What is Mounajaro®

Mounjaro® (tirzepatide) is a once-weekly injectable medication manufactured by Eli Lilly. It’s a dual GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 (glucagon-like peptide-1) receptor agonist. This means it mimics the action of the two hormones GLP and GIP produced by the intestines.

Mounjaro® is the brand name for tirzepatide in Europe and Asia. In the US, the brand name for tirzepatide is Zepbound®.

FDA approved Mounjaro® in May 2022 for treatment of type 2 diabetes and later in November 2023 was approved for weight management.

How does tirzepatide work?

• First medication to target both GIP and GLP-1 receptors
• Mimics the effects of natural incretin hormones
• Stimulates insulin release when blood sugar is high
• Slows gastric emptying
• Reduces appetite through brain signalling
• Decreases glucagon production
  
  

What is the recommended BMI for injecting Mounjaro®

You may be eligible to take Mounjaro® or Zepbound® if your BMI is >30 kg/m2 or your BMI falls between 27-30 kg/m2 with any added comorbidity such as diabetes, hypertension, hyperlipidaemia, stroke etc. For individuals of Asian/Indian origin, the BMI cut off is reduced by 2.5kg/m2. This means if your BMI is more than 27.5Kg/m2 you would fit the criteria for Mounjaro®/Zepbound®.

Always consult your physician before starting Mounjaro® or Zepbound®.

Is Mounjaro®/Zepbound® safe to take if below the recommended BMI?

No, Mounjaro® is not recommended if your body weight falls below the recommended BMI. Please contact your specialist for further advice regarding Mounjaro®.

However there may be some exceptions which your doctor will decide. This will depend on how much the gain in weight is affecting your physical/mental health.

How long do I need to stay on Mounjaro® for?

Mounjaro® or Zepbound® can be used for weight loss in the long term. Mounjaro® has the active component called tirzepatide which is approved by the FDA. GLP-1 group of drugs has been in use for more than 10 years for weight loss. You may take Mounjaro® in the long term but it is always advisable to speak to a medical practitioner for advice regarding how long you need to stay on Mounjaro® or Zepbound®.

Will regain if stopped. Long term use will help reach a new hypothalamic set point. The body will forget what the previous weight was.

What do I do if I see no weight loss with Mounjaro® or Zepbound®

If you have been taking Mounjaro® or Zepbound® along with consistent changes to diet and lifestyle and yet you are not losing weight, please speak to your healthcare provider. They may be able to assess and treat if you have any underlying hormone problems, drug interactions or you may need a combination of medications for weight loss.

May not be injecting correctly, or other interference, or medical conditions, dose may be wrong.

How much weight will I lose with Mounjaro® or Zepbound®

The amount of weight you will lose will vary from person to person. Some tend to lose more weight in the first month while some may lose considerably less weight. Based on research, people lost between 15% – 20% of their body weight. 

Based on the SURMOUNT-1 trial on Mounjaro®, people on 15mg dose had an average weight loss of about 22.5% of body weight over 72 weeks, those on Mounjaro® 10mg lost about 21.4% and 5mg lost on an average 16% of their body weight over a 72 week period.

Please speak to your doctor for the best advice regarding Mounjaro® or Zepbound®.

How often do I need to inject the medication?

You need to inject the medication once a week at the same time. If you miss a dose of Mounjaro®, make sure you take it as soon as you remember. But there must be a minimum of 3 days gap between your missed dose and your next dose. Please speak to your specialist if you need advice on Mounjaro®.

How long does 1 pen of Mounjaro® last for?

Each pen is intended for single use which will last you 4 weeks. Please contact your doctor for instructions regarding the right way of use.

Can I go to a higher dose to start with of Mounjaro®

No, your doctor will gradually increase your Mounjaro® dose. Do not start with a higher dose of Mounjaro® without knowing how you tolerate it. Always start with a low dose of Mounjaro® as prescribed by your doctor and contact your specialist for any queries.

Who should not take Mounjaro®

If you fall in any of the below categories, you may not be eligible to take Mounjaro®: 

• Senior citizens (>75 years of age)
• Children (<18 years of age)
• Pregnant and lactating mothers
• Individual with a history of thyroid cancer
• Individual with a history of gallbladder issues
• Individual with a history of Pancreatitis
• Individual with a history of Multiple Endocrine Neoplasia Syndrome type 2 (MEN2)
• Individuals who do not meet the BMI criteria

Please speak to your health care provider to understand the suitability of Mounjaro®.

