What education materials should be provided to patients regarding semaglutide (glucagon-like peptide-1 receptor agonist) and tirzapatide (dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist)?

Patient Education Materials for Semaglutide and Tirzepatide

Patients starting semaglutide or tirzepatide require comprehensive education on medication administration, gastrointestinal side effect management, recognition of serious adverse events (pancreatitis, thyroid tumors, diabetic ketoacidosis), and the critical importance of never sharing injection pens with others. 1, 2, 3

Critical Safety Education

Never Share Injection Pens

• Patients must be explicitly instructed to never share their semaglutide or tirzepatide pen with another person, even if the needle is changed, as this carries risk for transmission of blood-borne pathogens 2

Thyroid C-Cell Tumor Warning

• Educate patients that both medications cause thyroid C-cell tumors in rodents (human relevance unknown) 2, 3
• Instruct patients to immediately report symptoms including: a lump in the neck, hoarseness, difficulty swallowing (dysphagia), or shortness of breath (dyspnea) 2
• Both medications are contraindicated in patients with personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 4, 5

Pancreatitis Recognition

• Teach patients to recognize pancreatitis symptoms: severe abdominal pain that may radiate to the back, with or without vomiting 1, 2
• Instruct patients to discontinue medication immediately and contact their physician if pancreatitis is suspected 2

Gastrointestinal Side Effect Management

Expected Side Effects

• Nausea, vomiting, diarrhea, and decreased appetite are the most common adverse events, typically mild to moderate in severity and occurring primarily during dose escalation 1, 4, 6, 7
• For semaglutide: nausea occurs in 18%, diarrhea in 12%, vomiting in 8% 6
• For tirzepatide: nausea occurs in 17-22%, diarrhea in 13-16%, vomiting in 6-10% 6

Practical Management Strategies

• Start with small portion sizes for meals 1, 4
• Limit or avoid alcohol and carbonated drinks 4, 5
• Avoid high-fat diets 4, 5
• Reassure patients that gastrointestinal symptoms typically improve over time as the body adjusts 1
• Emphasize the importance of slow dose titration to minimize nausea 1, 4

Dehydration and Renal Function

Volume Depletion Education

• Teach patients to recognize symptoms of dehydration: lightheadedness, orthostatic hypotension (dizziness upon standing), weakness 1, 2
• Instruct patients to hold medication if experiencing low oral intake or inability to maintain hydration 1
• Advise patients to take precautions to avoid fluid depletion, particularly during gastrointestinal side effects 2

Renal Impairment Warning Signs

• Educate patients about signs of worsening renal function 2
• Explain that acute kidney injury can occur, particularly in the setting of dehydration 5
• Inform patients that dialysis may be necessary if renal failure occurs 2

Medication Administration Instructions

Dosing Schedule for Semaglutide

• Administered subcutaneously once weekly 2
• If a dose is missed: administer as soon as possible within 5 days after the missed dose 2
• If more than 5 days have passed: skip the missed dose and administer the next dose on the regularly scheduled day 2
• Resume regular once-weekly dosing schedule 2

Dosing Schedule for Tirzepatide

• Administered subcutaneously once weekly 3
• Start at low dose with gradual titration to maximum tolerated dose (5 mg, 10 mg, 12.5 mg, or 15 mg weekly) 4, 5
• Assess effectiveness and safety at least monthly during dose escalation 4

Injection Site Guidance

• Both medications can be administered in the abdomen, thigh, or upper arm 3
• Rotate injection sites to prevent lipodystrophy 1

Glucose Monitoring and Hypoglycemia Risk

Enhanced Monitoring Requirements

• Instruct patients to more closely monitor glucose at home for the first 4 weeks of therapy, especially if taking insulin, sulfonylureas, or glinides 1
• Patients on insulin should be informed that their total daily insulin dose may be reduced by up to 20% when starting therapy 1

Diabetic Ketoacidosis Education (for patients with diabetes)

• Teach patients to recognize diabetic ketoacidosis symptoms: nausea, vomiting, abdominal pain, weakness 1
• Critical point: diabetic ketoacidosis can occur even if blood glucose readings are in the 150-250 mg/dL range (not just high glucose) 1
• Instruct patients to seek urgent medical attention if experiencing these symptoms 1

Vision and Retinopathy Monitoring

Diabetic Retinopathy Complications

• Patients should undergo appropriate, guideline-recommended eye examinations before starting therapy if not done within the last 12 months 1
• Instruct patients to contact their physician if changes in vision are experienced during treatment 2
• Discuss potential risk of diabetic retinopathy complications, particularly with semaglutide 1

Cardiovascular and Other Monitoring

Heart Rate Monitoring

• Educate patients about potential for elevated heart rate 1, 5
• Instruct patients to report symptoms of cardiac arrhythmias or tachycardia 5

Gallbladder Disease

• Inform patients that both medications may cause cholelithiasis (gallstones) and gallstone-related complications 1, 5
• Avoid use in patients with active gallbladder disease 1

Foot Care (for patients with diabetes)

• Educate patients regarding proper foot care, especially those with diabetic neuropathy 1
• Instruct patients to report any foot wounds immediately 1

Pregnancy and Contraception

Reproductive Counseling

• Advise women to inform their healthcare provider if they are pregnant or intend to become pregnant 2
• Advise pregnant women of potential risk to the fetus 2
• All patients of reproductive potential must be counseled regarding the use of reliable methods of contraception 1

Medication Interactions

Drug Absorption Considerations

• Both medications delay gastric emptying, which may affect absorption of oral medications 4, 5, 3
• This effect is most pronounced after the first dose and diminishes over time 3
• Patients taking oral medications with narrow therapeutic indices require closer monitoring 5

Discontinue Before Starting

• Patients must discontinue DPP-4 inhibitors before starting GLP-1 receptor agonists 1

Long-Term Expectations

Weight Loss and Maintenance

• Long-term use is necessary to maintain weight loss benefits 5
• Medication must be used in conjunction with lifestyle modifications for optimal results 5
• For tirzepatide: expect 15-21% weight loss at 72 weeks depending on dose 5, 7
• For semaglutide 2.4 mg: expect approximately 9.6% weight loss at 72 weeks 1