Tirzepatide

How it works

It is a dual agonist of both the glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors, enhancing glucose-dependent insulin secretion, suppressing glucagon, slowing gastric emptying, and reducing appetite.

Prescribing in practice

• When combined with a sulfonylurea or insulin it increases the risk of hypoglycaemia, so a dose reduction of the insulin or sulfonylurea should be considered.
• Gastrointestinal effects such as nausea, vomiting, and diarrhoea are common, especially during dose escalation, and acute pancreatitis has been reported, so persistent severe abdominal pain should be investigated.
• It is not a treatment for type 1 diabetes or diabetic ketoacidosis, and is generally avoided in pregnancy.

Monitoring

Monitor HbA1c and glycaemic response, body weight, and gastrointestinal tolerability, and review for symptoms suggestive of pancreatitis or gallbladder disease.

Counselling the patient

• Inject under the skin once weekly, on the same day each week, rotating injection sites.
• Nausea is common at first and usually settles; report severe or persistent abdominal pain.
• Tell your clinician if you become pregnant or are planning pregnancy.

Evidence & guidelines

Glycaemic and weight-loss efficacy were demonstrated in a large randomised controlled trial programme supporting its approval in type 2 diabetes and weight management.