Important Safety Information for Zepbound (tirzepatide) injection

Warning: Risk of Thyroid C-Cell Tumors

• In rats, Zepbound caused thyroid tumors, including thyroid cancer. It is not known if Zepbound will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people. Tell your provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer.
• Do not use Zepbound if you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

What is the FDA-approved use of Zepbound?

Zepbound is used along with a reduced-calorie diet and increased physical activity for chronic weight management in adults with an initial body mass index (BMI) of:

• 30 kg/m^2 or greater (obesity) or
• 27 kg/m^2 or greater (overweight) in the presence of at least one weight-related comorbid condition (e.g., hypertension, dyslipidemia, type 2 diabetes mellitus, obstructive sleep apnea, or cardiovascular disease).

Limitations of Use:

• Zepbound should not be used in combination with other tirzepatide-containing products or any other GLP-1 receptor agonist.
• The safety and efficacy of coadministration with other products for weight management have not been established.
• Zepbound has not been studied in patients with a history of pancreatitis.

Who should not use Zepbound?

Do not use Zepbound if:

• You or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
• You have a known allergic reaction to Zepbound.

How should I take Zepbound?

You can take Zepbound with or without food. The pre-filled injector pen is self-administered as a subcutaneous injection in the stomach, thigh, or upper arm once a week on the same day every week. Your provider will guide you on a treatment regimen that may include an increase in dose every four weeks.

You should not change your dosing regimen or stop taking Zepbound as prescribed without discussing with your provider first.

What should I tell my provider before using Zepbound?

• Zepbound has certain drug interactions. It’s important to tell your provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements.

Some medications to watch out for include:

• Medications for diabetes: Medications used to treat type 1 or type 2 diabetes, including insulin or sulfonylureas (such as Amaryl or Glucotrol XL)
• Other oral medications: Zepbound causes a delay in gastric emptying, so it has the potential to impact the absorption of medications that are taken by mouth at the same time. Your provider can guide you on how to schedule your medications.
  • Hormonal birth control: If you are using an oral hormonal contraceptive (birth control), Zepbound may decrease its efficacy, especially after the first dose. Switch to a non-oral contraceptive method or use a barrier method of contraception for 4 weeks after starting Zepbound and for 4 weeks after each dose escalation, until you reach a maintenance dose.
• Other GLP-1 medications: Including Mounjaro, Wegovy, Ozempic, Saxenda, Victoza, Byetta, or Bydureon. These medications should not be taken with Zepbound.
• Other products for weight loss: Including dietary supplements
• It’s important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:
  • Type 1 or type 2 diabetes
  • Thyroid cancer
  • Gastrointestinal disease
  • Pancreatitis
  • Kidney disease
  • Diabetic retinopathy
  • Depression
  • Suicidal thoughts or behavior
• Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding.
  • If you are pregnant: Zepbound should not be used during pregnancy. Based on animal studies, there may be potential risks to an unborn baby from exposure to Zepbound during pregnancy. There is no benefit to weight loss during pregnancy and it may cause harm to the unborn baby.
  • If you are a female reproductive potential: Zepbound may reduce the efficacy of oral hormonal contraceptives. Switch to a non-oral contraceptive method, or add a barrier method of contraception for 4 weeks after starting medication and for 4 weeks after each dose escalation until you reach a maintenance dose.
  • If you are breastfeeding: It is not known if Zepbound passes into breast milk. Talk to your provider first about the benefits and risks of using Zepbound while breastfeeding.
• Pregnancy registry: There will be a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to Zepbound during pregnancy. Pregnant patients exposed to Zepbound and healthcare providers are encouraged to contact Eli Lilly and Company at 1-800-LillyRx (1-800-545-5979).

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

What are the most serious side effects that I or a caregiver should monitor for when taking Zepbound?

