Weight Loss Service - Mounjaro

Mounjaro lowers body weight in humans mainly through reducing calorie intake. It regulates appetite by increasing
feelings of fullness, while lowering feelings of hunger, leading to reduced food intake. The active ingredient in
Mounjaro is tirzepatide. Tirzepatide is a dual GIP and GLP-1 receptor agonist (glucose-dependent insulinotropic
polypeptide receptor and glucagon-like-peptide-1 receptor agonist).

Mounjaro is a licensed medication in the UK for the management of weight alongside diet and exercise. Mounjaro can only be supplied or prescribed by a suitably qualified healthcare professional such as a doctor, nurse or pharmacist. Your clinician will assess during your consultation if Mounjaro is a safe and appropriate medication for you. It is not available over the counter.

It can only be prescribed to adults with at least one weight-related condition and a body mass index (BMI) of at least 27 kg/m2 or to people with a BMI of 30.0 kg/m2 or more. It is prescribed as part of a weight management programme that might include diet changes and exercise. You will be asked to submit your BMI on booking, using the calculator on this page, and the nurse or pharmacist will take your measurements and blood pressure during your appointment.

All weight loss medicine should look to be supported with diet and exercise where possible in order to appropriately manage weight. This combined approach can also increase how much and over what time period you lose weight. For further advice on safe weight management with diet and exercise see the NHS Live Well resource here.

The manufacturer’s study data* shows that after 72 weeks of Mounjaro use, the weight loss was superior and clinically meaningful compared with a placebo control group. 81.6% of patients on the 10 mg maintenance dose and 86.4% of patients on the 15 mg maintenance dose of tirzepatide had a body weight reduction of 5% or more at 72 weeks, compared to 30.6% in the placebo group. More patients who had received tirzepatide had reductions in body weight of ≥10%, ≥15% and ≥20% from baseline compared to patients who were in the placebo group.

If you have not lost at least 5% of your body mass (kg) after 6 months of using Mounjaro at the highest tolerated dose, it may not be beneficial to continue and this should be discussed with your clinician.

* https://www.medicines.org.uk/emc/product/15484

Mounjaro is not currently available via the NHS for the treatment of weight loss (this may change, so check with your GP for updates). There are however other medications such as orlistat or liraglutide that may be available for some patients on the NHS. You can discuss with your GP if you feel you may be eligible or want to know more. Remember your GP can also provide other advice and resources to support weight loss such as a nutritionally balanced diet and advice on suitable exercise/physical activity.

All patients should read the instructions for use included in the package leaflet carefully before administering this medicinal product.

Mounjaro is for subcutaneous use only (to be injected under the skin). It must not be given in a vein or in a muscle.

Mounjaro is administered once weekly at any time, independent of meals.

It should be injected in the abdomen or thigh, but can also be injected in the upper arms (less preferable due to chance of incorrect administration). The injection site and timing can be changed without dose adjustment. You can inject in the same body area each week, but make sure it is a different injection site in that area compared to the last time.

Mounjaro should be injected on the same day each week, when the most convenient time has been chosen.

Each Mounjaro pen contains 4 x once weekly doses. Therefore each pen provides treatment for up to 28 days.

1 pen = 4 weeks treatment
2 pens = 8 weeks treatment
3 pens = 12 weeks treatment

Your pens should be taken home and placed in the fridge as soon as possible.
● Pens that are in use can also be stored in the fridge or at room temperature up to 30°C.
● Pens that are in use, have a shelf-life of maximum 30 days.
● Unused pens / additional pens / pens for future use should be in a fridge (2°C to 8°C).
● Keep away from the cooling element in the fridge (usually the cooling element is at the back). It may be
advisable to keep the pens in a dairy drawer in the fridge for example.
● Do not freeze Mounjaro and do not use it if it has been frozen.
● Keep the pen cap on when the pen is not in use in order to protect it from light.

Your first pen, once being used, has a shelf-life of up to 30 days.

