Weight Loss Information

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Knowledge is POWER so let us explain your treatment in full

This is your information pack. We ask that you read this before attending your treatment and keep it as it contains information you may need later.

We offer a completely exclusive and inclusive service you wont find anywhere else that covers everything you will need on your weight loss journey.

Start your weight loss journey through our medical medication therapy or non medical total diet replacement options , or combined these for the biggest results, and we will provide you with free monthly health screens, full body biometric scans, access to our online community, gym and gym class offers. We also have fat melting machines, lymphatic drainage to tone and sculpt, at home online personal trainers and help with skin tightening. We aim to make weight loss fun by meeting new like minded friends and of course getting you those big results.

WHY YOU SHOULD TRUST US

Our medical weight loss practitioners have completed intense training provided by The National Weight Loss Programme. They have studied under Dr Matt Capehorn who has run the largest Obesity Clinic in the United Kingdom for over 12 years. Dr Capehorn has also been involved in a huge number of research studies relating to obesity and sits as an advisor on multiple obesity council boards. Having the input of Dr Capehorn provides our clients with unparalleled support during their weight loss journey. Dr Capehorns programme is based on hundreds of years of research and hard facts, is endorsed by the National Institute of Clinical Excellence and supported by the Royal College of Nursing.

We have worked really hard to try and develop a system that fully supports you and all of your possible needs, we have a medical and non medical approach, medication and a medically formulated diet. The medication curbs your hunger and you are expected to loose a stone a month this way, the medically fortified diet (which is delicious I might add, cheesy bacon carbonara yes please) aims to shed 2.2 stone in just 6 weeks. However, when combined these give outstanding guaranteed results. The diet replaces all of your weekly food shop and costs the same as your weekly food shop so you therefore arnt out of pocket each month.
We also wanted to give you a safe space to chat, swap recipes and tips and meet people who are also on a weightloss journey so we started an online private community so you can make friends along the way. We also wanted you to get the benefits of any perks we could maybe pass along so we put special offers from gyms and trainers that they have given exclusively to our clinic. We want to make sure you really succeed at your weightloss and the facts are this if you buy something on line with no help no guidance and no accountability you are statistically going to have side effects and fail. We invite you to come see us once a month for free a health check to physically see your body improving and discuss how its going with a weight loss consultant so you can keep on track. We are also available night and day should you have any issues.
Moving on from this we also have fat melting machines for those stubborn areas, lymphatic drainage which just treats so many things its a personal favourite of ours and is mind blowing all the benefits it has from better skin to cellulite removal, body sculpting, weight reduction etc etc . We touch a little on supplements and diet and exercise in your consultation so you can be the healthiest version of you but moving on from that we wanted to provide a service in a safe space where you could get in shape that you were most likely to use, so we introduced personal at home online trainers who are nurses and youtube stars who specialise in weight loss and rehabilitation recovery exercises.

So now youve hit you target, youve smashed it and we are so very proud of you… but your worried you have loose skin, well we have an answer for that too dont worry.

Lastly the ups and the downs, the reality of it all, the online community is there to be used on the days you feel like giving up, insecure or the past is biting at you. We wanted to create something to FULLY support people not just at there highs but more importantly in the lows, we are always here for a chat and the people in the group are all lovely welcoming individuals who would be happy to cheer you on because everyone deserves to be happy, to be confident in their body and live longer for their family.

What is Prescription Weight Loss?

We are delighted to able to bring you the world renowned prescription weight loss drugs as they come on the market. Saxenda , Ozempic, Wegovy and Mounjaro are revolutionising prescription weight loss as we are sure you will have heard about them all over the news, Hollywoods best kept secret now revealed and now available to you. You are invited to attend a consultation where you will meet with a medical weight loss expert who will do a number of tests (measurement of your waist circumference, weight, height, blood glucose and medical history) to determine your suitability for the medication.

How does it Work?

Your body produces two hormones, Ghrelin (the gremlin) which causes hunger and Leptin which makes you feel full. Your medication works on the GLP-1 protein which increases your Leptin levels removing your cravings, stimulating your insulin production making your cells absorb more sugars giving you more energy and slowing your stomach emptying time making you feel fuller for longer.

Used to Treat

This prescription weight loss is used to treat people of larger waist circumferences or body mass index’s (BMI). Women with a waist circumference greater than 88cm and men with a waist circumference greater than 102cm are at much higher risk of diseases such as Diabetes, Heart Failure, COPD and Cancer. There are over 300 disease’s and 13 different Cancers directly related to obesity. But the good news is you can decrease your risk of dying by up to 50% if you loose 10kg of body fat and we are here to insure you do this in a healthy way. This medication is quickly becoming a holy grail in medicine and is now used to treat obesity, heart failure and diabetes. However, it has also been shown to help people reduce or remove menopause symptoms, regulate high blood pressure, beat addictions such as smoking and even fight against anxiety and depression. It is also believed to stop kidney and liver disease, slash the risk of dying from covid and if all this wasnt enough GLP-1`s are anti aging life extending drugs so they will help us live longer. We are seeing this drug being applied across the board in more and more studies for ailments with remarkable results and its expected that most of us will use the drug in some form through out our lifetime.

