Zepbound® Weight Loss Medication Treatment

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GLP-1 weight loss medications should only be used in people with obesity (BMI >= 30). They may also be used if the BMI is >= 27 with a related medical problem, like high blood pressure, high cholesterol or pre-diabetes. GLP-1 weight loss medications should not be used for purely cosmetic weight loss.

In addition, GLP-1 weight loss medications should not be used in the following situations:

1. Personal or family history of medullary thyroid carcinoma, or multiple endocrine neoplasia type 2.
2. History of pancreatitis (discuss with provider).
3. Known allergy to GLP-1, or any of the excipients in the GLP-1.
4. May cause fetal harm – discontinue Wegovy / Ozempic / Semaglutide 2 months before a planned pregnancy, or when pregnancy is detected. Zepbound / Mounjaro / Tirzepatide should be discontinued when pregnancy is recognized.
5. GLP-1 weight loss medications may be excreted in breast milk – we generally recommend against restarting GLP-1 weight loss medications until at least 6 months post-partum AND the baby is no longer breastfeeding; however, discuss your unique circumstances with your provider.
6. In addition, note that Zepbound / Mounjaro / Tirzepatide may affect oral contraceptive pills (OCPs). If you are using OCPs as a sole method of birth control, a second barrier method is recommended during the first month at each new dose.

This is a complex question. Our providers are skilled in helping you navigate this and find a cost effective option. We recommend the following 3 steps:

1. Call your health insurance provider – ask if you have coverage for GLP-1 weight loss medications including Wegovy and Zepbound.
2. Visit wegovy.com and zepbound.com and research your savings card options or direct to patient cash price.
3. Schedule a visit with a CNC provider to review your options.

If you have coverage, GLP-1 weight loss medications can cost as little as $25 per month. If you don’t, our providers can help you navigate the most cost-effective option. As of the date of this post, Zepound is available through Lilly Direct for $349 / month (2.5 mg dose) and $499 / month (5, 7.5, and 10 mg doses). Wegovy is available through Novocare for $499 / month (all doses); however, some patients are not eligible.

GLP-1 weight loss medication injections do not hurt.

The injections are done by yourself at home once a week for Wegovy / Ozempic and Zepbound / Mounjaro, or once daily for liraglutide.

If the missed dose will be done more than 48 hours before the next regularly scheduled dose, then administer as soon as possible. If less than 48 hours before the next regularly scheduled dose, you may wait and resume on your regularly scheduled day. If you miss more than 2 doses, talk with your provider about possibly resuming at a lower dose to lower the chance of side effects.

GLP-1 weight loss medications don’t take the weight off by themselves – they help control your appetite so you can eat a lower calorie food plan without feeling hungry. However, if you don’t eat a healthy diet and get regular physical activity, a lot of the weight lost will be muscle. For this reason, it is important to review your eating plan and physical activity plan with your CNC staff. Further, we recommend monitoring body composition on our SECA medical body composition analyzer so we can track your fat vs. lean loss.

1. We recommend starting your GLP-1 weight loss medication on a Sunday or Monday evening. Then, if there are side effects, you can call us at the office at (303) 750-9454 to assist you.
2. Avoid eating out the first couple days after your first shot at each new dose..
3. Avoid high-fat or high-carb foods the first couple days after your first shot at each new dose.
4. Careful with Alcohol – it may seem a lot stronger than you remember.
5. To avoid nausea, eat something immediately when you wake up, even if you are nauseous. We’ve found a protein drink can really settle down the stomach. Even a glass of water can help reduce or prevent nausea.
6. Eat frequent small meals throughout the day the first couple days after the injection. Choose small amounts of proteins and vegetables.
7. For constipation, use a stool softener (colace, surface, dulculax) or Miralax.
8. For heartburn, feel free to use Tums, Pepcid, or Prevacid/Protonix/Nexium. Also, certain foods are more likely to trigger heartburn including tomato sauces and spicy foods – consider avoiding these while your digestive system gets used to your medication.
9. If the injection site hurts, it could be from injecting the medication while it is cold – consider allowing your medication to come to room temperature before the injection.
10. See a provider or dietitian at CNC each month to customize your plan, figure out your best dose, and help you maximize your results.
11. Do not stop your GLP-1 medication without discussing this with your CNC provider – obesity is a chronic health problem, and we usually use these medications long-term.

Zepbound / Mounjaro single dose pens, click here.

Wegovy single dose pen, click here.

Ozempic / Saxenda multi-dose pens, click here.

To inject from a vial (Zepbound – from Lilly Direct):

For a video, click here.