If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

These serious side effects are rare, but can occur with Zepbound. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

• Thyroid C-Cell Tumors: In rats, Zepbound caused a dose-dependent and treatment-duration-dependent increase in thyroid C-cell tumors. It is unknown whether Zepbound causes thyroid C-cell tumors in humans. Zepbound is contraindicated in patients with a family history of medullary thyroid cancer (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Tell your provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer.
• Severe Gastrointestinal Disease: Zepbound is associated with gastrointestinal side effects, such as nausea, diarrhea, vomiting, constipation, and stomach pain, and can sometimes be severe. It hasn’t been studied in patients with severe gastrointestinal disease and isn’t recommended in these patients. The majority of nausea, vomiting, and/or diarrhea events occurred during a dose increase and decreased over time.
• Acute Kidney Injury: Gastrointestinal side effects of Zepbound like diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration), which may cause kidney problems if dehydration is severe. It is important for you to drink plenty of water to help reduce your chance of dehydration.
• Acute Gallbladder Disease: Zepbound, other GLP-1 receptor agonists, and weight loss are associated with an increased chance of acute gallbladder disease. Tell your provider right away if you have pain in your upper stomach, yellowing of skin or eyes (jaundice), fever, or clay-colored stools.
• Inflammation of Pancreas (Acute Pancreatitis): Monitor for signs of acute pancreatitis, including severe abdominal pain that does not go away, sometimes radiating to the back, with or without vomiting.
• Allergic Reactions: Stop using Zepbound right away if you experience symptoms of a serious allergic reaction, including swelling of your face, lips, tongue or throat, severe rash or itching, very rapid heartbeat, problems breathing or swallowing, or fainting or feeling dizzy.
• Low Blood Sugar (Hypoglycemia): Zepbound lowers blood glucose. It can cause too low blood sugar in patients with type 2 diabetes who also take another glucose control medication. Monitor your blood sugar and watch out for signs of too low blood sugar such as dizziness, blurred vision, mood changes, sweating, or fast heartbeat.
• Diabetic Retinopathy Complications in Patients with a History of Diabetic Retinopathy: Rapid improvement of glucose control has been associated with temporary worsening of diabetic retinopathy. Tell your provider right away if you experience changes in vision.
• Suicidal Behavior and Ideation: You should pay attention to any mental health changes, especially sudden changes in your mood, behaviors, thoughts, or feelings. Call your healthcare provider right away if you have any mental changes that are new, worse, or worry you.
• Never Share a Pen: Pen-sharing poses a risk of infection.

What are the most common side effects of Zepbound?

• Nausea
• Diarrhea
• Vomiting
• Constipation
• Stomach pain
• Indigestion
• Injection site reactions
• Feeling tired
• Allergic reactions
• Belching
• Hair loss
• Gastroesophageal reflux disease (heartburn)

You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

This information is not comprehensive. Please see the full Prescribing Information for complete safety information.

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Important Safety Information for Mounjaro® (tirzepatide) Injection

Warning: Risk of Thyroid C-Cell Tumors
Mounjaro® (tirzepatide) injection may cause thyroid tumors, including thyroid cancer. Watch for symptoms such as a lump or swelling in the neck, hoarseness, difficulty swallowing, or shortness of breath. If you experience any of these symptoms, inform your healthcare provider immediately.

• Do not use Mounjaro® (tirzepatide) injection if you or any family members have a history of medullary thyroid carcinoma (MTC).
• Do not use if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

What is the FDA-approved use of Mounjaro® (tirzepatide) injection?

Mounjaro® (tirzepatide) is an injectable medication approved for adults with type 2 diabetes. It is used alongside diet and exercise to improve blood sugar (glucose) control.

Limitations of Use:

• It is not known if Mounjaro® can be used in people with a history of pancreatitis.
• It is not approved for type 1 diabetes or for use in children under 18 years of age.

Who should not use Mounjaro® (tirzepatide) injection?

Do not use Mounjaro® if:

• You or a family member has a history of medullary thyroid carcinoma (MTC) or MEN 2.
• You are allergic to Mounjaro® or its ingredients.

How should I take Mounjaro® (tirzepatide) injection?

• Take Mounjaro® once weekly, on the same day each week, with or without food.
• Use the pre-filled injector pen as a subcutaneous injection in your stomach, thigh, or upper arm. Rotate injection sites weekly.
• Follow the dosing regimen provided by your WeightMeds provider, which may include dose increases every four weeks.

Do not change or stop your prescribed regimen without consulting your WeightMeds provider. If you take too much Mounjaro®, contact your healthcare provider immediately.

What should I discuss with my WeightMeds provider before starting Mounjaro®?

• Share your full medical history, including any thyroid, gastrointestinal, pancreatic, kidney, or vision issues.
• Discuss all medications, including over-the-counter drugs, supplements, and vitamins, as Mounjaro® may interact with some medications.
• Inform your provider if you are pregnant, planning to become pregnant, or breastfeeding.
• If using oral birth control, switch to a non-oral method or use a barrier method for 4 weeks after starting or increasing your dose of Mounjaro®.

