Indications

Tirzema in Indicated au an adjunet to diat and woarcien to impraen glycamic cantrol in acuts with typa 2 dabaie mellitun.

Limitatione of us:
it has not baan studied in patlants with a histary of paneraatie.
. it l not indcabed foruss in patiants with type 1 diabetes malitut.

.

Pharmacology
Tirzepatide in a GiP ncapor and GLP-1 rcaptor agonitt it i a 39-amino-acid modifed peptide with a D20 fatty dlacid mainty that arblas alburrin binding ard pralong th half-life. it salactively binds to and actiates
both the GiP and GLP-4 rceptore, tha targata for ntien GiP and GLP- it anhancas frat and sacond-phase insuin sacrwan and rduces glucagon lweale, both in a gluccas dapandant marnar.

Dosage & Administration

Route of adminitration. Tirzapatide thouid be administared an a subeutarous injactian.

Dosing Instructiont-
The racommanded starting doenge in 2.5 mg injected subeutaneculy onen wnsky. The 2.5mg donage in for treatmant Initlation and is nat Intanded for glycamic condirol.
Adar 4 wanks, inerans the dacage to 5 mg onen wsiy. if additioral glycemic cantrol is nanded Increane the donage In 2.5mg ncremants after at laast 4 weake on the current daos. The maximum dacage ix 15 mg
Injected mubeutaroutly onon weady:
. ifa done lx minsed, Instruct atlents to adminsterit au sson a ponsble within 4 days (Fo hours) after the misted daos. Ifmore than 4 days have paused, akip tha micnd dooe and administar the nast doss on tha
regularty schadued day. in nach cann, patants can than recuma ther rgular ance weekly doeing schaduls.
Tha day of wsaky administration can be changed, if nacsary, as long at the fima betwean the two donns x at lnast 3 days [72 hours]
Preparation and adminitration-
Tha nendie cower of tha pre-fled syringe contain dry matura rubber ja dervavs of lato, whic may caune allargie rwactlore.
Do not franas. Do not ue Tiraspatide that at been froasn.
Pronct pre-tled syringes fram light.
Parenbaral drug producte thoud ba irapected visually farparticulate mattar and diacoloration prior to adminitration. Do not u any pre-fled syringas axhibiting particulate matter and discoloralan.
Handia it caretully. if tha pre-filed syringe dropped on a ard surface, do not uss It.
Do not dlute Tirzapalsde and da not adminictarin conjunctianwith other drug sslutiore.
Administration Instructiona-
Administer onca wenkly. any tima o day, with ar without maslt.
.

.

.

Inject it subcutanaounly in the abdoran, thigh aruppar arm. Rotate Injection sites with aach dess. Whan wng with Insuin, administer at saparate Injection and nawermle. it is acceptable to iinjact Tirzapatide and
Intulin in the same body ragian but th injactione should nat be acacant ts nach othar.

Interaction

Drug Intaracion with madicatior Candiderreducing the don of concomitanty administared insuin sacretagoguasagmulonylura or insuin ta reduen the rik afhypoglycamia. Tirzera delye gaetre amptying and
tharsby ha tha potential to impact th absorpisan of concomitarity administared oral macicalsane. Hontorpatiane on oral madicatione dapendent on threchold concentrationa for affeacy and theos with a narrow
tharapnue index e.g .. warfaring) whan cancoritantly adminstared. Advss patlere uting oral harmonal contracaptives to wwitch ta a non-oral contracepvn mathad or add a barrier mathed of contracapon for 4 wwekx
after Initiation and for 4 weeke afier anch doss ascalasan with It. Haronal contraceptives that are nat adminittared orally thauld nat ba affected.

Contraindications

Tirzepatide in contraindicated in patienta with known lyparsarivity to tirzapatide ar any ather componan of this praduct. it in ales contraindicated in patarta with a parsoral ar family hitory of madullary thyrald
carcinoma [MTTE) or in palsants with multipls andocrina naplasia tyndroms type 2 [EN 2)].

Side Effects

The moat common tide affecie are naucen, diarrhan, decreatad appatite, vorniting, constipation, dyspapala and abdominal pain.

Pregnancy & Lactatiion

Thare are ritk to the mothar and fetua.assoclated with poarly cantrolled dabalet in pragnncy. Tirzpalsde thould be ued during pregnancy anly if tha potara barwft Juntfes the poerda risk to th fetux. Tha
dewsoprnantal and haaith benatts of breastfesding should ba condidared along with the mathar's dinical nnd far tirzapatide and any potantial adwerse affects on the braastad infant from tirzapatids or from the
undartying matamal candition.

Precautions & Warnings

Couneai patlante ragarding the potential riak for MTC with the uas of Tirzema and infsem tham af symptorne af thyraid tumors. Aftar Initlation, obarwe patierte carefully far signa and syrrptome af pancraatitit. f
panereattie ix sspactad, discantinun Tirzema and intiat appeapriate managemant. The ritk of ypaglycamia may be lowwred by a rduction in the doos af sufonylursa pr othr concomitanty administared insulin
nacwtagogun) orinauln. if hyparsanaltivity mctians accur, discortinun us of Tirzerna: trwat prampily per standand of care and monitor ur aigne and syrporne resoles. Honitorrenal funetion when Initlating or
eccalating doost in patiente with ranal impairmant raporiing awwre gastrointastinal advarse meaction. Patlene with a histary af diabalse retinopathy should ba monitared for progreasion of diabetic ratinapathy if
cholalithlasie in mapactnd, galbladder diagnade shudis.and appraprate cainical follow-up are Indicated.

Use in Special Populations
Lioe in children and adolascants: Sadaty and affactivares of Tirzama haww not baan astablinhad in patiante nder 10 yuars of age.

Overdose Effects

Apprapriate supportles trastmant should be iniated accarding ta tha palsant's diinicall aigrw and symptorne.A peried off abearvation and treatrnant for ths symptoma may be nacaasary, taking ino account the half-ife
of Tirzama ix approximately 5 dayt.

Therapeutic Class

GLP-1 macaptaragonists

Storage Conditions
Keep out of the rach and sight af childnan. Stan In a nefrigerator at 2C to 0'C. Do not fresse and probact from light. Da not un ifit has bean fracen. Ta betakan and sold only on the praseripian of aragistered phytican.