You can begin to use this pen as long as you do not use it after 30 days from the day it was supplied to you.

Additional pens for future use that you have received that have not been placed into the fridge for several hours or more, should NOT be used until you have consulted your health care professional.

It is recommended to place them in the fridge until you have received advice from your health care professional on whether these can be used
or need to be discarded.

The weight loss injection service is not suitable if any of the following apply:

Patient currently not registered with a GP
● Confirmed anaphylactic reaction to either:
o A previous dose of semaglutide (Wegovy) or other GLP-1 agonist
o Any of the components of the medication – refer to specific product information for list of excipients (www.medicines.org.uk) (e.g. propylene glycol)
● Informed consent has not been given for the supply or administration of the medication.
● Patients aged under 18 years or over 75 years of age.
● Current pregnancy or planned pregnancy within the next 2 months
● Breastfeeding
History of / current eating disorder (includes bulimia and anorexia nervosa)
● Concomitant use of other GLP-1 agonists (see interactions below)
● Concomitant use of other weight loss medication (e.g. orlistat, Mysimba etc)
● Diabetes (Type 1 or Type 2)
● Pre-diabetes
● Patients with renal impairment
● History of pancreatitis
● Diabetic retinopathy (diabetics are wholly excluded)
● Heart failure
● Weight gain suspected to be caused by current medication

Yes!

NHS Choices suggests adults should aim to:

• do strengthening activities that work all the major muscle groups (legs, hips, back, abdomen, chest, shoulders and arms) on at least 2 days a week
• do at least 150 minutes of moderate intensity activity a week or 75 minutes of vigorous intensity activity a week
• spread exercise evenly over 4 to 5 days a week, or every day
• reduce time spent sitting or lying down and break up long periods of not moving with some activity

You are supplied with KwikPen compatible disposable needles to use with your Mounjaro pen.

You will use one needle for each weekly dose you take.

Needles should be for subcutaneous use and no more than 8mm in length and a gauge of 32G/4mm is
recommended.

Examples of KwikPen compatible needles:
● BD Micro-Fine Ultra 32G/4mm, GlucoRx Ultra Carepoint 32G/4mm, GlucoRx Finepoint 32G/4mm

You should consult your healthcare professional or local pharmacist if you want to check if any additional needles are suitable for Mounjaro before use.

You should be in possession of a sharps bin if you are using Mounjaro.

Please use the sharps bin to dispose of used needles. If you require disposal of your sharps bin please see the following link.

We would recommend waiting until your sharps bin is nearly full or you are terminating treatment before requesting a collection from your local council, as you may not be entitled to have several collections in a year. Each council may have different provisions.

You should not use other weight loss medications at the same time as Mounjaro.

If you are currently using or finishing treatment with other weight loss medications ensure your clinician is aware before you start using
Mounjaro.

They can advise any precautionary steps when switching over if needed.

○ Stopping semaglutide (Wegovy, Ozempic) and starting Mounjaro: start at the lowest dose of Mounjaro 2.5 mg once weekly. Ensure at least a 5 week gap before finishing semaglutide and starting Mounjaro.
○ Stopping liraglutide (Saxenda) and starting Mounjaro: you should start at the lowest dose of Mounjaro 2.5 mg once weekly. Ensure at least a 7 day gap before finishing liraglutide and starting Mounjaro.
○ Going forward if you wish to change from Mounjaro to Wegovy you should advise your prescriber about your current use of Mounjaro. A 1 month interval after Mounjaro is recommended before Wegovy use.
○ No minimal interval is currently required between starting Mounjaro and stopping orlistat or Mysimba (naltrexone/bupropion) but they should NOT be used at the same time. Always inform your health care professional of current medications you are taking to ensure a safe and thorough consultation.

If you miss a dose you should administer as soon as possible and within 4 days after the missed dose. Then administer the next dose as usual on the scheduled day.

If more than 4 days have passed since you should have used Mounjaro, you should skip the missed dose, and the next dose should be administered on the regularly scheduled day.