Most Serious Side Effects to Monitor For:

• Thyroid C-Cell Tumors
• Severe Gastrointestinal Issues: Nausea, vomiting, or diarrhea that may worsen pre-existing conditions.
• Pancreatitis: Severe abdominal pain that may radiate to the back.
• Low Blood Sugar (Hypoglycemia): Symptoms include dizziness, sweating, confusion, or rapid heartbeat.
• Allergic Reactions: Swelling, rash, or difficulty breathing.
• Kidney Problems: Dehydration may worsen kidney function.
• Gallbladder Issues: Look for abdominal pain, fever, jaundice, or unusual stools.
• Vision Changes: Particularly if you have diabetic retinopathy.
• Mental Health Changes: Report any suicidal thoughts or mood changes immediately.

Common Side Effects:

• Nausea, vomiting, or diarrhea
• Constipation or indigestion
• Injection site reactions
• Tiredness
• Belching or heartburn

For a full list of side effects and complete safety information, consult the prescribing information.

Disclaimer:
WeightMeds has no affiliation with Novo Nordisk, Eli Lilly, or Amylin Pharmaceuticals. Medications offered by WeightMeds are not manufactured by these companies. Trademarks such as Ozempic®, Wegovy®, and Mounjaro® are owned by their respective manufacturers.

For more information, contact WeightMeds or your healthcare provider.

Important Safety Information for Ozempic (semaglutide) injection

Warning: Risk of Thyroid C-Cell Tumors

• In studies with mice and rats, semaglutide (the active ingredient in Ozempic and Wegovy) caused thyroid tumors, including thyroid cancer. It is not known if Ozempic will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people. Tell your provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer.
• Do not use Ozempic if you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

What is the FDA-approved use of Ozempic?

Ozempic is a glucagon-like peptide-1 (GLP-1) receptor agonist that is used:

• with diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus.
• to reduce the risk of major adverse cardiovascular events in patients with type 2 diabetes mellitus and established cardiovascular disease.

Limitations of Use:

• Ozempic has not been studied in patients with a history of pancreatitis.
• Ozempic is not for treatment of type 1 diabetes mellitus.

Your provider may recommend the use of Ozempic as treatment for chronic weight management (obesity or overweight).

Who should not use Ozempic?

Do not use Ozempic if:

• You or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
• You have a known allergic reaction to semaglutide (the active ingredient in Wegovy or Ozempic).

How should Ozempic be administered?

You can take Ozempic with or without food. The pre-filled injector pen is self-administered as a subcutaneous injection in the stomach, thigh, or upper arm once a week on the same day every week. Your provider will guide you on a treatment regimen that may include an increase in dose every four weeks.

You should not change your dosing regimen or stop taking Ozempic as prescribed without discussing with your provider first.  

What should I tell my provider before using Ozempic?

• Ozempic has certain drug interactions. It’s important to tell your provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements.

Some medications to watch out for include:

• Medications used to treat type 1 or type 2 diabetes, including insulin or sulfonylureas (such as Amaryl or Glucotrol XL)
• Ozempic causes a delay in gastric emptying so it has the potential to impact the absorption of medications that are taken by mouth at the same time. Your provider can guide you on how to schedule your medications.
• Other GLP-1 medications, including Wegovy, Saxenda, Victoza, Byetta, or Bydureon
• If you’re using other products for weight loss, including dietary supplements

It’s important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:

• Type 1 or type 2 diabetes
• Thyroid cancer
• Pancreatitis
• Kidney disease
• Diabetic retinopathy
• Depression
• Suicidal thoughts or behavior

Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding.

• If you are pregnant: Ozempic should not be used during pregnancy. Based on animal studies, there may be potential risks to an unborn baby from exposure to Ozempic during pregnancy. There is no benefit to weight loss during pregnancy and it may cause harm to the unborn baby.
• If you are a female or male of reproductive potential: Discontinue Ozempic at least 2 months before a planned pregnancy since the drug can stay in the bloodstream for a long time.
• If you are breastfeeding: Ozempic was found in the milk of lactating rats. Tell your provider if you are breastfeeding before you start Ozempic.

Pregnancy registry: There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to semaglutide (the active ingredient in Ozempic and Ozempic) during pregnancy. Pregnant women exposed to semaglutide and healthcare providers are encouraged to contact Novo Nordisk at 1-800-727-6500.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

What are the most serious side effects that I or a caregiver should monitor for when taking Ozempic?