How Long will it Last?

Your Saxenda medication is a daily injection and your Ozempic/Wegovy/Mounjaro medication are weekly injections. Sexanda lasts only a few days in your body where as the once weekly injections Ozempic/Wegovy/Mounjaro can take some weeks before they are fully out of the bod. For your convivence we generally provide a months supply of medication and give a free health check and biometric scan when you come to collect your monthly prescription. Possible weight regain and expected length of time taking the drug will be further explained at consultation but varies on how much weight you would like to loose and general eating habits etc.

What’s in the Treatment Information pack?

You will receive your information pack when you are deemed suitable for treatment and are given your medication. The pack includes a guide to how fat affects the body and how to recognise your risk of disease and reduce that risk, how weight is affected by sleep patterns, diet , recommended diets, understanding calories, intermittent fasting information, exercise, information on putting weight back on and how to avoid this, a guide to how your medication works and lots of tips throughout.

Does it Hurt?

No most people barely feel their injections. An extremely fine diabetic needle nearly invisible to the eye is used and this treatment is not described as painful and can be tolerated well with no anaesthetic.

BEFORE YOUR APPOINTMENT

Please be aware that you can not receive this medication if you –
Aged under 18 or above 75
Severe renal/kidney impairment (with eGFR of 50 or below) or a history of renal disease
Severe hepatic/liver impairment
Personal or family history of medullary thyroid cancer(MTC)
Hypersensitivity to Ozempic/Saxenda/Wegovy/Mounjaro or to any of the excipients: disodium phosphate dihydrate, propylene glycol, phenol and water for injection.
Concurrent treatment with any other products for weight management
Weight problems related to endocrinological or eating disorders
Concurrent insulin or sulfonylurea
Patients on warfarin (more frequent INR monitoring required)
Concurrent use of any medicinal products with may cause weight gain
Pregnancy, breastfeeding or trying to/planning to become pregnant.
Congestive heart failure
History of pancreatitis, gallbladder disease, inflammatory bowel disease, diabetic gastroparesis.

If you have diabetes you will need to discuss the medication with your diabetic nurse before hand who we will also need to contact.
Do cancel if you are at all unwell, even minor coughs and colds can increase your risk of post treatment complications.
Please try not to drink a large amount of water before your appointment as this will change your weight.
Please wear comfortable clothes where access to your waist can be had. We usually recommend you wear similar clothes each time to get a true weight reading.
Do contact the clinic to discuss any illness or new medicines prior to attending.

TREATMENT AFTER CARE

So you have your prescription what now ?

Thank you for choosing the Clybaun Clinic to have your treatment with. We endeavor to assure you have an excellent experience from start to finish and this aftercare advice has been devised from the frequently asked Do`s and Don’t`s of post treatment. Please understand this advice is to ensure you achieve optimum results and by not following your aftercare advice your desired treatment effects may be affected and you may incur unwanted complications. Should you have any concerns please contact a member of the team.

AFTERCARE ADVICE

During your consultation you will be given an information pack containing everything you need for on going care. You will need to notify us one week before you prescription is due for renewal and come to the clinic once monthly for a review and to collect a repeat prescription. You will have on going support from professionals and new friends through our Facebook community but you are welcome to contact the clinic directly if you have any questions. When you start any new medication it is advised you start low and build up to avoid any side effects. If you start to experience side effects such as nausea, diarrhoea, constipation, vomiting, injection site reaction, low blood sugar (hypoglycaemia), headache, tiredness (fatigue), dizziness, stomach pain, and change in enzyme (lipase) levels in your blood you may need to reduce your dose.

Emergencies

All drugs carry risks. The most serious but rare risk is anaphylaxis (a severe allergic reaction) which in itself is life threatening and requires immediate medical attention. Clients have access to our 24 hour phone number (07809902432) should an emergency arise. However, as explained to you if you experience any shortness of breath, wheezing, coughing, difficulty speaking, swallowing, swelling of the tongue, eyelids, lips, hoarseness of the voice, stomach pain, nausea or diarrhea you should ring 999 immediately do not wait.

Manufactures Information

Mounjaro

Mounjaro

What Mounjaro KwikPen is and what it is used for

Mounjaro is a medicine that contains an active substance called tirzepatide.

