What testing and side effects should be assessed in a patient with obesity and impaired fasting glucose returning for recheck after increasing Zepbound (tirzepatide) dose to 15mg weekly?

Monitoring and Side Effect Assessment for Patients on Zepbound 15mg Weekly

When evaluating a patient with obesity and impaired fasting glucose returning for follow-up after increasing Zepbound (tirzepatide) to 15mg weekly, monitoring should focus on gastrointestinal side effects, weight loss effectiveness, and glucose parameters, with laboratory testing including fasting glucose, HbA1c, and lipid profile.

Key Assessments to Perform

Clinical Parameters to Assess

• Weight change: Document percent weight loss from baseline (target ≥5% at 3 months) 1
• Blood pressure: Monitor for improvements as weight decreases 1
• Heart rate: Check for potential increases, which can occur with GLP-1 based medications 1

Laboratory Testing

• Fasting plasma glucose: Essential to monitor improvement in impaired fasting glucose 1
• HbA1c: To assess longer-term glycemic control and risk of progression to diabetes 1
• Lipid profile: Tirzepatide typically improves lipid parameters 1
• Renal function: Monitor creatinine/eGFR, especially if patient has experienced significant GI side effects with dehydration 1

Side Effect Assessment

Gastrointestinal Side Effects (Most Common)

• Nausea: Assess severity, timing (typically during dose escalation), and duration 1
• Vomiting: Document frequency and severity 1
• Diarrhea: Evaluate impact on daily activities 1
• Constipation: Often overlooked but common 1
• Dyspepsia/GERD symptoms: May require additional management 1
• Abdominal pain/distension: Assess if interfering with medication adherence 1

Other Important Side Effects

• Injection site reactions: Check for redness, irritation, or pain 1
• Fatigue: Common side effect that may impact quality of life 1
• Headache: Document frequency and severity 1
• Dizziness: May indicate dehydration from GI side effects 1

Management Algorithm Based on Findings

For Weight Response Assessment:

1. If weight loss ≥5% at 3 months: Continue current dose and management 1
2. If weight loss <5% at 3 months:
   • Assess medication adherence
   • Review dietary and physical activity compliance
   • Consider potential medication interactions
   • Evaluate for physiological resistance factors 1

For Side Effect Management:

1. For mild-moderate GI symptoms:

   • Recommend smaller meal portions
   • Slower eating pace
   • Adequate hydration
   • Temporary dietary modifications 1

2. For severe GI symptoms:

   • Consider temporary dose reduction
   • Anti-nausea medications if needed
   • Ensure adequate hydration 1

3. For persistent severe side effects:

   • Consider dose reduction or medication discontinuation
   • Evaluate alternative weight management approaches 1

Important Considerations and Pitfalls

• Pancreatitis risk: Ask about severe abdominal pain radiating to back; discontinue if suspected 1
• Gallbladder disease: Monitor for right upper quadrant pain, especially with rapid weight loss 1
• Dehydration: Can occur secondary to GI side effects, particularly in elderly patients 1
• Hypoglycemia risk: While uncommon with tirzepatide monotherapy in non-diabetic patients, assess for symptoms, especially if patient is on other glucose-lowering medications 1
• Medication adherence: Verify proper administration technique and consistent dosing 1

Follow-up Recommendations

• Schedule next follow-up in 1-3 months based on side effect profile and response
• Consider more frequent follow-up if side effects are significant or weight loss is suboptimal
• Document weight loss as percentage of initial body weight to properly assess effectiveness 1
• If response is adequate (≥5% weight loss) at 3 months, continue current dose and monitoring 1

Remember that most GI side effects are transient and typically improve after the dose escalation period. However, some patients may require ongoing management strategies for persistent symptoms.