If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

These serious side effects can occur with Ozempic. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

• Thyroid C-Cell Tumors: In mice and rats, semaglutide (the active ingredient in Ozempic and Ozempic) caused an increase in thyroid C-cell tumors, including medullary thyroid carcinoma (MTC). It is unknown whether Ozempic causes thyroid C-cell tumors in humans. There were cases of MTC reported in patients who took liraglutide (the active ingredient in Victoza and Saxenda) after the drug was put on the market. Ozempic is contraindicated in patients with a family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Tell your provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer.
• Inflammation of Pancreas (Acute Pancreatitis): Monitor for signs of acute pancreatitis, including severe abdominal pain that does not go away, sometimes radiating to the back, with or without vomiting.
• Diabetic Retinopathy Complications in Patients with Type 2 Diabetes: If you have type 2 diabetes, tell your provider right away if you experience changes in vision.
• Never Share a Pen: Pen-sharing poses a risk of infection.
• Low Blood Sugar (hypoglycemia): Ozempic lowers blood glucose. It can cause too low blood sugar in patients with type 2 diabetes who also take another glucose control medication. Monitor your blood sugar and watch out for signs of too low blood sugar such as dizziness, blurred vision, mood changes, sweating, or fast heartbeat.
• Acute Kidney Injury: In people who have kidney problems, diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration) which may cause kidney problems to get worse. It is important for you to drink plenty of water to help reduce your chance of dehydration.
• Serious Allergic Reactions: Stop using Ozempic right away if you experience symptoms of a serious allergic reaction, including swelling of your face, lips, tongue or throat, severe rash or itching, very rapid heartbeat, problems breathing or swallowing, or fainting or feeling dizzy.
• Acute Gallbladder Disease: Ozempic may cause gallbladder problems, including gallstones. Some gallbladder problems require surgery. Tell your provider right away if you have pain in your upper stomach, yellowing of skin or eyes (jaundice), fever, or clay-colored stools.
• Increase in Heart Rate: Tell your provider right away if you have a racing heartbeat while at rest.

• Suicidal Behavior and Ideation: You should pay attention to any mental health changes, especially sudden changes in your mood, behaviors, thoughts, or feelings. Call your healthcare provider right away if you have any mental changes that are new, worse, or worry you.

What are the most common side effects of Ozempic?

• Nausea
• Vomiting
• Diarrhea
• Stomach pain
• Constipation

You are encouraged to report negative side effects of prescription products:

• Contact Novo Nordisk Inc. at 1-833-934-6891
• Contact FDA MedWatch at 1-800-FDA-1088 or visit www.fda.gov/medwatch

This information is not comprehensive. Please see the full Prescribing Information for complete safety information.

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Oral Semaglutide GLP-1

*Compounded medications may be prescribed by physicians but have not been FDA regulated for safety, effectiveness, or quality. FDA-approved medicines containing semaglutide are available.

WARNING

Please contact your doctor ASAP and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea and/or vomiting resulting in dehydration -  it is important to stay well hydrated and drink plenty of fluids while on this medication.
• Kidney problems/kidney failure - vomiting, nausea, diarrhea can cause dehydration and kidney issues and make kidney problems worse in individuals who have pre-existing kidney conditions; may sometimes lead to the need for hemodialysis.
• Thyroid C-Cell Tumor: Trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath (see black box warning below).
• Pancreatitis: Severe pain in your abdomen or back that will not go away.
• Acute gallbladder disease - Pain in the middle or right upper stomach, fever, white parts of your eyes turn yellow or skin turns yellow, nausea/vomiting. If gallstones or inflammation of the gallbladder is suspected further studies are needed.
• Hepatitis/Elevated liver enzymes/Jaundice
• Diabetic retinopathy problems: Changes in vision in those with type II diabetes, particularly vision problems may worsen in those with a history of diabetic retinopathy.
• Severe gastrointestinal disease - may cause gastrointestinal disease; do not use if you have a history of severe gastrointestinal disease
• Signs of low blood sugar (for example, dizziness, weakness, shakiness, jitteriness, headache, anxiety/mood changes, rapid heartbeat, confusion, slurred speech, sweating, or lightheadedness). While this is rare with GLP-1s, if it occurs, please seek in-person care immediately. If you have these symptoms, try having liquid or food containing sugar (around 15-20 grams) —drinking juice, having regular soda, or eating some hard candies right away, as this will help raise your blood sugar quickly. If taken with insulin or an insulin secretagogue (i.e. sulfonylurea such as Glipizide, glimepiride, and glyburide) it is best to talk to your healthcare provider about possibly lowering the dose of these medications to lower the risk of hypoglycemia.
• Increasing heart rate
• Worsening depression, behavior changes, or suicidality
• Never share the semaglutide with other people

