Tirzepatide is the ingredient in the brand name medications Mounjaro and Zepbound. It was originally  approved for use in adults with type 2 diabetes as Mounjaro, and more recently approved as Zepbound for weight loss. It is a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist. This means that it works by imitating not one, but two unique hormones produced by the human body. GIP has been shown to decrease food intake & increase energy expenditure  resulting in weight reduction. It also results in beneficial improvements on markers of metabolic dysregulation such as body weight, glucose, & lipids.

Tirzepatide (Mounjaro) activates the receptors for GIP and GLP-1 found in the brain,in the areas that control appetite regulation. As a result, it reduces food intake as shown in multiple studies. It also impacts fat utilization enhancing fat loss as a part of a weight loss program. Along with its effectiveness for weight loss, tirzepatide is increasingly being seen as providing therapeutic benefits for sleep apnea, fatty liver, heart disease, chronic kidney disease, and reducing the risk of other diseases. It can also help a host of other medical conditions.

In a major published study tirzepatide was taken for 72 weeks, and the weight loss reported can be seen as astounding. The study participants weighed an average of 241lbs at the start, and lost on average 64.4 pounds by the end of the study period. To accomplish this result, the use of tirzepatide was accompanied by intensive lifestyle intervention that included a low calorie diet, exercise and counseling sessions. Side effects can occur with Tirzepatide as with all medications, but they are generally mild to moderate in severity. They include nausea, diarrhea or constipation. Vomiting may occur but is much less frequent. These problems are generally able to be minimized with adjunctive care by the physician. These are the only common side effects, while others occur rarely. As with many medications, side effects are related to the dosage that is used. As a result patents are advised to start with a relatively low dose of 2.5 mg. Common practice is to increase the dose every 4 weeks as tolerated. The higher dose is expected to be more effective for appetite control. Most often patients increase up to 10mg as long they are not limited by side effects. The maximum dose is 15mg .

A NEW WEIGHT LOSS MEDICATION

The FDA recently approved Zepbound (Tirzepatide) for weight management. Zepbound contains the same medication as the previously released Mounjaro. It is given as a weekly injectable medication for chronic weight management in adults with obesity, (body mass index of 30 or greater), or overweight with at least one weight related condition (high blood pressure, diabetes or high cholesterol), for use in addition to a reduced calorie diet and increased physical activity.

 John Sharrets,MD is the director of the Division of Diabetes, Lipid Disorders and Obesity in the FDA’s Center for Drug Evaluation and Research. In regard to the need for the approval of Zepbound  for weight management he explains, ” Obesity and overweight are serious conditions that can be associated with some of the leading causes of death such as heart disease, stroke and diabetes. In light of increasing rates of both obesity and overweight in the United States, today’s approval addresses an unmet medical need”.

  The prevalence of obesity and overweight in the United States is approximately 70% of the population. There are many health problems associated with being overweight that can be greatly reduced if a patient loses weight in a healthy manner. There has been great success, and therefore great demand for the medication Mounjaro, which although FDA approved only for diabetes, has been used “off-label” by many doctors and their patients across the country to lose weight. Now with an actual approval of Tirzepatide for weight loss as the medication Zepbound, there will likely be continued increased demand.

The New Weight Loss Drugs are Found to Benefit Other Medical Conditions

 PCOS

Polycystic Ovarian Syndrome (PCOS) is a  condition of hormonal imbalance that is characterized by menstrual cycle irregularity, weight gain, fertility problems, excessive hair growth, and acne. There are also metabolic factors involved in PCOS such as insulin resistance, with its associated risk of pre-diabetes and diabetes. And these conditions  impart a  greater risk of cardiovascular disease. Because insulin resistance is involved in this disorder, it makes sense that Ozempic (Semaglutide)  and Mounjaro  (Tirzepatide) which were developed as diabetes medications might help PCOS.

In patients with PCOS weight loss will improve menstrual

irregularities, restore ovulation, and improve fertility. Another hormonal abnormality that exists in PCOS is the presence of excessive levels of androgens, specifically Testosterone levels. According to Marilyn Tan MD, an associate professor of Medicine at Stanford U. School of Medicine, losing weight may reduce androgen levels and thus improve symptoms like excess hair growth and acne.

Since Ozempic and Monjauro are not currently approved as a treatment for  PCOS it’s current use in patients with PCOS is considered an off-label use of the medication. But many leading gynecologists around the US are indeed prescribing it for PCOS patients.

