What is Mounjaro?

Mounjaro is a medication manufactured by Eli Lilly and contains the active ingredient 'Tirzepatide'.

Tirzepatide is a long-acting GIP (glucose-dependent insulinotropic polypeptide) receptor and GLP-1 (glucagon-like peptide) receptor agonist that increases insulin sensitivity and secretion.

This means it mimics the action of two hormones; GIP and GLP-1. These two hormones work by slowing your stomach emptying after a meal and signal the brain to feel full.

Mounjaro was approved in the UK in October 2023 to treat type 2 diabetes on the NHS and has only recently been approved for use in weight management. Mounjaro has recently launched for weight management and has already sparked a huge amount of interest amongst prospective patients.

Mounjaro may not be suitable for all patients and will require you to fill out a consultation form beforehand which will be assessed by a prescriber who will then determine suitability. Components such as your medical and health conditions and body mass index will be taken into account when prescribing.

What Exactly is Mounjaro (Tirzepatide)?

Mounjaro is the brand name for the active drug tirzepatide. Tirzepatide is a GIP and GLP-1 which works by mimicking a natural hormone present in the body.

Mounjaro is to be used as an adjunct to diet and exercise to improve glycaemic control in adults that have type 2 diabetes. Whilst that is the current licensing, it will soon launch in the UK to be used for weight management, meaning the product will be more accessible to those requiring assistance in their weight loss journey.

How Does Mounjaro Work?

Mounjaro is a single peptide which activates both GIP and GLP-1 and it helps with glycaemic control through several mechanisms. Mounjaro helps to improve insulin sensitivity, decreases food intake and slows gastric emptying. This means Mounjaro not only works in type 2 diabetes but also works for weight management.

The glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) are incretin hormones that are released in the body in response to food intake. Incretins stimulate the release of insulin from pancreatic cells which in turn lowers blood glucose levels. Mounjaro works by enhancing insulin secretion which increases insulin levels in the body.

The incretin effect is known as a phenomenon whereby oral glucose causes a greater stimulation of than infused glucose when the same plasma glucose levels are achieved. Both GIP and GLP-1 drive the incretin effect. The incretin effect is responsible for up to 70% of the insulin secreted after a meal in healthy humans. However, in humans with type 2 diabetes, the incretin effect is impaired, which contributes to the insufficient control of blood glucose levels after a meal.

Mounjaro and Weight Loss: What You Need to Know

As mentioned above, Mounjaro plays a role in the treatment of type 2 diabetes and weight management. Mounjaro contributes to weight loss by decreasing your food intake but also slowing down the emptying of your stomach.

Evidence has been gathered and data from a clinical trial has demonstrated that participants have lost around 6% of their weight by the time they reach week 8 of treatment. The 72-week trial concluded the once-weekly injection provided substantial and sustained reductions in body weight.

Mounjaro works to reduce appetite, in turn reducing the number of calories you eat. This effect is almost immediate but does wear off after around four to five days. This is only for the first month, after which Mounjaro reaches a steady state in the body. A steady state refers to a consistent level of tirzepatide in the body, rather than spiking when injected and falling after 4-5 days.

Every individual will react differently to Mounjaro and this will affect how much weight they lose whilst on treatment. Typically, according to studies, you could lose 2% of your body weight in as little as 4 weeks and 4% at the end of 8 weeks. This could benefit patients significantly as the steady weight loss could help them achieve their goals and allow them to become healthier, contributing to a reduced risk of serious health problems such as heart disease and stroke.

Mounjaro Injection: Administration and Dosage

Mounjaro is an injectable medication that is in the form of a pen. It contains 4 doses, for 4-weeks worth of treatment. Mounjaro is injected once weekly.

The administration of Mounjaro is straightforward and very similar to the administration of Wegovy (semaglutide) and other insulins. Mounjaro is administered as follows:

• Once you have taken your pen out of the refrigerator, check the label and strength to make sure you have selected the correct medicine and it is not expired or damaged.

• Make sure the pen is not frozen or cloudy, free of particles and colourless or ever so slightly yellow in colour.

• Ensure your hands are washed and cleaned before injecting.

• Select a new needle - pull off the paper tab from the outer needle shield.

  • Push the capped needle straight onto the pen and twist the needle until it is tight.

  • Pull off the outer needle shield - do not throw this away as you'll need it later)

  • Pull off the inner needle shield and throw this away.

• Turn the dose knob until the dose indicator shows '1' - this indicates ONE dose.

  • The pen will not allow you to dial more than one dose.

  • The pens are not designed to be 'split' - each requisite pen is designed to deliver the relevant dose. For example, a 2.5mg pen will deliver 2.5mg of Mounjaro.