1. Gather Supplies: You’ll need the medication vial, a syringe, a needle, and alcohol swabs.
2. Wash Your Hands: Begin by washing your hands thoroughly with soap and water or using hand sanitizer.
3. Prepare the Vial:
   • Remove the cap from the vial.
   • Use an alcohol swab to clean the rubber stopper on the vial to minimize the risk of infection.
4. Draw Up the Medication:
   • Pull back the plunger of the syringe to draw air into it that is equal to the dose of medication you intend to take.
   • Insert the needle into the vial and push the plunger to inject the air into the vial (this helps create a vacuum).
   • Invert the vial while keeping the syringe in it, and pull back on the plunger to draw up the correct amount of medication.
   • Make sure there are no air bubbles in the syringe. If there are, gently tap the side of the syringe and push the plunger slightly to expel the air.
5. Prepare for Injection:
   • Choose a suitable injection site (such as the thigh or abdomen) and clean it with an alcohol swab.
   • Remove the needle cap, being careful not to touch the needle.
6. Administer the Injection:
   • Pinch the skin around the injection site if necessary.
   • Insert the needle at the recommended angle (usually 90 degrees for intramuscular injections or 45 degrees for subcutaneous injections).
   • Push the plunger down steadily to inject the medication.
7. Dispose of the Needle Safely: Once the injection is complete, safely dispose of the needle and syringe in a sharps container.
8. Apply Pressure: If needed, apply gentle pressure to the injection site with a cotton ball or gauze.
9. Wash Your Hands Again: After disposing of the needle, wash your hands thoroughly.

Important Safety Information about GLP-1 Weight Loss Medications

GLP-1 may cause serious side effects, including:

• Possible thyroid tumors, including cancer. Tell your healthcare 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. In studies with rodents, GLP-1 medicines caused thyroid tumors, including thyroid cancer. It is not known if GLP-1 will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people. Do not use GLP-1 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)
• Do not use GLP-1 if you have had a serious allergic reaction to semaglutide or tirzepatide or any of the ingredients in GLP-1.

Before using GLP-1, tell your healthcare provider if you have any other medical conditions, including if you:

• have or have had problems with your pancreas or kidneys
• have type 2 diabetes and a history of diabetic retinopathy
• have or have had depression, suicidal thoughts, or mental health issues
• are pregnant or plan to become pregnant. GLP-1 may harm your unborn baby. You should stop using GLP-1 2 months before you plan to become pregnant (Wegovy / Ozempic products), or if pregnancy is detected (Zepbound / Mounjaro products).
• are breastfeeding or plan to breastfeed. It is not known if GLP-1 passes into your breast milk
• Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. GLP-1 may affect the way some medicines work and some medicines may affect the way GLP-1 works. Tell your healthcare provider if you are taking other medicines to treat diabetes, including sulfonylureas or insulin.
• GLP-1 slows stomach emptying and can affect medicines that need to pass through the stomach quickly.

GLP-1 may cause serious side effects, including:

• inflammation of your pancreas (pancreatitis). Stop using GLP-1 and call your healthcare provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without vomiting. You may feel the pain from your abdomen to your back
• gallbladder problems. GLP-1 may cause gallbladder problems, including gallstones. Some gallstones may need surgery. Call your healthcare provider if you have symptoms, such as pain in your upper stomach (abdomen), fever, yellowing of the skin or eyes (jaundice), or clay- colored stools
• increased risk of low blood sugar (hypoglycemia), especially those who also take medicines for diabetes such as insulin or sulfonylureas. This can be a serious side effect. Talk to your healthcare provider about how to recognize and treat low blood sugar and check your blood sugar before you start and while you take GLP-1. Signs and symptoms of low blood sugar may include dizziness or light-headedness, blurred vision, anxiety, irritability or mood changes, sweating, slurred speech, hunger, confusion or drowsiness, shakiness, weakness, headache, fast heartbeat, or feeling jittery
• kidney problems (kidney failure). 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 fluids to help reduce your chance of dehydration
• serious allergic reactions. Stop using GLP-1 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
• change in vision in people with type 2 diabetes. Tell your healthcare provider if you have changes in vision during treatment with GLP-1
• increased heart rate. GLP-1 can increase your heart rate while you are at rest. Tell your healthcare provider if you feel your heart racing or pounding in your chest and it lasts for several minutes
• depression or thoughts of suicide. You should pay attention to any mental 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
• Alert your healthcare provider if you are planning to have surgery or procedures that require deep sedation

The most common side effects of GLP-1 may include: nausea, diarrhea, vomiting, constipation, stomach (abdomen) pain, headache, tiredness (fatigue), upset stomach, dizziness, feeling bloated, belching, low blood sugar in people with type 2 diabetes, gas, stomach flu, heartburn, and runny nose or sore throat.

This information is intended for your private use only. See the full safety information for Wegovy here, fo Zepbound here, and for liraglutide here.

Most side effects are mild to moderate. They may include: nausea, vomiting, diarrhea, constipation, abdominal pain, headache, fatigue, dyspepsia, dizziness, abdominal distention, eructation (burping), hypoglycemia in patients with diabetes, flatulence, gastroenteritis, gastroesophageal reflux disease, and nasopharyngitis.

Rare but more serious problems include a potential risk for medullary thyroid carcinoma, pancreatitis, gallstones, hypoglycemia, acute kidney injury, hypersensitivity reactions, diabetic retinopathy complications in patients with type 2 diabetes, and heart rate increases.

See the full safety information for semaglutide here, fo tirzepatide here, and for liraglutide here.