Subcutaneous Injectable Tirzepatide (Mounjaro)

This treatment plan reviews the risks and benefits of the treatment we are recommending. Please make sure to read it and the manufacturer's pamphlet that comes with the medicine. The manufacturer's pamphlet contains full information on potential medication interactions, side effects, and other important information you should know about the medicine before you start.

Instructions

You have stated that you wish to obtain treatment for weight loss management with subcutaneous injectable Mounjaro. Please note branded Mounjaro does not have an FDA approval for weight management. Please follow the directions on your prescription for administration of treatment and your dosing titration.

GLP-1s (glucagon-like peptide-1 receptor agonists) are a class of medications used primarily for the treatment of type 2 diabetes and, more recently, for weight management. These drugs mimic the effects of a natural hormone called GLP-1, which is released in the gut after eating.

These medications work by:

• Increasing insulin secretion to help lower blood glucose after meals
• Suppress glucagon release to limit glucose release by the liver
• Slow gastric emptying to allow a more gradual absorption of glucose to reduce post-meal blood sugar spikes and to help you feel full longer
• Works on receptors in the brain to increase fullness and reduce hunger
  
  

Special Alerts:

Safety Updates

The U.S. Food and Drug Administration (FDA) has been evaluating reports of suicidal thoughts or actions in patients treated with a class of medicines called glucagon-like peptide-1 receptor agonists. Because the information provided was often limited and because these events can be influenced by other potential factors, we determined that the information in these reports did not demonstrate a clear relationship with the use of GLP-1 RAs. Similarly, our reviews of the clinical trials, including large outcome studies and observational studies, did not find an association between use of GLP-1 RAs and the occurrence of suicidal thoughts or actions. However, because of the small number of suicidal thoughts or actions observed in both people using GLP-1 RAs and in the comparative control groups, we cannot definitively rule out that a small risk may exist; therefore, FDA is continuing to look into this issue.

If you experience new or worsening depression, suicidal thoughts, or any unusual changes in mood or behavior please reach out to your Wisp provider right away.

Pulmonary Aspiration During Surgery or Sedation

Tirzepatide products, like Mounjaro, can delay stomach emptying, which may increase the risk of pulmonary aspiration (inhalation of stomach contents into the lungs) during surgeries or procedures requiring general anesthesia or deep sedation. Inform your healthcare provider if you are taking Tirzepatide, like Mounjaro, before any planned surgeries or procedures so they can take appropriate precautions to reduce this risk.

Boxed Warning

The FDA has boxed warning labeling reporting semaglutide has been shown to cause dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant doses in rodents. It is unknown whether semaglutide causes C-cell tumors, including medullary thyroid carcinoma (MTC), in humans, as the relevance of semaglutide-induced rodent thyroid C-cell tumors to humans has not been determined.

Tirzepatide is contraindicated in patients with a personal or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). If you experience symptoms of a mass in your neck, trouble swallowing, shortness of breath, or persistent voice hoarseness, please reach out to your Wisp provider right away.

Administering Your Mounjaro Injection

Mounjaro branded Tirzepatide comes in single use pens in a pack or 4 with the same dosage.

Each prefilled pen has a tiny subcutaneous needle at the tip. Each pen is meant to be used only once and by the prescribed individual. Do not share your medication or needles with anyone.

The pens should be stored in the refrigerator at 36-46 degrees fahrenheit, but they may be kept between 86 degrees fahrenheit for up to 21 days. If you keep the pen at room temperature do not return to the refrigerator. Discard the pen if not used within 21 days from removing it from the refrigerator. Do not freeze the pens. If it’s been frozen, discard the pens. The pen has glass parts, if dropped on a hard surface do not use it and discard.

Use the pen on the same day each week, any time of day, with or without food.

If you have medication pen issues you may need to contact the manufacturer

• Eli Lilly and Company: www.mounjaro.com
• Lilly: 1-800-Lilly-Rx (1-800-545-5979)
  
  

Preparing your medication

• When using a new pen, ensure the pen indicates your correct medication and dosage you were prescribed and ensure the expiration date hasn’t passed.
• Choose your injection site
  • Change (rotate) your injection site each week.
  • You may use the same area of your body but be sure to choose a different injection site in that area.
• Pull the gray base cap - Review photos and Mounjaro administration instructions at THIS LINK.
  • Make sure the pen is locked.
    • Do not unlock the pen until you place the clear base on your skin and are ready to inject.
  • Pull the gray base cap straight off and throw it away in your household trash.
    • Place the clear base flat against your skin at the injection site.
    • Unlock by turning the lock ring.
• Press and hold up to 10 seconds. Press and hold the purple injection button for up to 10 seconds. Listen for:
  • First click = injection started
  • Second click = injection completed
  • You will know your injection is complete when the gray plunger is visible.

1. Dispose of the used pen in a sharps container (your local pharmacy may be able to provide one) or a heavy-duty plastic container with a screw on lid. Do not throw in the regular trash.
   

Missed Doses

If a dose is missed, administer Mounjaro as soon as possible within 4 days (96 hours) after the missed dose

If more than 4 days have passed, skip the missed dose and administer the next dose on the regularly scheduled day

Day of administration can be changed, as long as the time between the 2 doses is at least 3 days (72 hours)

Administering Too Much Medication

• Call Poison Control at 1-800-222-1222
• Notify your Wisp provider
• Monitor for any side effects that may develop over the next several days
• If your side effects aren’t manageable after speaking to your Wisp provider or if your side effects become more severe seek treatment at an emergency care (ER) facility
• Notify your Wisp provider of your ER visit
  

Allergies

This medicine, like all medications, may cause an allergic reaction if you are allergic to similar medicines or components. If you are allergic to any of the following please do not take the medicine and call or message us or follow up with an in-person healthcare provider.