• Choose your injection site - this is usually the thigh, upper arm or abdomen. Be sure to rotate the injection site regularly to prevent scar tissue from forming in the same area.

• Insert the needle into your skin

  • Push the dose knob all the way in until the dose window displays '0'.

  • Continue to hold the dose knob in and slowly count to 10 before removing the needle.

• Pull the needle out of our skin - a droplet on the end of the needle is perfectly normal.

  • Carefully replace the outer needle shield and unscrew the needle disposing of it appropriately.

• Return the pen to the fridge.

Mounjaro is available in 6 different strengths: 2.5mg, 5mg, 7.5mg, 10mg, 12.5mg and 15mg. Patients will start on 2.5mg and increase on a 4-weekly basis. However, it may not be necessary for you to continue increasing the doses if a lower dose, such as 5mg, works for you. This is a conversation that needs to occur between yourself and the prescriber to assess which treatment plan is best for you. Each strength must be used for a minimum of 4 weeks before increasing to the next one.

What Are the Potential Side Effects of Mounjaro?

As with all medication, Mounjaro does have side effects. Side effects do not occur in all patients and may affect individuals differently. These side effects do range from common symptoms to serious health complications, so it is best to declare any medication you take or medical conditions you suffer from when completing your consultation form or speaking with a healthcare professional.

Common Side Effects

• Nausea (feeling sick)

• Vomiting

• Diarrhoea

• Constipation

• Indigestion

• Stomach problems such as minor pain

• Decreased appetite

• Hair loss has also been reported

More Serious Health Risks

• Pancreatitis - symptoms include: Severe pain in the abdomen that spreads to the back or chest and may feel worse when you eat, nausea, vomiting, and fever. You should not use Mounjaro if you have a history of pancreatitis.

• Gall bladder problems e.g. gallstones - symptoms include: pain in your upper stomach, fever, yellowing of the skin or eyes (jaundice) and clay-coloured stools. In a clinical study, 0.6% of patients reported gallbladder disease.

• Severe allergic reaction - symptoms of this include: swelling of the lips, tongue, face or throat, difficulty breathing or swallowing, severe rash or itching, fainting or feeling dizzy and a rapid heartbeat. If you experience any of these symptoms, seek medical help immediately.

• Thyroid T cell tumours - It is unknown if Mounjaro causes thyroid cancer including medullary thyroid cancer. Tests have shown Mounjaro to cause thyroid c cell tumours in rodents but there is no evidence to conclude this occurs in humans too. Patients with a personal or family history of medullary thyroid carcinoma (MTC) or Multiple endocrine neoplasia syndrome type 2 (MEN2) should not be prescribed Mounjaro. Symptoms of thyroid c cell tumours include: a lump in your neck that can be felt through the skin, difficulty swallowing, changes to your voice including hoarseness, swollen lymph nodes in your neck and pain in your neck and throat.

If you experience any of the symptoms above, please seek medical attention immediately.

A complete list of side effects can be found in the patient information leaflet.

Mounjaro’s Impact on Blood Sugar and Chronic Diseases

Mounjaro works by enhancing insulin secretion and increasing insulin sensitivity as well as demonstrating significant weight loss in patients. By enhancing insulin secretion, blood sugar levels decrease in the body having a positive effect in those with type 2 diabetes. Type 2 diabetes occurs when the body doesn't produce enough insulin or when the body cells do not react to the insulin produced. So when Mounjaro is used in these patients, not only does it resolve the issue of reduced insulin production but also combats the cells reduced sensitivity to the insulin. The regulation of blood sugar is now better optimised.

Chronic diseases such as high blood pressure, high cholesterol, heart attack and stroke are increasingly common and the diet and lifestyle choices the population is now making increase the risk of these diseases. By aiding a reduction in body weight and lowering blood sugar levels, Mounjaro may have a potential impact on these health problems. Many overweight or obese patients are at risk of type 2 diabetes and by reducing body weight, Mounjaro may prevent the patient from becoming diagnosed with this and other illnesses.

Comparing Mounjaro with Other Weight Loss Medications

There are many weight loss drugs currently available to aid weight reduction and choosing between them without the necessary research and information may be difficult. Currently, Mounjaro, Wegovy, Orlistat and Saxenda are viable options for weight loss.

It is difficult to directly compare Mounjaro with other medications that are used for weight loss because clinical trials have not been carried out to do this. Although when original studies have been compared, tirzepatide is shown to result in more weight loss than semaglutide. Both drugs are effective in weight loss and one may be more effective than the other, based on the health profile of the individual.

Semaglutide is a GLP-1 receptor agonist whilst tirzepatide is a GIP and GLP-1 receptor agonist. This means Mounjaro activates two incretin hormones as opposed to the one incretin hormone semaglutide mimics.

Wegovy and Mounjaro are both once-weekly injections with a very similar side effect profile and both have the same contraindications and precautions.

Saxenda is a once-daily injection and Orlistat is a three-times daily tablet. they are both licensed for weight loss but are less popular options due to the side effects associated with Orlistat and the reduced availability of Saxenda.

Mounjaro in Clinical Trials: What the Research Says

Various clinical trials have been conducted to assess the efficacy of Mounjaro.

SURMOUNT-1, a clinical trial of 2,539 adults, with a BMI of 30 or 27 with a weight-related complication, was conducted for 72 weeks. Patients were given either 5mg, 10mg, 15mg of tirzepatide or received placebo injections. By the end of the trial, the percentage of study participants who had a weight reduction of 5% or more was 85%, 89%, 91% and 35% with the placebo. In the 10mg and 15mg groups, 50% of patients lost 20% or more of their body weight, compared to 3% in the placebo group. This shows a significant difference in the groups and demonstrates how tirzepatide (Mounjaro) notably reduces body weight.

Other benefits noted in the trial were changes in waist circumference, systolic and diastolic blood pressure, lipid levels and fasting insulin levels.

HbA1c refers to your blood glucose levels. The target HbA1c in diabetic patients is 6.5% or below. In studies, the percentage of participants who reached a HbA1c of 7% ranged from 75% to 90%. It was also tested to confirm if Mounjaro plus basal insulin worked better than basal insulin alone, and 90% of participants reached a HbA1c of 7% with Mounjaro plus basal insulin.

Overall, Mounjaro has proved to be extremely effective for diabetes and weight loss. Positive outcomes have resulted from all studies alongside additional benefits such as lower blood pressure, which contributes to better cardiovascular health.

Who Should Use Mounjaro? Eligibility and Precautions

To be eligible for Mounjaro, a patient should meet the following criteria:

• Have a BMI (body mass index) of 30 or greater

• Have a BMI of 27 and other weight-related health conditions such as high blood pressure, high cholesterol, sleep apnea etc.

The final decision to prescribe Mounjaro lies with the prescribing clinician who will consider a multitude of factors to ensure safe prescribing. This may mean that the above criteria are deviated from but this does not necessarily increase any risks associated.

It is essential to consult a healthcare professional before purchasing Mounjaro through a private service. Mounjaro is not eligible for all individuals and must be noted that it is a prescription-only medicine, regardless of it being readily available online to purchase. Prescription-only medicines have an increased risk of associated side effects and contraindications and a patient should be assessed for their suitability before initiating treatment.

Certain health conditions may affect your eligibility for Mounjaro use. Contraindications include:

• Diabetes type 1 - Patients who have type 1 diabetes and take diabetes medications are not eligible for Mounjaro. Mounjaro reduces blood sugar and there is an increased risk of hypoglycaemia if taken alongside a sulfonylurea or insulin.

• Acute kidney injury - Mounjaro is associated with an increased risk of gastrointestinal side effects such as nausea, vomiting and diarrhoea. These side effects in turn potentially lead to dehydration which, if severe, may cause acute kidney injury. Patients who suffer from kidney issues should avoid using Mounjaro as it can worsen the condition.

• Hypersensitivity reactions - If you are allergic to tirzepatide or any of the ingredients in Mounjaro or have had a severe allergic reaction to Mounjaro before, do not use it.

• Diabetic retinopathy - The rapid improvement in glucose control has been closely associated with the temporary worsening of diabetic retinopathy. If there are any changes to your vision whilst using Mounjaro, seek medical attention immediately.

Females who are using oral contraceptives alongside Mounjaro should also use a barrier method of contraception (e.g. a condom) or switch to a non-oral contraceptive for 4 weeks after starting Mounjaro as well as for 4 weeks after every strength increase. Mounjaro can affect the effectiveness of oral contraceptives, so females should take necessary action when using Mounjaro for weight management.To be eligible for Mounjaro, a patient should meet the following criteria:

• Have a BMI (body mass index) of 30 or greater

• Have a BMI of 27 and other weight-related health conditions such as high blood pressure, high cholesterol, sleep apnea etc.

The final decision to prescribe Mounjaro lies with the prescribing clinician who will consider a multitude of factors to ensure safe prescribing. This may mean that the above criteria are deviated from but this does not necessarily increase any risks associated.