After this you can resume your regular once weekly dosing schedule. If more than one dose is missed, you may need to consider reducing your starting dose for re-initiation as you may experience side effects (unless you were on the lowest dose 2.5 mg). Consult your healthcare provider in this case.

Yes, you can still book an appointment and attend our clinics for a consultation. You will need to know what strength and dose of Mounjaro you are currently on and for how long, so that our nurses can advise appropriately.

Side effects can occur with any medication. There are some things that can help prevent side effects during your treatment with Mounjaro. Please be aware of the following possible side effects:

Very common (more than 1 in 10 people affected):
Nausea, vomiting, diarrhoea, constipation

Common (less than 1 in 10 but more than 1 in 100):
Hypoglycaemia in Type 2 diabetics, dizziness, diabetic retinopathy in Type 2 diabetics, Allergic reaction (hypersensitivity e.g. rash, itching, eczema), dizziness/low blood pressure, abdominal pain, indigestion, bloating of the stomach, eructation, flatulence, reflux/heartburn, hair loss, tiredness, injection site reactions, increased levels of pancreatic enzymes

Uncommon (less than 1 in 100 but more than 1 in 1000)
Acute pancreatitis, severe allergic reactions (anaphylactic reaction, angioedema)

If you are experiencing any concerning side effects, you can contact a GP immediately or contact NHS 111 (call 111 or visit https://111.nhs.uk/).

You can report any side effects not listed above to your clinician. In particular, if you are experiencing milder side effects and these are becoming intolerable, contact your clinician for support with your ongoing weight management journey. Current patients only can contact us via email at: contact@healthclinics.superdrug.com and we will pass on your query within our team.

Please note that you can also report side effects from using Mounjaro as a member of the public to the Medicines and Healthcare products Regulatory Agency which helps to ensure its safe and effective use. This is via the Yellow Card scheme https://yellowcard.mhra.gov.uk/ . However, if you need current medical support with your side effects then contact your clinician.

Acute Pancreatitis
An uncommon side effect of Mounjaro is acute pancreatitis. This is where the pancreas can become swollen over a
short period of time.
If you experience any of the following symptoms of acute pancreatitis you should stop using Mounjaro (tirzepatide) and contact a GP immediately or contact NHS 111 (call 111 or visit https://111.nhs.uk/):
Severe pain in the centre of the belly/abdomen. This can worsen and travel along the back
Nausea/vomiting
Indigestion
Fever (>38 degrees celsius)
Yellowing of the eyes/ Yellowing of the skin
Tenderness in the belly/abdomen or swelling
Faster heart rate (tachycardia) or rapid breathing

Dehydration
There is a risk of dehydration due to gastrointestinal side-effects such as vomiting and diarrhoea. Ensure you drink plenty of fluids and stay hydrated to avoid depletion.

Dizziness
Using Mounjaro and increasing your dosage may cause dizziness. You should exercise caution with driving or use of machines. See also above to ensure you are hydrated.

Mounjaro should not be used during pregnancy.

If you become pregnant during your use of Mounjaro, you should stop using it and inform your GP.

Mounjaro should not be used during breastfeeding.

Women planning a pregnancy should not use tirzepatide for at least 1 month prior to planned conception.

For women of childbearing age it is strongly advised to use an adequate form of contraception during use of tirzepatide and to use a non-oral contraceptive method (e.g. a barrier method such as a condom) for 4 weeks after starting Mounjaro and for 4 weeks after each increase in dose.

The Eatwell Guide shows that to have a healthy, balanced diet, people should try to:

• eat at least 5 portions of a variety of fruit and vegetables every day
• base meals on higher fibre starchy foods like potatoes, bread, rice or pasta
• have some dairy or dairy alternatives (such as soya drinks)
• eat some beans, pulses, fish, eggs, meat and other protein
• choose unsaturated oils and spreads, and eat them in small amounts
• drink plenty of water (at least 6 to 8 glasses a day)