What should I do if I miss a dose of Mounjaro®

If you miss a dose of Mounjaro® because you were busy, you can take it whenever you remember. It is ideally taken on the same day each week at the same time. If the gap between your missed dose and next dose is less than 3 days away, you can simply take the next dose. Please speak to your provider regarding any queries regarding the mode of use of Mounjaro®.

Why don’t I feel full with Mounjaro®

The way Mounjaro® works is by improving satiety and reducing your appetite. It is not natural if you don’t feel full with Mounjaro®, some people feel full at a smaller dose and some people feel full with a larger dose. If you do not feel full with a larger dose, please speak to your doctor for any information regarding Mounjaro®. Recent studies also shows, people do not feel full with Mounjaro® if they are on it for more than a year.

• Maybe not right dose
• Not following lifestyle recommendations 
• Been on GLP-1 before and body has got adapted to it and it becomes ineffective
• Underlying medical conditions – problem in hypothalamus, overactive thyroid, genetic disorder

What diet should I follow whilst on Mounjaro®

You can follow a balanced diet with plenty of vegetables and fruits when you are on Mounjaro®. Avoid high calorie fatty food and too much spice in your diet. Follow a balanced diet with plenty of vegetables and fruits, good quality of protein and drink plenty of water and stay active. Such modifications can help boost your weight loss process when on Mounjaro®. Please speak to your doctor or a dietitian for personalised advice when you are on Mounjaro®. Mounjaro® must always be taken under medical supervision. 

It is advised to have regular consultations with a dietitian.

How much water should I drink whilst on Mounjaro®

Staying hydrated when you are on Mounjaro® is important. You must drink at least 2-3 litres of water every day. Always take Mounjaro® under medical supervision. Excess water consumption is not advisable for people with kidney, liver and heart failure.

Can I take Contraceptive pills with Mounjaro®

Yes, you can take contraceptive pills when you are on Mounjaro® but it may not be very effective in every one and is advisable to adopt other contraceptive measures like the barrier method. The action of Mounjaro® may hinder the activity and absorption of contraceptive pills. Please speak to your doctor to understand more about Mounjaro®.

Can I take Mounjaro® if I am pregnant?

No, you cannot take Mounjaro® if you are pregnant as there is insufficient evidence as far as we know. Please speak to your doctor for any other suitable alternative. 

However if you get pregnant whilst on Mounjaro®, please inform your doctor immediately and stop Mounjaro®. Most women find that with semaglutide or tirzepatide, which is Mounjaro®, fertility improves. Hence it is always safe to adopt contraceptive measures whilst on these classes of medications. More so if you are not planning to get pregnant.

Mounjaro® must always be taken under medical supervision.

Can I take Mounjaro® if I am breastfeeding?

No, you cannot take Mounjaro® if you are breastfeeding as there is insufficient evidence as far as we know. Please speak to your doctor for any other suitable alternative. 

Mounjaro® must always be taken under medical supervision.

Can I take metformin with Mounjaro®

Yes, you can take metformin with Mounjaro®. Please speak to your doctor to understand if you need to adjust your dose of medication. Mounjaro® or tirzepatide must always be taken under medical supervision.

Can I take insulin along with Mounjaro®

You can take insulin along with Mounjaro® after you have been prescribed by your doctor. If you are already on insulin and you have been prescribed Mounjaro®, you need to be aware that your blood glucose may reduce or you may have hypoglycaemic episodes. 

It is recommended that you monitor your blood glucose closely or even use a continuous glucose monitoring system. You may need to decrease the dose of insulin when you start Mounjaro®.

Always inform your doctor of all the medications you are taking before starting Mounjaro®.

Can I take medications for diabetes along with Mounjaro®

Mounjaro® is the trade name for tirzepatide and is licensed for type 2 diabetes and weight loss.

If you have type 2 diabetes and you are taking medications, starting Mounjaro® may lower your blood glucose or you may have hypoglycaemic episodes, more so if you are on medications like glimepiride or gliclazide or insulin. These medications should be reduced in dose or avoided after discussing with your doctor to prevent hypoglycaemia.

It is usually safe to take medications like metformin, gliflozins like dapagliflozin, empagliflozin and canagliflozin or pioglitazone.

Please inform your doctor of all the medications you are prescribed before you start tirzepatide.

If I am planning to have an endoscopy, colonoscopy or any surgery can I take Mounjaro®

If you are planning to have endoscopy, colonoscopy or any surgery under general anaesthesia you should stop Mounjaro® at least 2 weeks before the procedure.