Drug Interactions

As with other medications, oral semaglutide can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of hypoglycemia is increased when combined with insulin or insulin secretagogues such as sulfonylureas. Oral semaglutide delays gastric emptying and may impact the absorption of oral medications. If you are on thyroid hormone medication, prior to starting oral semaglutide, please review the timing of taking your thyroid hormone medication with the doctor who prescribes it as it may need to be adjusted. The drug levels of medications with narrow therapeutic windows (ie warfarin) should be monitored closely while on oral semaglutide.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information.

To report suspected adverse reactions to o semaglutide, contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

Note: The above statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

Compounded Tirzepatide

*Compounded medications may be prescribed by physicians but have not been FDA regulated for safety, effectiveness, or quality. FDA-approved medicines containing trizepatide are available.

WARNING

Compounded tirzepatide usage has been associated with the potential development of thyroid tumors, including thyroid cancer. Watch for any potential symptoms, such as neck lumps or swelling, hoarseness, difficulty swallowing, or breathlessness. Should any of these symptoms arise, it is imperative to inform your healthcare provider promptly.

Avoid using compounded tirzepatide if you or any family members have a history of medullary thyroid carcinoma (MTC), a specific type of thyroid cancer. Similarly, refrain from its use if diagnosed with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), or if you've previously experienced a severe allergic reaction to tirzepatide or any of its components.

Serious Side Effects

Compounded tirzepatide carries the risk of severe side effects, which include:

• Gastrointestinal Issues: Reports indicate the possibility of severe stomach problems associated with compounded tirzepatide usage. Notify your healthcare provider if you experience persistent or severe stomach discomfort.
• Kidney Complications: Diarrhea, nausea, and vomiting may lead to dehydration, potentially resulting in kidney problems. Adequate fluid intake is crucial to mitigate this risk.
• Gallbladder Concerns: Some individuals may encounter gallbladder problems while using compounded tirzepatide. Seek immediate medical attention if symptoms such as upper abdominal pain, fever, jaundice, or changes in stool color occur.
• Pancreatitis: Discontinue use and contact your healthcare provider if you experience persistent abdominal pain, with or without vomiting, as it could indicate inflammation of the pancreas.
• Allergic Reactions: Cease compounded tirzepatide usage and seek urgent medical assistance if you develop symptoms of a severe allergic reaction, including facial swelling, breathing difficulties, rash, or rapid heartbeat.
• Hypoglycemia: The risk of low blood sugar may increase when using compounded tirzepatide alongside medications that lower blood sugar levels. Recognizable symptoms include dizziness, sweating, confusion, and rapid heartbeat.
• Vision Changes: Notify your healthcare provider of any alterations in vision observed during tirzepatide treatment.
• Depression or Suicidal Thoughts: Pay close attention to changes in mood or mental state while using tirzepatide, and promptly report any concerns to your healthcare provider.

Common Side Effects

The most frequently reported side effects of compounded tirzepatide include:

• Nausea
• Diarrhea
• Vomiting
• Constipation
• Abdominal pain
• Indigestion
• Injection site reactions
• Fatigue
• Allergic reactions
• Belching
• Hair loss
• Heartburn

These side effects are not exhaustive. Should you experience any persistent or bothersome side effects, discuss them with your healthcare provider for appropriate management.

Tell your healthcare provider if you have any side effects.

To report suspected severe side effects or adverse reactions to compounded trizepatide, contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. In case of emergencies, please call 911 or go to the nearest emergency room.

Drug Interactions

As with other medications, compounded trizepatide can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of hypoglycemia is increased when combined with insulin or insulin secretagogues such as sulfonylureas. Compounded trizepatide delays gastric emptying and may impact the absorption of oral medications. If you are on papillary hormone medication, prior to starting compounded trizepatide, please review the timing of taking your papillary hormone medication with the doctor who prescribes it as it may need to be adjusted. The drug levels of medications with narrow therapeutic windows (ie warfarin) should be monitored closely while on compounded trizepatide.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information.

