Physician-Guided, Medical Weight Loss
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About Mounjaro
What is Mounjaro ?
Mounjaro (tirzepatide) has received much attention recently for its effectiveness as a weight loss medication. Mounjaro is an FDA-approve medication originally prescribed to diabetics for the purpose of controlling blood glucose. This medication (exact same medication) has also been branded as Zepbound when used for weight loss. Compounded Tirzepatide is also available through providers such as Metabolic MD who arrange to have the medication supplied to our patients through licensed pharmacies. Compounded Terzipitide is prescribed to patients who have specialized dosing needs or specific clinical issues requiring the compounded medication. All three formulations (Mounjaro, Zepbound, Compounded Tirzepatide) are once-weekly injectable medications. When treatment is initiated, they are started as a low dose, and the dose is gradually increased until a therapeutically effective dose is reached. These drugs belong to a class of medications called the “GLP-1 Agonists”. They mimic the body’s natural GLP-1 gastrointestinal hormones.
In the initial studies on diabetics the GLP-1 medications were found to be very effective at lowering blood sugar with the added benefit of achieving weight loss. After seeing the weight loss these medicines achieved in patients with Type II diabetes, the manufacturer of Mounjaro performed studies seeking FDA approval for the treatment of obesity in nondiabetics. In 2023, tirzepatide was approved for weight loss with the brand name Zepbound, and became available to patients as a once-weekly injection to treat elevated Body Mass Index (BMI). The compounded version, which has the advantage of more succinct titration of dosing, came on the market in 2023 as well.
Of The Three Types of Tirzepatide, Which Is the Right One for Me?
In the initial studies on diabetics with this medication was found to be very effective at lowering blood sugar with the added benefit of achieving weight loss. After seeing the weight loss this medicine achieved in patients with Type II diabetes, the manufacturer of Mounjaro performed studies seeking FDA approval for the treatment of obesity in nondiabetics. In 2023, Tirzepatide was approved for weight loss with the brand name Zepbound, and became available to patients as a once-weekly injection to treat elevated Body Mass Index (BMI). The compounded version came on the market in 2023 as well.
The type of Tirzepatide prescribed to a patient is dependent on both that person’s medical conditions and need to titrate medications up and down precisely.
For diabetics, Mounjaro is usually the most appropriate medication, and is usually covered by insurance. Out of pocket costs are often low. For patients who are not diabetic, however, insurance coverage for Mounjaro is limited.
Zepbound can be prescribed for obesity or for overweight individuals who are not diabetic. However, insurance coverage for Zepbound is very limited. In our experience, only 5-10% of private health insurances cover Zepbound. Medicaid and Medicare do not cover Zepbound, and only very generous privately insurances provide coverage for this medication.
The cost for the two branded medications (Mounjaro and Zepbound) without insurance coverage can be well over $1,000 dollars per month.
Tirzepatide, the compounded version of Zepbound and Mounjaro, can be prescribed to patients who are diabetic or not diabetic. Metabolic MD has been providing this medication to our patients since its first availability in 2023. It has been shown to be safe and effective in our patients. However, compounded Tirzepitide is prescribed only to patietns who require secialized dosing needs or hwo a clinical need requiring this medication.
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When & How Should These Medications be Prescribed for Weight Loss?
Metabolic MD prescribes Tirzepatide with a focus on using lower doses and only as part of a comprehensive weight loss and metabolic health program. We use these medications in two instances:
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For a patient who wants to get a “jump start” on their weight loss program, but only with the understanding that other lifestyle changes be implemented simultaneously (low carb diet, intermittent fasting, exercise routine emphasizing strength training)
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Temporarily (usually a period of months ort about a year) for a patient who stalls without medication or plateaus during their weight loss effort, despite participation in a comprehensive program (as outlined above).
