $750 for the month supply (4 Injections)

Phase 4:  The dose can be increased to 10mg subcutaneously once weekly.

The cost for this dose is $950 for the month supply (4 Injections)

Any dose can be maintained as a maintenance dose.

If a dose is missed, administer Tirzepatide as soon as possible within 5 days after the missed dose. If more than 5 days have passed, skip the missed dose, and administer the next dose on the regularly scheduled day. Administer Tirzepatide subcutaneously to the abdomen, thigh, or upper arm. It is ok to use a different injection site each week.

What are the common side effects that can occur using Tirzepatide?

Nausea, Constipation, Diarrhea, Abdominal Pain, Vomiting

Hypoglycemia, if used with Insulin therapy

Injection site reaction

Treating any stomach or gastrointestinal side effects

Maalox, Mylanta, Pepcid AC

Anti- Diarrhea (Lomotil, Imodium, Pepto-Bismol, Kao pectate)

Anti-nausea Ginger Root (tea, chewing gum, or any form)

Constipation: MiraLAX, Magnesium (Trivalent or Oxide), Dieter’s Tea, Smooth Move etc…

Adhering to the proper diet as discussed with Dr. Fortino will provide better results and minimal side-effects.  Please discuss any side-effects with Dr. Fortino as soon as possible. You may reach me by email at drrob4tno@aol.com. If a side-effect is intolerable, the Tirzepatide can be stopped.  Tirzepatide can be re-started at a lower dose.  This generally allows for better tolerance of the medication.  Any dose can be maintained weekly for continued appetite and weight control.