Some people who have had these procedures have had aspiration pneumonia as food is remaining in their stomach. Mounjaro® slows down the movement of food and in some people the food remnants can get into the lungs during or after the procedure

Always inform your doctor of all the medications you are taking before any surgery or procedure. You should also inform your dentist if any procedure is to be done under general anaesthesia.

Can I continue to smoke when I am on Mounjaro®

Not sure if you are planning to start Mounjaro® or already have this medication. 

You have been advised by your doctor to take this medication to lose weight and improve your health. Hence smoking is not advisable especially if you are trying to lose weight and improve your lifestyle habits, irrespective of whether you take Mounjaro® or not. 

To quit smoking please contact your healthcare provider.

Can I continue to drink alcohol when I am on Mounjaro®

Our experience shows that people who are on Mounjaro® are not able to consume too much alcohol. It is advisable to significantly reduce your alcohol intake.

Some people cannot even tolerate the recommended amount of alcohol of 14 units whilst on tirzepatide.

If you are planning to lose weight and improve health, we would advise you to gradually reduce your alcohol intake. Alcohol contributes to your calorie consumption. So please cut down your alcohol intake. Some of our patients have complained of increasing nausea, vomiting, heart burn and altered bowels when they consume alcohol whilst on tirzepatide.

The medication makes you more sensitive to alcohol. It’s now being researched if it can be used for de-addiction.

Can I skip meals with Mounjaro®

Yes, you can skip meals with Mounjaro® especially if you are busy or planning to do intermittent fasting. If you are skipping meals for a long time you may experience heartburn. Every individual’s response to skipping meals is different.

If you have a medical condition you should discuss with your doctor if you are skipping meals. Especially if you have diabetes and are taking certain tablets like gliclazide or glimepiride or insulin you may have low blood glucose after a skipped meal.

Can I do intermittent fasting with Mounjaro®

Yes, you can practise intermittent fasting alongside Mounjaro®. This could help in your weight loss journey. However some people may develop nausea, vomiting, heart burn and constipation especially if the duration of fasting is prolonged. It is always advisable to start with a short fasting period and gradually extend it depending on your tolerance.

For example you could fast for 12 hours and have your meal during a 12 hour window period. If you are tolerating, gradually extend the fasting period to 14 hours and so on till you reach the 16 hour fasting period.

Always discuss with your doctor if you have any medical conditions or if you take any medications.

How should Mounjaro® be stored?

Mounjaro® should be stored in the refrigerator between 36 °F and 46 °F (2 °C and 8 °C). Once opened, Mounjaro® can be stored between 46 °F and 86 °F (8 °C and 30 °C) in the original carton for up to 28 days. Never freeze your Mounjaro® pens.

Can I take Mounjaro® if I am travelling?

Yes, you can take Mounjaro® with you when you are travelling. Make sure you store it in a cool place in your carry on or hand baggage. Do not keep it in your check in baggage. You may need a letter from your specialist if you plan to travel abroad.

How should I carry Mounjaro® when I am travelling?

When travelling by road, train or air , it is always recommended to carry Mounjaro® in a cool bag. Ensure you have spare needles and also a sharps bin, to dispose of used needles. Once you have reached your destination, take the Mounjaro® pen and keep it in the fridge.

What are the common side effects of Mounjaro®

The common side effects of Mounjaro® you may experience are: 

• Nausea
• Diarrhoea
• Vomiting
• Constipation
• Abdominal pain
• Headache
• Fatigue
• Stomach upset
• Light headedness
• Burping
• Heartburn

Please contact your specialist if you experience any symptoms.

What are the rare side effects of Mounjaro®

The rare side effects of Mounjaro® individuals experience are:

• Anaphylaxis
• Gallbladder issues
• Pancreatitis
• Severe hypoglycaemia
• Renal issues
• Tachycardia
• Diabetic retinopathy
• Suicidal ideation
• Depression

Please go to the nearest accident and emergency if you experience any of the above symptoms.

Can I get constipation with Mounjaro®

Yes, some individuals who take Mounjaro® may experience constipation. Including fibre rich food and plenty of water can help reduce constipation. If you face chronic constipation, please speak to a health care provider.

Can I get diarrhoea with Mounjaro®

Yes, some individuals who take Mounjaro® may experience diarrhoea especially when the dose of Mounjaro® is increased. Please speak to your doctor if you have severe diarrhoea.

Can I get heartburn or rotten eggy burps with Mounjaro®

Yes, heartburn is a fairly common symptom. This is usually due to Mounjaro® slowing down the intestinal movement. 