We believe that one of the goals when using these mediations, is that their use be temporary. We do not believe Tirzepatide should be prescribe to patients in a manner that commits them to lifetime medication dependence. This is why we only use them as part of a comprehensive program as outlined above. We use limited (not maximum) dosing so we can eventually titrate our patients off the medication without significant weight regain. Weight regain upon medication discontinuation is very common (often up to 60% of the weight lost), and can only be avoided with the institution of diet and exercise lifestyle changes while under treatment.
Howdoes Tirzepatide (Mounjaro/Zepbound) work?
Tirzepatide (Mounjaro / Zepbound ) is effective for several reasons. First, it acts on the hypothalamus in the brain, which regulates our sensation of hunger. With this action on the hypothalamus the drug alters the food-reward system and prolongs our sense of fullness (satiety). Tirzepatide also slows down the motility of the gastrointestinal tract. Put more simply, it keeps food in your stomach for longer than usual, keeping you full longer. Finally, it lowers blood glucose. When blood glucose is lowered, fatty acids are used by the body as an energy source. When fat is burned, weight is lost.
How Much Weight Can I Lose?.
We believe a comprehensive program utilizing the following components best achieves optimal weight loss and health improvement:
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A focused low carb diet (best guided by the use of a continuous glucose monitor)
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Intermittent fasting
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An exercise regimen with a focus on strength training.
Tirzepatide (Mounjaro/Zepbound) can help you lose weight, but that weight loss is likely not to permanent after medication discontinuation, without lifestyle changes. Weight regain after stopping the medication is common, unless diet and exercise lifestyle changes have been ingrained. In our practice, we help our patients address the root causes of weight gain with a comprehensive program. We look to help our patients implement healthy lifestyle changes that will last a lifetime, and prevent weight regain when the medication is discontinued. In studies using Tirzepitide, some patients achieved a weight loss of 25% of their body weight.
How Fast Does Tirzepatide (Mounjaro/Zepbound) Work?
The short answer is that many of our patients begin to lose weight in the first month. The first dose is small, but then the dose is titrated up over the following months. These lower doses are primarily used to gently introduce the medication to the body without risking developing significant side effects (mostly nausea).
Most studies done on weight loss with this medication, Tirzepatide (Mounjaro/Zepbound), have shown effectiveness only when it is used in combination with an effective diet and exercise plan. At Metabolic MD, we believe the most effective dietary approach is a low carb diet, and the best exercise plan includes strength training. Our Tirzepatide prescribing always is accompanied by detailed guidance related to your diet and an appropriate associated exercise regimen. We have proven that an extremely effective approach to weight loss is a continuous glucose monitor guided low carb diet in conjunction with Tirzepatide.
Who is Eligible for Weight Loss Treatment with Tirzepatide (Mounjaro/Zepbound) ?
Mounjaro is often covered by most private insurance for those diagnosed with type 2 diabetes.
Zepbound is the brand name approved for weight loss in nondiabetics. It can be prescribed to patients with a weight meeting the BMI criteria of a BMI of 30 or greater, or a BMI of 27 in association with a metabolid health issues such as prediabetes, hypertension, high cholesterol, sleep apnea, or fatty liver disease. At his time, insurance coverage for Zepbound is limited, meaning it’s cost may not be covered by most insurances, including Medicaid, Medicare, and a majority of private insurances.
Does Tirzepatide (Mounjaro/Zepbound) have side effects?
Some people can have mild to moderate side effects, however most of these are manageable by proper dosing. Significant side effects may occur, but in our experience are very rare. Sometimes compounded medication offers an option for more precise dosing.
The most common side effects are: nausea, diarrhea, vomiting, constipation, mild stomach pain, mild headache, fatigue, feeling bloated, belching, gas, stomach flu, and heartburn. We see some mild nausea in many patients, however based on our dosing regimens, we have found that both significant side effects and other side effects are very rare.
How Fast Can You Increase the Dose?
Tirzepatide (Mounjaro/Zepbound) is taken as a once weekly injection “escalating” dose. This means you start the medication at a low dose, and increase the dosage gradually over a period of months. Progression on this regimen assumes side-effects are minimal. We have not had any patients need to discontinue treatment due to side effects.