• Zepbound
• Mounjaro
• Tirzepatide
• Hypersensitivity to GLP-1 Receptor Agonists in the past
  

Conditions

We have evaluated your health history and the specific health information you provided us, however if anything changes and you develop one of these conditions, please stop taking this medicine and call or message us immediately. This list may not be all inclusive.

• Pregnancy
• Breastfeeding
• BMI less than 27
• Personal or Family History of Medullary Thyroid Carcinoma
• Personal or Family History of Multiple Endocrine Neoplasia Type 2
• History or Active Renal disease
• Type I Diabetes
• Poorly controlled Type II Diabetes
• History of Pancreatitis
• Elevated Triglycerides
• Significant Alcohol Use
• Gallbladder disease without surgical removal
• History of Retinopathy
• History of a bowel obstruction
• History of eating disorders
• History of Suicidal Ideation in the past
• Recent bariatric surgery
  

Pregnancy and Breastfeeding

Medications for diabetes or weight loss therapy are not recommended during pregnancy. Based on animal reproduction studies, there may be potential risks to the fetus from exposure to semaglutide during pregnancy, however available pharmacovigilance data and data from clinical trials with Mounjaro use in pregnant patients are insufficient to establish a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. Mounjaro should be discontinued for more than 2 months prior to becoming pregnant.

If you become pregnant while taking Mounjaro you should discontinue your treatment. Weight loss offers no benefit to a pregnant patient and may cause fetal harm. Based on animal reproduction studies, there may be risks to the fetus from exposure to Tirzepatide during pregnancy. A pregnancy registry is available to monitor outcomes for pregnant individuals and their infants following exposure to semaglutide. Patients who have been exposed to Tirzepatide during pregnancy are encouraged to contact Eli Lilly and Company at 1-800-LillyRx (1-800-545-5979) to participate in monitoring for pregnancy outcomes.

There are no data on the presence of Tirzepatide or its metabolites in animal or human milk, the effects on the breastfed infant, or the effects on milk production. However, breastfeeding during therapy is not recommended as you should be eating an additional 340-400 calories to support your breastmilk production.

Medicines, Supplements, and Foods

We have evaluated the specific health information you provided us, however if you are taking any of the medicines, foods, or supplements listed below call or message us before you take the medicine. Some of these can cause dangerous interactions with the medicine we are prescribing you and we will help you evaluate that risk and decide on an appropriate treatment plan. Please ensure your chart is up to date with your current medications, allergies, and medical conditions so your provider can safely treat you as this list may not be all inclusive.

• Sulfonylureas
• Insulin
  

Emergency Side Effects

This medicine can cause dangerous and potentially life-threatening side effects. If any of the emergency side effects listed in the manufacturer’s pamphlet or those below happen to you please stop taking the medicine and call 911 or seek immediate medical help in person.

• Inflammation of the pancreas (pancreatitis) OR severe pain in the stomach area
• Sudden onset of chest pain
• Shortness of breath
• Difficulty or painful swallowing
• Severe skin rash and/or itching
• Facial or throat swelling
• Blurred or changes in vision
• Severe diarrhea with or without blood
• Severe vomiting
• Palpable mass in your neck
• Trouble swallowing
• Shortness of breath
• Persistent voice hoarseness
• Decreased urine output
• Pain in the right upper stomach with or without fever
• Yellowing of the skin or eyes
  

Other Side Effects

This medicine can also cause other side effects including (this list is not all inclusive):

• Abdominal discomfort
• Constipation
• Diarrhea
• Nausea
• Vomiting
• Decreased appetite
• Altered sensation of taste
• Fatigue
• Headache
• Belching
• Gas
• Heartburn
• Discomfort, irritation, or redness at the injection site
  

Risks

Accurate Information

We have evaluated your health history and your specific health information you provided and determined it is safe to proceed with this treatment at this time. If your health history changes including diagnoses or medications please message or call us before you take the medicine to ensure it's safe to proceed. Some medications and conditions can cause dangerous interactions with the medicine we are prescribing and we will help you evaluate that risk and decide on an appropriate treatment plan.

Treatment Failure

This treatment is not guaranteed to be effective. It may not work or may only partially resolve the condition for which you are seeking treatment. If the treatment is not working, or if you are experiencing new or worsening symptoms, give us a call or message us anytime. If it is an emergency, call 911 or seek immediate medical help in person. You may need to seek alternative treatment such as those listed below or in the follow up plan.

Misdiagnosis or Delayed Diagnosis.

Through telehealth, there is also a risk that we misdiagnose or fail to diagnose conditions that you may have which could affect our recommendation for treatment. This risk exists with a doctor in person as well but they may have additional resources to aid their evaluation. We use evidence-based practice and guidelines as well as clinical decision-making to minimize these risks.

Accepting or Declining Our Recommendation

We have based our recommendation on your specific case and medical guidelines, but there may be alternative treatments or strategies that may be helpful to you. Some may be more or less effective than what we provide. Some treatments may require an in-person exam or procedure which we can’t provide. Message us or talk to your doctor in person to discuss alternative treatments.

Share with Your In-Person Healthcare Team

You can access your records anytime. We strongly recommend that you update your in-person doctor, pharmacist, and the rest of your healthcare team to let them know about any new medicines you are taking or other changes in your health.

You can also ask us questions anytime and we are happy to help you share any information about your health with your in-person healthcare team.

Wisp is not affiliated and does not sponsor or endorse any company names, logos, or brands shown or mentioned. All product names, logos, brands, and other trademarks or images shown or mentioned are the property of the respective brand owners.