From the Guidelines
Zepbound (tirzepatide) can be used after gastric sleeve surgery, but with caution and careful monitoring, as patients with a history of gastric surgery may be at increased risk of adverse effects, as noted in studies such as 1 and 1. When considering the use of Zepbound after gastric sleeve surgery, it's essential to weigh the potential benefits against the risks. The medication works by mimicking GLP-1 and GIP hormones, which regulate appetite and blood sugar, complementing the restrictive effects of the gastric sleeve. However, patients who've had gastric sleeve surgery may require lower doses due to altered absorption and metabolism, as suggested by the study 1.
Key Considerations
- Patients should wait until they've fully recovered from surgery and their diet has stabilized, usually 3-6 months post-operation, before starting Zepbound.
- The starting dose is usually 2.5mg once weekly by subcutaneous injection, gradually increasing to a maintenance dose of 5-15mg weekly based on response and tolerability, as seen in similar medications like semaglutide, which is discussed in 1.
- Regular monitoring by a healthcare provider is essential to adjust dosing and manage potential side effects, such as nausea, vomiting, and diarrhea, which could be more pronounced in post-surgical patients.
- Adequate hydration and a protein-rich diet are important while using Zepbound after bariatric surgery to prevent nutritional deficiencies and optimize weight loss results.
Potential Risks and Contraindications
- Patients with a history of pancreatitis, medullary thyroid cancer, or multiple endocrine neoplasia type 2 (MEN2) should use Zepbound with caution or avoid it altogether, as noted in 1 and 1.
- Zepbound may delay gastric emptying, which could be a concern for patients with gastroparesis or other gastrointestinal issues, as mentioned in 1.
- The medication may also increase the risk of hypoglycemia when used with insulin, sulfonylureas, or glinides, as discussed in 1.
From the Research
Zepbound after Gastric Sleeve
- Zepbound, also known as tirzepatide, is a medication that has been studied for its effectiveness in weight loss after gastric sleeve surgery 2, 3, 4, 5, 6.
- Studies have shown that tirzepatide can lead to significant weight loss in patients with weight recidivism after sleeve gastrectomy, with some studies reporting a mean weight loss of 12.0% at 6 months 4 and 15.5% at 6 months 6.
- Tirzepatide has been compared to other medications, such as semaglutide, and has been shown to be more effective in achieving weight loss in some studies 2, 6.
- The medication has also been shown to improve metabolic parameters, such as HbA1c, and reduce the risk of adverse events, such as hypoglycemia 5.
- However, tirzepatide can cause gastrointestinal adverse events, such as diarrhea, nausea, and vomiting, which are similar to those caused by other GLP-1 receptor agonists 5.
Comparison to Semaglutide
- Semaglutide is another medication that has been studied for its effectiveness in weight loss after gastric sleeve surgery 2, 6.
- Studies have shown that semaglutide can lead to significant weight loss in patients with weight recidivism after sleeve gastrectomy, but may not be as effective as tirzepatide in achieving weight loss 2, 6.
- Semaglutide has been shown to be effective in improving metabolic parameters, such as HbA1c, and reducing the risk of adverse events, such as hypoglycemia 5.
Safety and Efficacy
- Tirzepatide and semaglutide have been shown to be safe and effective in achieving weight loss in patients with weight recidivism after sleeve gastrectomy 2, 3, 4, 5, 6.
- However, the long-term efficacy and safety of these medications need to be further studied, as weight regain after discontinuation of the medication is highly likely 6.
- The high cost of these medications can also limit their use, and further studies are needed to determine their cost-effectiveness 6.