tirzepatide: clinical use

Prescribing considerations

• Hypoglycaemia risk increases with insulin or sulphonylureas; ensure appropriate glucose monitoring.
• Use cautiously with previous pancreatitis, severe gastrointestinal disease including severe gastroparesis, advanced diabetic retinopathy requiring treatment, or severe renal or hepatic impairment where experience is limited.
• Gastrointestinal adverse effects can cause dehydration and deterioration in renal function; assess fluid status and renal function when clinically indicated.
• Ensure the anaesthetic team knows about treatment before general anaesthesia or deep sedation because delayed gastric emptying may increase aspiration risk.
• Prescribe and dispense this biological medicine by brand name.

Contraindications and cautions

• Hypersensitivity to tirzepatide or any formulation excipient.

Monitoring

• Glycaemic response and blood glucose where clinically relevant, especially with insulin or sulphonylureas
• Weight and clinical response during weight management
• Hydration, electrolytes and renal function with significant gastrointestinal symptoms
• Symptoms of pancreatitis or gallbladder disease
• Diabetic retinopathy in patients with pre-existing advanced disease

Clinical pharmacology

Tirzepatide is a selective, long-acting agonist at GIP and GLP-1 receptors. Its actions include glucose-dependent insulin secretion, reduced glucagon, improved insulin sensitivity, delayed gastric emptying and central appetite regulation.

Formulation and product differences

• Clear, colourless to slightly yellow solution in a multiple-dose pre-filled KwikPen.
• Each KwikPen contains four usable injections; excess solution must be discarded.
• Needles are not included.
• Contains benzyl alcohol and is essentially sodium-free.
• Store refrigerated before use and do not freeze. After first use, it may be kept below 30°C for up to 30 days before disposal.

Injection

Route: Parenteral

Strengths: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg