Mounjaro is an injection which is approved for the treatment of type 2 diabetes. It is now also approved for chronic weight management. The trade name of tirzepatide is Mounjaro. Mounjaro is an effective drug which works through a combination of glucagon like peptide-1 receptor agonist (GLP-1 RA) and GIP (Glucose dependent insulinotropic polypeptide). It’s dual action makes it an effective weight loss medication.

Who can use Mounjaro ?

The National Institute of Health and Care Excellence (NICE) has approved the use of Mounjaro for the treatment of type 2 diabetes along with a good quality diet and physical activity.

The eligibility criteria for the use of Mounjaro:

• • The target demographic of the drug are adults with uncontrolled type 2 diabetes mellitus post use of 3 or more hypoglycaemic agents (due to intolerance or contraindication).

• • Individuals with BMI > 30 kg/m2 or a BMI of 27 Kg/m2 with a weight related issue (diabetes, hypertension, hyperlipidaemia, obstructive sleep apnoea (OSA), heart attack, stroke, and blood vessel disorders).

• • Individuals with < 35 kg/m2.

• • Possible complications to insulin therapy.

• • Possible improvement in weight related issue post weight loss.
    
    

Note – A lower BMI (reduced by 2.5 kg/m2) threshold is used for individuals of South Asian, Chinese, other Asian, Middle Eastern, Black African or African Caribbean family backgrounds.

According to clinical trials of tirzepatide, there was a

• • Reduction in weight (higher the dose prescribed resulted in larger weight loss).

• • Reduced blood glucose levels (HbA1c reached below 7% or 53 mmol/mol).
    
    

Contraindications and risks of Mounjaro (tirzepatide)

• • Mounjaro may not be effective in individuals with type 1 diabetes.

• • Children below 18 years of age.

• • Pregnant and lactating mothers.

• • Individuals with a history of pancreatitis.

• • Hypersensitivity reaction to any of the ingredients of Mounjaro or tirzepatide.

• • Individuals with a genetic history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2 (MEN 2).
    
    

How does Mounjaro (tirzepatide) work ?

• • Glucagon and insulin are hormones secreted by the pancreas.

• • Glucagon is a hyperglycaemic hormone while insulin is a hypoglycaemic agent

• • On consumption of food, the brain stimulates the release of GLP-1 and GIP, which signals the pancreas to release insulin which stabilises the blood sugar levels.
    
    

Mounjaro thereby helps –

• • Improve insulin secretion

• • Improve insulin sensitivity

• • Decrease appetite and improve satiety.

• • Delay gastric emptying

• • Promotes weight loss
    
    

Side effects of Mounjaro (tirzepatide)

The common side effects of Mounjaro can be gastrointestinal (GI) manifestations such as –

• • Nausea

• • Vomiting

• • Diarrhoea

• • Suppressed appetite

• • Chest burn

• • Stomach pain

• • Bloating or flatulence

• • Frequent burps

• • Constipation

• • Tiredness

• • Low blood sugar level

• • Vivid dreams

• • Hair loss

The doctor may progressively titrate the dose depending on the effectiveness and GI side effects. Dietary management can help ease the side effects. 

Uncommon or rare or possible side effects are –

• • Thyroid C-Cell tumours, seen in other GLP-1 medications in rat models.

• • Pancreatitis

• • Hypoglycaemia

• • Hypersensitivity

• • Acute kidney injury

• • Gastrointestinal issues

• • Diabetic retinopathy

• • Gallbladder diseases
    
    

Can Mounjaro be a long term medication ?

There are multiple doses of Mounjaro available in the market. Mounjaro is an FDA approved drug for long term use. The doctor may prescribe a starting dose of 2.5mg weekly for 1 month/ 4 weeks. The maintenance dose may be 5mg weekly for 4 weeks. If additional glycaemic control or weight loss is required, the dose may be increased progressively to –

• • 7.5mg once weekly for 4 weeks.

• • 10mg once weekly at least 4 weeks.

• • 12.5mg once weekly for at least 4 weeks.

• • 15mg once weekly for at least 4 weeks.
    
    

The multiple benefits provided by Mounjaro may be a motive for it’s long term use –

1. 1. Satiety – The drug functions in such a way that the appetite centres of the brain suppress hunger and appetite. This may help in weight loss and weight management in the long term due to the reduced calorie intake for maintenance.   
      
      
   2. Blood sugar control – Mounjaro helps in the maintenance of blood sugar over a prolonged duration. A control of blood glucose can help improve eye health, helps prevent common health issues, improves heart health, lowers cholesterol levels etc.
      
      
   3. Promotes a healthy lifestyle – The prescription drug Mounjaro, is to be complemented with a healthy diet and lifestyle to maintain weight loss in the long term. This can help in sustaining the weight lost even after stopping the medication.
      
      

Tips to have a sustainable diet and lifestyle

• • Eat small quantity meals.

• • Check blood glucose levels at regular intervals.

• • Avoid food rich in trans fat and deep fried food.

• • Drink plenty of water or fluids like juices, tender coconut water etc.

• • Restrict alcohol and caffeine intake.

• • Have an early dinner.

• • Stay physically active.

• • Consume plenty of fruits and vegetables rich in fibre.

• • Focus on good quality protein like eggs, meat, poultry etc.

• • Improve sleep quality.

• • Avoid sugary drinks, aerated beverages, sweets, bakery products and confectionary items.
    
    

Note

• • Mounjaro should not be mixed with insulin and administered in the same injection.

• • The area of injecting Mounjaro and insulin can be the same area of the body but must be next to each other.

• • The minimum duration of gap between 2 doses of Mounjaro must be 72 hours. The day of injecting can vary each week.

• • A missed dose of Mounjaro can be taken on the regular scheduled day if 4 days have passed.

• • Always consult a physician before starting Mounjaro (tirzepatide) or for its related concerns.
    
    

Conclusion

Type 2 diabetes and obesity are chronic diseases. Mounjaro is approved for the management of type 2 diabetes and obesity. Mounjaro is intended to be used long term in the management of these chronic conditions. However more data is required of its effectiveness in the long term.