It is essential to consult a healthcare professional before purchasing Mounjaro through a private service. Mounjaro is not eligible for all individuals and must be noted that it is a prescription-only medicine, regardless of it being readily available online to purchase. Prescription-only medicines have an increased risk of associated side effects and contraindications and a patient should be assessed for their suitability before initiating treatment.

Certain health conditions may affect your eligibility for Mounjaro use. Contraindications include:

• Diabetes type 1 - Patients who have type 1 diabetes and take diabetes medications are not eligible for Mounjaro. Mounjaro reduces blood sugar and there is an increased risk of hypoglycaemia if taken alongside a sulfonylurea or insulin.

• Acute kidney injury - Mounjaro is associated with an increased risk of gastrointestinal side effects such as nausea, vomiting and diarrhoea. These side effects in turn potentially lead to dehydration which, if severe, may cause acute kidney injury. Patients who suffer from kidney issues should avoid using Mounjaro as it can worsen the condition.

• Hypersensitivity reactions - If you are allergic to tirzepatide or any of the ingredients in Mounjaro or have had a severe allergic reaction to Mounjaro before, do not use it.

• Diabetic retinopathy - The rapid improvement in glucose control has been closely associated with the temporary worsening of diabetic retinopathy. If there are any changes to your vision whilst using Mounjaro, seek medical attention immediately.

Females who are using oral contraceptives alongside Mounjaro should also use a barrier method of contraception (e.g. a condom) or switch to a non-oral contraceptive for 4 weeks after starting Mounjaro as well as for 4 weeks after every strength increase. Mounjaro can affect the effectiveness of oral contraceptives, so females should take necessary action when using Mounjaro for weight management.

Lifestyle Considerations: Diet and Exercise While Using Mounjaro

It is important to make lifestyle changes when using Mounjaro and to maintain them if treatment is discontinued. Mounjaro is intended to be used as an adjunct to diet and exercise and not as a medication that will help you lose weight regardless of your food choices and exercise regime.

Exercise

Incorporating exercise into your lifestyle can greatly enhance the effects of Mounjaro. Losing weight rapidly can lead to a loss of muscle mass. If you are not building up your muscles by doing strength training exercises, you may feel weaker and more tired. Additionally, having a higher muscle mass leads to a higher resting metabolic rate which facilitates weight loss as well as maintenance. Becoming more active will also reduce the risk of cardiovascular health issues such as heart attack and stroke.

Diet

Taking Mounjaro will require you to make positive changes to your diet. Weight loss drugs are not a singular component of an individual's weight loss journey and must be worked alongside. Mounjaro does work to reduce appetite and decrease cravings, so naturally, whilst using Mounjaro, you will notice that you are eating a lot less than you used to and not indulging in the foods you once did. It is important to make better choices with food to maximise your weight loss with Mounjaro. Eating less sugar and processed foods will also contribute to a reduced risk of serious health problems such as heart disease and stroke.

Here are some tips for sustainable weight loss:

• Eat a balanced diet - make sure you are incorporating all food groups into your diet daily.

• Set yourself a weight loss target - this should be a realistic target and should be achievable. Setting unrealistic expectations for yourself may lead to a loss of motivation.

• Make changes that work for your lifestyle

• Drink plenty of water

• Avoid added sugar products when grocery shopping

• Share your weight loss plan with someone you trust - this can help motivate you, especially the you have had a bad day

• Be active for at least 150 minutes per week - you can break this up into five 30-minute sessions over a week

Conclusion

Mounjaro (tirzepatide) is a GIP and GLP-1 receptor agonist. It was initially licensed for type 2 diabetes as it works by enhancing insulin secretion, improving insulin sensitivity and reducing food intake.

Mounjaro has recently launched in the UK as a weight loss drug, designed to help patients with weight management. The starting dose is 2.5mg which then increases to 5mg after 4 weeks. Mounjaro can be increased on a 4-weekly basis until the maximum dose of 15mg has been reached.

Mounjaro is available to order at Quick Meds. To obtain a Mounjaro pen, an online consultation must first be completed. This does not guarantee the supply of the medication. The clinical prescriber will go on to assess your consultation form and determine whether this medication is suitable for your use taking into consideration your direct consultation with them (usually via telephone) and a multitude of other factors. If suitable, the medication will promptly be despatched in discreet packaging.

Mounjaro is a prescription-only medicine and you should seek advice from your GP or local healthcare professional before purchasing. Ensure you are purchasing your medicine from a registered pharmacy or being prescribed Mounjaro through your GP. Counterfeit medicines are widely available and can seriously harm your health. If an offer seems too good to be true, it probably is.

Here at QuickMeds, we take pride in our health and care excellence, and one of our clinicians will be happy to provide you with any information that you require.