Mounjaro - what’s that?

Is exactly what I was asked by a customer this morning. Many people have heard bits and pieces about this medicine, from social media, through word of mouth, celebrities and news stories, but have you got the whole picture? Let’s break it down.

What is it?

Mounjaro (or Tirzepatide, which is the name of the drug itself) is a medicine designed for the treatment of adults with type 2 diabetes (uncontrolled), and for weight management (including weight loss and weight maintenance) in adults classed as obese. It is a medicine which has sky-rocketed in popularity in the last 12 months, for its very effective weight loss effects.

How does it work?

Mounjaro activates the actions of two hormones in the body - GIP (glucose-dependent insulinotrophic polypeptide) and GLP-1 (glucogon-like peptide-1). GIP and GLP-1 are different and have different effects, and when combined can help to manage type-2 diabetes and weight loss by:

• Promoting satiety (feeling full) and reducing food intake

• Slowing gastric emptying (slowing the rate food leaves the stomach)

• Reducing cravings for fats, sugars, carbs and starches (you don’t want to eat as much fast-food)

• Improving glycaemic control (maintaining blood glucose levels)

• Regulating fat utilisation (meaning your body knows when to break down fat for energy)

How is it used?

Mounjaro is injected subcutaneously (under the skin) once weekly. In the UK, it is available in a Kwikpen of 4 doses (a month’s worth). The Kwikpen is a device which delivers measured doses, meaning you don’t have to draw up the medicine with a syringe and inject it. This makes it easier and safer to use for patients.

The starting dose for Mounjaro is 2.5mg per week. This can be increased by the prescriber as necessary. Typically Mounjaro is prescribed for between 6 and 18 months, though it can vary from person to person and their individual needs.

Is it that easy?

Well, no. Mounjaro is a very effective medicine, when it is combined with lifestyle changes. This means changing diet to increase fruits, vegetables and grains, and reducing fats and sugars, while increasing exercise. This can be very daunting for prospective patients, as it’s a lot of big changes to make. A little progress day-by-day in these areas is all that’s needed to get Mounjaro to work as effectively as possible.

Are there side-effects?

Side-effects are possible with all medicines, including Mounjaro. Some of the most common are:

• Low blood sugar

• Nausea

• Diarrhoea

• Vomiting

• Constipation

These side-effects are usually not serious and can be managed effectively with over-the-counter medicines. They usually resolve quickly, and we typically see most patients experience them after a dose-increase.

Can’t people just exercise more to lose weight?

Increased exercise on its own may help people to lose some weight, yes. However, there are a lot of other factors to consider.

• Mounjaro is prescribed for people who have a BMI over 30 (or over 27 with certain conditions). Being overweight can make exercise very difficult, and place more stress on the joints which can be painful.

• The body takes time to adjust its metabolism, and for someone who is very overweight, or who has been overweight for a long time, this can be very difficult.

• Most of the patients we see for weight management treatment have tried diet and exercise over a number of years with limited success.

• Being overweight increases the risk of other illnesses (known as co-morbid diseases), such as coronary heart disease, strokes, transient ischemic attacks (TIAs), peripheral artery disease, aortic disease, and diabetes.

Someone may choose medicinal weight-loss treatment based on the above factors, over just exercising alone.

Could Mounjaro be micro-dosed?

Mounjaro is licensed only for weight management and type-2 diabetes, to be used at the stated, measured dose, once a week. This means the manufacturers have made it only for this purpose, and that is what is ‘indicated’ on the product licensing in the UK. This is because the manufacturers have carried out clinical trials for these purposes, so it is known what is safe and effective for the patient.

Prescribers working outside these guidelines, for example, prescribing to people whose BMI is in the ‘normal’ or ‘underweight’ categories, not prescribing for weight-loss or type-2 diabetes, prescribing for ‘longevity’ or ‘body support’ are doing so off-license.

At Pharmacy Clinic Edinburgh, we do not endorse the off-label prescribing of Mounjaro and recommend it is used safely within the clinical guidelines.

Who can’t use Mounjaro?

Mounjaro cannot be used in:

• Children and adolescents (those under 18)

• People using certain other medicines

• Pregnant people

• Breast-feeding people

• People with certain medical conditions or medical history

How do we prescribe safely?

Unlike many other providers who hide behind questionnaires, with no identity verification, our clinical team always meet the patient and verify their height and weight, age and medical history. This allows us to verify that our patients are suitable for treatment, make a plan together for lifestyle changes, and work together to get the best outcomes.

We prescribe within the guidelines and work to meet high standards of patient care and satisfaction.

Want to find out more?

Check out our Weight Management Service page for more information about the service we provide.