Tirzepatide may alter the efficacy of birth control pills. Talk with your doctor before starting tirzepatide if you are on birth control. Your healthcare provider may recommend another type of birth control for 4 weeks after you start tirzepatide and for 4 weeks after each increase in your dose.

Note: The above statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

Compounded Semaglutide + B12

*Compounded medications may be prescribed by physicians but have not been FDA regulated for safety, effectiveness, or quality. FDA-approved medicines containing semaglutide are available.

WARNING

Please contact your doctor ASAP and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea and/or vomiting resulting in dehydration—it is important to stay well hydrated and drink plenty of fluids while on this medication
  Kidney problems/kidney failure - vomiting, nausea, diarrhea can cause dehydration and kidney issues and make kidney problems worse in individuals who have pre-existing kidney conditions; may sometimes lead to the need for hemodialysis
• Thyroid C-Cell Tumor: Trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath (see black box warning below)
• Pancreatitis: Severe pain in your abdomen or back that will not go away
• Acute gallbladder disease - Pain in the middle or right upper stomach, fever, white parts of your eyes turn yellow or skin turns yellow, nausea/vomiting. If gallstones or inflammation of the gallbladder is suspected further studies are needed.
• Hepatitis/Elevated liver enzymes/Jaundice
• Diabetic retinopathy problems: Changes in vision in those with type II diabetes, particularly vision problems may worsen in those with a history of diabetic retinopathy
• Severe gastrointestinal disease - may cause gastrointestinal disease; do not use if you have a history of severe gastrointestinal disease
• Signs of low blood sugar (for example, dizziness, weakness, shakiness, jitteriness, headache, anxiety/mood changes, rapid heartbeat, confusion, slurred speech, sweating, or lightheadedness). While this is rare with GLP-1s, if it occurs, please seek in-person care immediately. If you have these symptoms, try having liquid or food containing sugar (around 15-20 grams) —drinking juice, having regular soda, or eating some hard candies right away, as this will help raise your blood sugar quickly. If taken with insulin or an insulin secretagogue (i.e. sulfonylurea such as Glipizide, glimepiride, and glyburide) it is best to talk to your healthcare provider about possibly lowering the dose of these medications to lower the risk of hypoglycemia.
• Increasing heart rate
• Worsening depression, behavior changes, or suicidality

Never share the semaglutide with other people

Drug Interactions

As with other medications, compounded semaglutide can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of hypoglycemia is increased when combined with insulin or insulin secretagogues such as sulfonylureas. Compounded semaglutide delays gastric emptying and may impact the absorption of oral medications. If you are on papillary hormone medication, prior to starting compounded semaglutide, please review the timing of taking your papillary hormone medication with the doctor who prescribes it as it may need to be adjusted. The drug levels of medications with narrow therapeutic windows (ie warfarin) should be monitored closely while on compounded semaglutide.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information.

To report suspected adverse reactions to compounded semaglutide, contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

Note: The above statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

BLACK BOX WARNING

GLP-1s are contraindicated in individuals with a history of medullary thyroid carcinoma, a family history of such, or in patients with multiple endocrine neoplasia syndrome type 2. Do not take them if you have ever had thyroid cancer. In studies with rodents, GLP-1s caused thyroid tumors, including thyroid cancer; it is not known if they will cause thyroid tumors or cancer in humans. Please notify your doctor ASAP if you develop trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath.

If you experience a medical emergency, call 911 or go to the nearest emergency room.

Tell your healthcare provider about your medical history prior to taking semaglutide.

Avoid alcohol while taking this medication. If you’re taking diabetes medications, please discuss this with your prescribing doctor before starting semaglutide, as your diabetes medications may need to be adjusted as you lose weight.

Use adequate contraception while taking this medication. Do not take this medication if pregnant, trying to get pregnant or breastfeeding. If you plan to become pregnant, this medication needs to be stopped at least 2 months before trying. This medication may cause fetal harm.

Notify your doctor if you have kidney, liver, or pancreas problems.

Stop using semaglutide and call your healthcare provider immediately if you have severe stomach or abdomen pain that will not go away, with or without vomiting.

Stop using semaglutide and get medical help right away if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; or very rapid heartbeat.

Serious hypersensitivity reactions (e.g., anaphylaxis and angioedema) have been reported. Discontinue semaglutide if suspected and promptly seek medical advice.

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