Rotten egg burps (unpleasant sulphur-like odour in burps or flatulence)  are a less common side effect, but possible side effect of Mounjaro®. It usually goes away on its own within a few weeks. Please talk to your doctor about other ways to manage them. 

To avoid heartburn or rotten egg burps, reduce the portion size of food, avoid spicy food and fried food. Also ensure you are well hydrated. If despite these precautions, you still have heartburn or eggy burps please contact your doctor.

Is thyroid cancer common with with Mounjaro®

No, thyroid cancer is a rare condition found in animal models. Mounjaro® can possibly increase the risk of thyroid cancer in animal models. 

Obesity on its own is a risk factor for thyroid cancer. Hence it is very important to talk to your doctor before you consider Mounjaro®. It is advisable not to have Mounjaro® if there is a family history of any thyroid cancer or you have had any form of thyroid cancer. Please speak to your health care provider to understand your suitability for Mounjaro®.

How common is pancreatitis with Mounjaro®

Pancreatitis is a rare side effect of Mounjaro®. If you have a history of pancreatitis, you may not be suitable to take Mounjaro®. Please speak to your doctor to understand the suitability of Mounjaro®. If you have abdominal pain, you should immediately go to the nearest emergency care to rule out pancreatitis.

Can I have hair loss with Mounjaro®

Hair loss is a possible side effect of Mounjaro®, but it is not a common one. There are a few possible reasons why Mounjaro® might cause hair loss:

• Rapid loss of weight
• Hormonal imbalance

But If you are concerned about hair loss while taking Mounjaro®, talk to your doctor. They can help you to determine whether the hair loss is caused by the medication or by another underlying condition.

Can I get a headache with Mounjaro®

Headaches are not a common side effect of Mounjaro®, However, it is possible that you may experience headaches while taking this medication. Headaches caused by Mounjaro® usually subside on their own within a few weeks. If your headaches are severe or do not subside, talk to your doctor. They may adjust your dose of Mounjaro® or switch to a different medication. In some people, the headache may be because of a relative drop in blood sugar when on Mounjaro®.

How common is gastroparesis with Mounjaro®

Gastroparesis with Mounjaro® is a rare complication but always a possibility. If you feel any gastrointestinal discomfort, please speak to your doctor to take necessary steps. Always take Mounjaro® under medical supervision. 
Mounjaro® may be an influencing factor of Gastroparesis but it can be because of the other factors also. In diabetes, gastroparesis is common due to nerve damage of stomach muscles.

Can I get an Ozempic® face with Mounjaro®

Mounjaro® face may occur due to the rapid loss of fat in the face leading to sagging facial muscles. Please speak to your doctor if you feel any discomfort in the way you look and feel. 

Will I get low blood glucose with Mounjaro®

Mounjaro® normally does not cause low blood glucose. But if you are on insulin, gliclazide or glimepiride etc. you may experience low blood sugar. Low blood glucose is a serious but rare side effect of Mounjaro®. Please speak to your doctor if you are taking other diabetic medications with Mounjaro® and you experience symptoms like fatigue, rapid heart rate, sweating, trembles etc.

Can I take Mounjaro® if I have retinopathy?

Retinopathy is a common complication of diabetes which can lead to vision loss. No you cannot take Mounjaro® if you have progressive retinopathy as it may worsen your condition. Please speak to your doctor and take Mounjaro® under medical supervision.

Can I take Mounjaro® with kidney failure?

No, you must not take Mounjaro® with moderate to severe kidney failure as it may worsen your condition but some doctors may recommend Mounjaro® if your eGFR is >30mL/min/1.73m2 under strict medical supervision. Please speak to your doctor if you want to know more about Mounjaro®. 

Will I lose muscle mass when taking Mounjaro®

Yes, you may lose muscle mass when taking Mounjaro®. It is important to exercise and have sufficient good quality proteins in your diet. Please speak to your doctor and dietitian for suitable advice.

Does Mounjaro® reduce the risk of heart attack and stroke?

Yes, Mounjaro® helps reduce cardiovascular risk factors. This can be because of weight loss caused by Mounjaro®. Please speak to your doctor if you plan to take Mounjaro®. Mounjaro® must always be taken under medical supervision.

Will PCOS get better with Mounjaro®

Mounjaro® can help you lose weight. Weight loss tends to regularise the menstrual cycle which improves fertility and PCOS. Always consult your doctor if you plan to start Mounjaro®. 

Does Mounjaro® reduce the risk of Alzheimer’s disease?

