Wikijet (Tirzepatide) Therapeutic Class: Dual GIP and GLP‑1 Receptor Agonist

Indications Wikijet is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.

Limitations of Use

Not studied in patients with a history of pancreatitis.
Not indicated for use in patients with type 1 diabetes mellitus.

Pharmacology Tirzepatide is a 39‑amino‑acid modified peptide with a C20 fatty diacid moiety that binds albumin and prolongs half‑life. It selectively activates both GIP and GLP‑1 receptors, enhancing insulin secretion and reducing glucagon levels in a glucose‑dependent manner.

Dosage & Administration

Route: Subcutaneous injection.
Starting dose: 2.5 mg once weekly (for initiation, not glycemic control).
After 4 weeks: Increase to 5 mg once weekly.
Further titration: Increase by 2.5 mg increments after ≥4 weeks, up to a maximum of 15 mg once weekly.
Missed dose: Administer within 4 days; if >4 days, skip and resume on next scheduled day.
Injection sites: Abdomen, thigh, or upper arm. Rotate sites. Do not mix with insulin; administer separately.

Interactions

May increase risk of hypoglycemia with insulin or sulfonylureas → dose reduction may be needed.
Delays gastric emptying → may affect absorption of oral drugs with narrow therapeutic index (e.g., warfarin).
Oral contraceptives: Use non‑oral or barrier method for 4 weeks after initiation and after each dose escalation.

Contraindications

Hypersensitivity to tirzepatide or any component.
Personal/family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2 (MEN 2).

Side Effects Common: Nausea, diarrhea, decreased appetite, vomiting, constipation, dyspepsia, abdominal pain.

Pregnancy & Lactation Use only if potential benefit outweighs risk. Consider maternal glycemic control, breastfeeding benefits, and possible adverse effects on infant.

Precautions & Warnings

Counsel patients on thyroid tumor risk.
Monitor for pancreatitis; discontinue if suspected.
Reduce insulin/secretagogue dose to lower hypoglycemia risk.
Monitor renal function in patients with severe GI reactions.
Monitor diabetic retinopathy progression.
Evaluate gallbladder if cholelithiasis suspected.