What education should be provided to a patient taking the maximum dose of Pergolide (pergolide) and Ozempic (semaglutide), who is requesting refills and prefers Monjaro (tirzepatide) over Ozempic, but declines additional medication pending neurology recommendation?

From the Guidelines

I strongly recommend continuing the patient on their current maximum dose of pregabalin and Ozempic, while offering Mounjaro as an alternative GLP-1 receptor agonist if the patient prefers to switch from Ozempic, as this approach prioritizes the patient's morbidity, mortality, and quality of life outcomes. The patient should wait for neurology recommendations before adding any other medications. Pregabalin (brand name Lyrica) is effective for neuropathic pain at its maximum dose of 300mg twice daily, working by binding to calcium channels to reduce excitatory neurotransmitter release 1. For diabetes management, both Ozempic (semaglutide) and Mounjaro (tirzepatide) are effective GLP-1 receptor agonists, with Mounjaro having the added benefit of also activating GIP receptors, potentially offering better glycemic control and weight loss 1.

When transitioning between these medications, there's no washout period needed, but starting at the lowest dose of Mounjaro (2.5mg weekly) and titrating up gradually is recommended to minimize gastrointestinal side effects. The patient should be monitored for hypoglycemia if also on insulin or sulfonylureas, and should continue regular blood glucose monitoring during any medication transition. According to the most recent evidence from 2024, the maximum approved daily dose of semaglutide (Ozempic) is 2mg, and the maximum approved daily dose of tirzepatide (Mounjaro) is 15mg, which should be taken into consideration when making treatment decisions 1.

Key points to consider in this treatment approach include:

• Continuing the patient on their current maximum dose of pregabalin for neuropathic pain management
• Offering Mounjaro as an alternative to Ozempic for diabetes management, considering its potential benefits for glycemic control and weight loss
• Waiting for neurology recommendations before adding any other medications
• Monitoring for hypoglycemia and continuing regular blood glucose monitoring during medication transitions
• Following the recommended dosing and titration guidelines for Mounjaro to minimize gastrointestinal side effects.

From the FDA Drug Label

The maximum recommended dosage is 1 mg once weekly. The patient is on the max dose of Ozempic.

• Key points:
  • The patient is already on the maximum recommended dose of Ozempic.
  • No further dosage increase is recommended.
  • The patient should continue with the current dosage regimen as prescribed. 2

From the Research

Patient Education on Pergalbin and Ozempic

• The patient is currently on the maximum dose of Pergalbin and Ozempic, and has requested refills.
• The patient has been offered Monjuouro, which is similar to Ozempic, but has denied the need for other medication, opting to wait for a neurology recommendation.

Medication Overview

• Ozempic (semaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist used for the treatment of type 2 diabetes and obesity 3, 4, 5, 6.
• Pergalbin is not a recognized medication, and it is possible that it may be a misspelling or incorrect name for a different medication.

Efficacy and Safety of Semaglutide

• Semaglutide has been shown to be effective in reducing body weight and improving glycemic control in patients with type 2 diabetes and obesity 3, 5, 6.
• The medication has also been found to have a favorable safety profile, with common adverse events including nausea and diarrhea 3, 5, 6.
• A study comparing the cost-effectiveness of semaglutide and other antiobesity medications found that semaglutide was not cost-effective at current prices, but may be cost-effective if prices are reduced 4.

Alternative Treatment Options

• Monjuouro is not a recognized medication, and it is possible that it may be a misspelling or incorrect name for a different medication.
• Other GLP-1 receptor agonists, such as dulaglutide, have been shown to be effective in reducing cardiovascular outcomes in patients with type 2 diabetes 7.
• Oral semaglutide has been found to be effective in improving glycemic control and reducing body weight, and may be a viable alternative to subcutaneous semaglutide 5, 6.