There are few studies going on to determine if GLP-1 analogies can reduce the incidence and severity of Alzheimer’s disease. At this point in time Mounjaro® cannot be used as a treatment for Alzheimer’s.

Can I regain weight after stopping Mounjaro®

Yes, you may regain weight if you stop Mounjaro®. It is suggested to continue to follow a healthy diet and lifestyle habits with Mounjaro®. Please speak to your doctor and dietitian for further advice. 

Your hunger and lack of fullness may return. Some people say they start to feel hungry and are able to eat larger portions.You may not only regain weight you may also have an increase in blood pressure with weight regain.

It is therefore important to ensure before you stop Mounjaro®, you should have adapted a good lifestyle and are able to sustain the new healthy lifestyle.

If you do have weight regain, consult your doctor to restart Mounjaro® or another GLP-1 analogue.

• Why people regain weight: fullness goes way, feel more hungry, effect of drug wears off
• Need to take it for long enough for body to erase memory of previous weight/set point
• How can people know about new set point – if miss a dose, they don’t feel like going back to previous portions
• Obesity is a significant chronic disease globally, responsible for numerous metabolic and other complications. Advances in treatment have shown that substantial weight loss, which improves health outcomes, can be achieved through both pharmacological and surgical approaches.
• Weight loss positively impacts various health outcomes, enabling patients to live longer and healthier lives. However, a common observation among individuals undergoing bariatric surgery or pharmacological treatment is that weight loss eventually plateaus, or in some cases, there is clear weight gain over time, especially after discontinuing treatment. 
• Multiple studies have consistently shown that after bariatric surgery, weight regain occurs in 30%-70% of patients over the years, particularly after 5 years. This regain is typically defined as a 10%-25% increase from their lowest post-surgery weight (nadir). Similarly, although supported by more limited evidence, discontinuing pharmacological treatments can also lead to weight regain. This is especially evident with high-efficacy injectable incretin-based therapies. 
• For example, discontinuing the glucagon-like peptide-1 (GLP-1) receptor agonist liraglutide (3 mg daily) is estimated to result in a 7%-9% weight increase. Stopping semaglutide (4 mg weekly) could lead to an estimated 11% weight regain within a year. For tirzepatide, a dual GLP-1 and GIP receptor agonist, weight regain is calculated at approximately 14% after discontinuation. 

How long can I take Mounjaro® for?

Obesity is a chronic condition. Mounjaro® is licensed for chronic weight management. Mounjaro® can be taken long-term to lose weight and maintain weight.

People stop Mounjaro® for several reasons including cost and side effects.

The NICE (National Institute for Health and Care Excellence) in the UK has recommended Mounjaro® to be used for up to 2 years only. The reason they cite is due to lack of evidence for long term use of Mounjaro®.

Always discuss with your doctor on how long to continue Mounjaro®. It is important that you do not regain weight and lose all the benefits of weight loss.

How to wean off Mounjaro®

There is no recommended protocol to wean off Mounjaro®. Some people stop Mounjaro® abruptly.

Some people on Mounjaro® reduce the frequency of injections from one to week to 10 days or to a fortnight and gradually reduce the frequency of injections.

Others go down on the dose of Mounjaro®.

Please consult your doctor if you are planning to wean off Mounjaro®.

What is the difference between Wegovy® and Mounjaro® 

Wegovy® contains semaglutide which is a GLP-1 (Glucagon like Peptide – 1) analogue while Mounjaro® contains tirzepatide which has GLP-1 (Glucagon like Peptide – 1) analogue and GIP (Glucose-dependent insulinotropic polypeptide).

What is the difference between Ozempic® and Mounjaro®

Ozempic® contains semaglutide which is a GLP-1 (Glucagon like Peptide – 1) analogue licensed for Type 2 Diabetes only. Mounjaro® contains tirzepatide which has GLP-1 analogue and GIP (Glucose-dependent insulinotropic polypeptide) and can be used for weight loss and Type 2 Diabetes.

What is the difference between Ozempic® and Wegovy®

Ozempic® and Wegovy® both contain semaglutide. Ozempic® is licensed for the management of Type 2 Diabetes Mellitus whereas Wegovy® is licensed for weight loss.

Can I have Mounjaro® prescribed if I am HIV positive?

Yes, some studies show that Mounjaro® may be safe in people with HIV. Weight loss helps to reduce visceral fat and cardiovascular risk

You should be aware of any lipohypertrophy fat or lipoatrophy at the injection sites

Always inform your doctor of all the medications you are taking before starting Mounjaro®.