Florencia Haperin, MD -Endocrinologist, states “because these medications (Semaglutide and Tirzepatide) cause significant weight loss and improve insulin resistance, it makes sense biologically, that they would be helpful for women with PCOS.”

It is important to note for women of child bearing age, that those who are pregnant should not be taking these medications because it is unknown if it would be harmful for fetal development. If a woman is taking either of these medications there should be a period of two to three months of discontinuing the medication before actively trying for a pregnancy.

Improving Insulin Resistance and Lowering Disease Risks

 In obesity, when the pancreas produces more insulin in an attempt to get blood glucose to enter the cells the cells stop responding as they normally would. They become resistant to the action of insulin. As a result the circulating glucose level becomes higher than normal, resulting in pre-diabetes and then, frank diabetes. Being significantly overweight is the leading cause of insulin resistance, the precursor to the development of diabetes.

  Diabetes itself is a worrisome condition to develop because there are many other serious health problems associated with diabetes.

 Diabetics have an increased risk of developing these conditions:

1. Cardiovascular Disease -heart attack and stroke.

    2   Kidney problems- the leading cause of needing dialysis treatment for kidney failure is having diabetes.

3  Nerve damage – diabetic neuropathy is a painful condition most commonly affecting the legs and feet- there is no cure for it, and medications are often not very effective for it.

4  Gum disease- too much sugar in the blood causes too much sugar in saliva which promotes gum and dental disease.

5. Cancer- there are many associations between the existence of obesity and the development of different cancers.

6  Sexual dysfunction in both men and women.

Just as there are many health problems linked to diabetes, there is hope and now evidence that there are benefits beyond weight loss to taking these new medications.

THE  MANY BENEFITS TO TAKING  THE NEW WEIGHT LOSS DRUGS

SEMAGLUTIDE (Ozempic and Wegovy) and Tirzepatide (Mounjaro and Zepbound)  

Because excess body fat is implicated in the risk and development of many other medical conditions, the evidence is now emerging that along with accomplishing your weight loss goal, these medications may benefit your heart, lower cancer risk, lower dementia risk and help you with addictive substances like alcohol.

Some studies below investigated semaglutide- the other GLP-1 agonist diabetes /weight loss drug. However, they are mentioned here because of the similar actions it has to Tirzepatide and the notion that their effects on health may be very similar. More studies are being done to further document what seems to be the very broad beneficial effects of these medications.

Reduces Heart Attack, Stroke and Cardiac Deaths

A study published in the prestigious New England Journal of Medicine has found that the weight loss drug Wegovy (semaglutide) reduced the risk of cardiac death by 20%.  Although these results of this study are very significant, they aren’t a great surprise. Research over the years has shown that obesity increases one’s risk of heart disease.

WEIGHT LOSS MEDICATIONS REDUCE COLON CANCER RISK

Recently completed research published in the scientific journal JAMA Oncology showed that diabetics who took GLP-1 agonist medications had a 44% lower risk of Colorectal cancer compared to those who took other Type 2 Diabetes medication.

REDUCED RISK OF OTHER CANCERS

Approximately two thirds of U.S. adults are overweight or have obesity. Approximately 4-8% of all cancers are obesity related.  Obesity is a risk factor for a wide variety of cancers including breast, uterine, kidney, gallbladder, liver and pancreatic cancers as well as colorectal cancer.

HELP WITH ALCOHOL ADDICTION

Success for weight loss is due to actions which reduce the desire for food.  But another striking effect that has emerged is that these medications also decrease the desire for things other than food- alcohol, nicotine and opioids! There is clearly a logic to this-if the medication reduces the desire for related to its effect on the brain’s pleasure center, then it would seem that it might reduce the desire for other substances people crave. This was first noticed when doctor’s prescribing these weight loss drugs were made aware by their patients that along with less desire for food, they found it easy to pass up their consumption of alcohol, which they were advised to do as a part of their weight loss plan.

 WEIGHT LOSS DRUGS  MAY LOWER DEMENTIA /ALZHEIMER’S RISK

The Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases in San Antonio,  is studying this.

Diabetes, obesity drug studied for effect on Alzheimer’s

According to the Alzheimer’s Association, diabetes raises the risk for heart and blood vessel disease. Damaged brain blood vessels contribute to the development of Alzheimer’s.

The San Antonio center is participating in two worldwide studies, regarding the use of weight loss drugs to delay early-onset dementia.

Tirzepatide appears to be a truly amazing medication which can not only help people lose weight, but greatly impact their risk of disease and dying from a number of causes.