We weigh several factors when deciding how and when to increase the dose for our patients. The first is whether you experienced significant side effects during your week of treatment during initiation or as the dose is increased. How fast dosing is increased for our patients is individualized and tailored to the needs of each patient. The individualized approach allows us to maximize the benefits of the medication while keeping side effects to a minimum.
Metabolic MD also has a philosophy of utilizing the lowest dose necessary to achieve effective weight loss. This is for two reasons. Avoiding high doses helps to avoid wight regain when patients are titrated back down and off the medication. Also, higher doses of medication can result in significant muscle loss. Lower dosing (in conjunction with the strength training guidance we provide) helps avoid muscle loss. This is especially important for older patients and in women at risk for osteoporosis.
How Do You Administer Tirzepatide (Mounjaro/Zepbound)?
This medication is taken as a once-weekly subcutaneous injection. This injection is self-administered at home with a VERY SMALL (31 gauge) needle into the abdominal area. If the brand names medicines are utilized, they are provided as an injectable pen. If a compounded formulation is provided, it must be drawn up into an insulin syringe from a vial. It is then injected in a manner similar to an insulin injection. The injection cannot be said to be 100% painless, but causes very minimal discomfort for most patients. We walk all our patients through the injection process either in office or by telemedicine.
Who Should Not Use Tirzepatide (Mounjaro/Zepbound)?
There are some situations where Mounjaro is “contraindicated,” meaning an individual with a condition should not use this medicine. The major contraindications to treatment are:
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patients with a personal or family history of medullary thyroid carcinoma
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patients with a personal or family history of Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
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diabetic retinopathy, a type of damage to the eye from diabetes
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a history of recurrent low blood sugar
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recurrent disease of the gallbladder (patients who have had their gallbladder removed are not included in this group)
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decreased kidney function
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pancreatitis
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Inflammatory bowel disease
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patients on any medications that lower blood sugar
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patients on the blood thinner coumadin (also called warfarin)
I Have heard Tirzepatide (Mounjaro/Zepbound) Is in Short Supply, and Medication Availability is subject to “Supply Chain” Issues.
Due to the demand for Tirzepatide (Mounjaro/Zepbound) at times these medications have been in short supply. This has been especially true of both Mounjaro and Zepbound. It is less true with the compounded version.
Regarding less expensive Compounded Tirzepatide, Metabolic MD, through our relationship with multiple licensed compounding pharmacies, has not had our patients experience any interruption in timely delivery of their medication. However, any patient choosing to pursue treatment with Tirzepatide should be aware of the potential risk of a supply chain issue, and potential medication unavailability. This is one reason our programs emphasize a comprehensive approach. We believe patients should not become solely dependent on this medication to achieve their weight loss and metabolic health goals.
Metabolic MD Pharmacies Network
To see the compounded pharmacies Metabolic MD utilizes to obtain medications for our patients click here: INSERT INFO HERE
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Is Tirzepatide (Mounjaro/Zepbound) Covered by Insurance?
As mentioned above Mounjaro is covered by most private insurances for those diagnosed with Type 2 Diabetes.
Zepbound is the brand name approved for weight loss in nondiabetics. It can be prescribed to patients with excess weight meeting the high BMI criteria as outlined above. At this time, insurance coverage for Zepbound is very limited, meaning it’s cost may not be covered by most insurances, including Medicaid, Medicare, and a majority of private insurances.
How Can I Learn More?
If you have an interest in being prescribed Tirzepatide (Mounjaro/Zepbound/Compounded Tirzepitide) as part of a comprehensive weight loss and metabolic health program please contact Metabolic MD at this link for a complimentary phone consultation.
Our initial goal is to work with patients and guide them in the process of determining if they are eligible for insurance coverage of Mounjaro or Zepbound. We will also assess, based on dosing considerations, if compounded medication use is appropriatee
Please click on the above link and complete our short patient inquiry form, and a member of the Metabolic MD team will be in touch with you to arrange your no cost phone consultation. This form is also on our website under the Contacts Tab.