Indications

Tizaro is indicated as an adjunet to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.

Limitations of use:
. It has not been studied in patients with a history of pancreatitis.
. It is not indicated for use in patients with type 1 diabetes mellitus.

Pharmacology

Tirzepatide is a GIP receptor and GLP-1 receptor agonist. It is a 39-amino-acid modified peptide with a C20 fatty diacid moiety that enables albumin binding and prolongs the halt-life. It selectively binds to and
activates both the GIP and GLP-1 receptors, the targets for native GIP and GLP-1. It enhances first and second-phase insulin secretion and reduces glueagon levels, both in a glucose dependent manner.

Dosage & Administration

Route of administration: Tirzepatide should be administered as a subcutancous injection.

Dosing instructions-
. The recommended starting dosage is 2.5 mg injected subeutaneously once weekly. The 2.5 mg dosage is for treatment initiation and is not intended for glycemic control.
After 4 weeks, increase the dosage to 5 mg once weckly. It additional glycemic control is needed, inerease the dosage in 2.5 mg increments after at least 4 weeks on the current dose. The maximum dosage
is 15 mg injected subeutancously once weckly.
. If a dose is missed, instruct patients to administer it as soon as possible within 4 days (96 hours) after the missed dose. If more than 4 days have passed, skip the missed dose and administer the next dose
on the regularty scheduled day. In each case, patients can then resume their regular once weskly dosing schedule.
. The day of weckly administration can be changed, if necessary, as long as the time betweon the two doses is at least 3 days [72 hours)
Preparation and administration-
. The needle cover of the pre-filled syringe contains dry natural rubber (a derivative of latex), which may cause allergie reactions.
Do not freeze. Do not use Tirzepatide that has been frozen.
. Protect pre-flled syringes from light.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration. Do not use any pre-filled syringes exhibiting particulate matter and discoloration.
Handle it carefully. If the pre-flled syringe dropped on a hard surface, do not use it.
Do not dilute Tirzepatide and do not administer in conjunction with other drug solutions.

Administration instructions-
Administer once weekly, any time of day, with or without meals.
Inject it subeutancously in the abdomen, thigh or upper arm. Rotate injection sites with each dose. When using with insulin, administer as separate injections and never mic. It is acceptable to inject
Tirzepatide and insulin in the same body region, but the injections should not be adjacent to each other.

Interaction

Drug interaction with medication: Consider reducing the dose of concomitantly administered insulin secretagogues (e.g., sulfonylureas) or insulin to reduce the risk of hypoglycemia. Tizaro delays gastrie
emptying and thereby has the potential to impact the absorption of concomitantly administered oral medications. Monitor patients on oral medications dependent on threshold concentrations for efficacy and
those with a narrow therapeutie index [e.g., wartarin) when concomitantly administered. Advise patients using oral hormonal contraceptives to switch to a non-oral contraceptive method or add a barrier method
of contraception for 4 weeks after initiation and for 4 weeks after each dose escalation with it. Hormonal contraceptives that are not administered orally should not be affected.

Contraindications

Tirzepatide is contraindicated in patients with known hypersensitivity to tirzepatide or any other components of this product. It is also contraindicated in patients with a personal or family history of medullary
thyroid carcinoma (MTC) or in patients with multiple endocrine neoplasia syndrome type 2 [MEN 2).

Side Effects

The most common side affects are nausea, diarrhea, decreased appetite, vomiting, constipation, dyspepsia and abdominal pain.

Pregnancy & Lactation

There are risks to the mother and fetus associated with poorly controlled diabetes in pregnancy. Tirzepatide should be used during pregnancy only it the potential beneiit justifies the potential risk to the fetus.
The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for tirzepatide and any potential adverse effects on the breastted intant from tirzepatide or
from the underlying maternal condition.