Mounjaro is used to treat adults with type 2 diabetes mellitus by reducing the level of sugar in the body only when the levels of sugar are high.

Mounjaro is also used for weight loss and weight maintenance in adults. Mounjaro primarily works by regulating your appetite, giving you a sense of satiety (‘fullness’), making you feel less hungry and experience less food cravings. This will help you eat less food and reduce your body weight.

What Mounjaro is used for

In type 2 diabetes, Mounjaro is used:

– on its own when you can’t take metformin (another diabetes medicine).

– with other medicines for diabetes when they are not enough to control your blood sugar levels. These other medicines may be medicines taken by mouth and/or insulin given by injection.

It is important to continue to follow the advice on diet and exercise given to you by your doctor, pharmacist or nurse.

Mounjaro is also used together with reduced-calorie diet and increased physical activity for weight loss and to help keep the weight under control in adults, who have:

– a BMI of 30 kg/m² or greater (obesity) or

– a BMI of at least 27 kg/m² but less than 30 kg/m² (overweight) and weight-related health problems (such as prediabetes, type 2 diabetes, high blood pressure, abnormal levels of fats in the blood, breathing problems during sleep called ‘obstructive sleep apnoea’ (OSA) or a history of heart attack, stroke or blood vessel problems)

BMI (Body Mass Index) is a measure of your weight in relation to your height.

What you need to know before you use Mounjaro KwikPen

Do not use Mounjaro KwikPen – If you are allergic to tirzepatide or any of the other ingredients of this medicine (listed in section 6).

Warnings and precautions

Talk to your doctor, pharmacist or nurse before using Mounjaro if:

– you have severe problems with food digestion or food remaining in your stomach for longer than normal (including severe gastroparesis).

– you have ever had pancreatitis (inflammation of the pancreas which may cause severe pain in the stomach and back which does not go away).

– you have a problem with your eyes (diabetic retinopathy or macular oedema).

– you are using a sulphonylurea (another diabetes medicine) or insulin for your diabetes, as low blood sugar (hypoglycaemia) can occur. Your doctor may need to change your dose of these other medicines to reduce this risk.

When starting treatment with Mounjaro, in some cases you may experience loss of fluids/dehydration, e.g. due to vomiting, nausea and/or diarrhoea, which may lead to a decrease in kidney function. It is important to avoid dehydration by drinking plenty of fluids. Contact your doctor if you have any questions or concerns.

If you know that you are due to have surgery where you will be under anaesthesia (sleeping), please tell your doctor that you are taking Mounjaro.

Children and adolescents

This medicine should not be given to children and adolescents under 18 years of age because it has not been studied in this age group.

Other medicines and Mounjaro

Tell your doctor, pharmacist or nurse if you are using, have recently used or might use any other medicines.

Pregnancy

This medicine should not be used during pregnancy as the effects of this medicine on an unborn child are not known. If you are pregnant, think you may be pregnant or are planning to have a baby, ask your doctor for advice before using this medicine. It is recommended to use contraception while using this medicine.

If you are a woman with obesity or overweight and are using oral contraceptives, you should consider also using a barrier method of contraception (e.g., a condom) or switching to a non-oral contraceptive method for 4 weeks after starting Mounjaro and for 4 weeks after each increase in dose.

Breast-feeding

It is unknown whether tirzepatide passes into breast milk. A risk to newborns/infants cannot be ruled out. If you are breast-feeding or are planning to breast-feed, talk to your doctor before using this medicine. You and your doctor should decide if you should stop breast-feeding or delay using Mounjaro.

Driving and using machines

Mounjaro KwikPen contains sodium

This medicine contains less than 1 mmol sodium (23 mg) per dose, that is to say essentially ‘sodium-free’.

Mounjaro KwikPen contains benzyl alcohol

Each multiple-dose pre-filled pen contains 5.4 mg Benzyl Alcohol [E1519] in each 0.6 ml dose. Benzyl alcohol may cause allergic reactions. Ask your doctor or pharmacist for advice if you have a liver or kidney disease. This is because large amounts of benzyl alcohol can build-up in your body and may cause side effects (called “metabolic acidosis”).

How to use Mounjaro KwikPen

Always use this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure how to use this medicine. Do not change your dose unless your doctor has told you to.

Testing blood glucose levels

If you are using Mounjaro with a sulphonylurea or insulin, it is important that you test your blood glucose levels as instructed by your doctor, pharmacist or nurse (see section 2, ‘Warnings and precautions’).

If you use more Mounjaro than you should If you use more Mounjaro than you should talk to your doctor immediately. Too much of this medicine may cause low blood sugar (hypoglycaemia) and can make you feel sick or be sick.

Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Serious side effects

Uncommon (may affect up to 1 in 100 people)

– Inflamed pancreas (acute pancreatitis) which could cause severe pain in the stomach and back which does not go away. You should see a doctor immediately if you experience such symptoms.

Rare (may affect up to 1 in 1 000 people)

– Severe allergic reactions (e.g. anaphylactic reaction, angioedema). You should get immediate medical help and inform your doctor if you experience symptoms such as breathing problems, rapid swelling of the lips, tongue and/or throat with difficulty swallowing and a fast heartbeat.

Other side effects

Very common (may affect more than 1 in 10 people)

– Low blood sugar (hypoglycaemia) when tirzepatide is used for the treatment of type 2 diabetes with medicines that contain a sulphonylurea and/or insulin. If you are using a sulphonylurea or insulin, the dose may need to be lowered while you use tirzepatide (see section 2, ‘Warnings and precautions’). Symptoms of low blood sugar may include headache, drowsiness, weakness, 5 dizziness, feeling hungry, confusion, irritability, fast heartbeat and sweating. Your doctor should tell you how to treat low blood sugar.

– Feeling sick (nausea)

* – Diarrhoea

* – Being sick (vomiting)

– this usually goes away over time

* – Stomach (abdominal) pain

– Constipation.

*These side effects are usually not severe. They are most common when first starting tirzepatide but decrease over time in most patients.

Constipation, abdominal pain and vomiting are very common in patients treated with weight management (including patients with OSA and obesity) but common in patients treated for type 2 diabetes. Common (may affect up to 1 in 10 people)

– Low blood sugar (hypoglycaemia) when tirzepatide is used for type 2 diabetes with both metformin and a sodium-glucose co-transporter 2 inhibitor (another diabetes medicine) Symptoms of low blood sugar may include headache, drowsiness, weakness, dizziness, feeling hungry, confusion, irritability, fast heartbeat and sweating. Your doctor should tell you how to treat low blood sugar.

– Allergic reaction (hypersensitivity) (e.g., rash, itching, and eczema)

– Dizziness observed in patients treated for weight management (including patients with OSA and obesity) – Low blood pressure observed in patients treated for weight management (including patients with OSA and obesity) – Feeling less hungry (decreased appetite) observed in patients treated for type 2 diabetes – Indigestion (dyspepsia) – Bloating of the stomach – Burping (eructation) – Gas (flatulence) – Reflux or heartburn (also called gastroesophageal reflux disease – GORD) – a disease caused by stomach acid coming up into the tube from your stomach to your mouth – Hair loss observed in patients treated for weight management (including patients with OSA and obesity) – Feeling tired (fatigue) – Injection site reactions (e.g. itching or redness) – Fast pulse – Increased levels of pancreatic enzymes (such as lipase and amylase2 ) in blood. Fast pulse is a common side effect when used for type 2 diabetes and uncommon when used for weight management. Increased levels of amylase is uncommon in weight management. Uncommon (may affect up to 1 in 100 people) – Low blood sugar (hypoglycaemia) when tirzepatide is used with metformin for type 2 diabetes. Symptoms of low blood sugar may include headache, drowsiness, weakness, dizziness, feeling hungry, confusion, irritability, fast heartbeat and sweating. Your doctor should tell you how to treat low blood sugar. – Gallstones – Weight loss observed in patients treated for type 2 diabetes – Injection site pain – Increased calcitonin levels in blood – Cholecystitis (infection of the gallbladder) observed in patients treated for weight management (including patients with OSA and obesity) – Changed sense of taste Reporting of side effects If you get any side effects, talk to your doctor, pharmacist or nurse.

Saxenda

The main benefits may include:

1.Saxenda (Liraglutide) is 97% similar to natural human GLP-1 and therefore acts as a physiological regulator of appetite and thereby reducing food intake by reducing feelings of hunger and increasing feelings of fullness/satiety. The exact underlying mechanism of action is not entirely clear.

2.Saxenda(Liraglutide 3mg injection)is a newly licensed medication indicated for reduction in appetite as an adjunct to a reduced-calorie diet and increased physical activity for weight management of patients with an increased Body Mass Index (BMI).

3.For long term success the treatment needs to be combined with lifestyle changes including nutritional, excercise and behavioural habits. Access to support modules are given through the Weight Journey online service.

4.Weight loss can lead to secondary benefits by improving weight loss related health problems such as cardiovascular risk factors (including hypertension, blood glucose levels and waist circumference) and physical health-related Quality of Life.

You should understand that:

1.Alternatives to Saxenda therapy are surgical procedures, oral medical treatments (including Orlistat)and / or dietary and lifestyle changes alone.

2.Several weeks to months of treatment may be required depending on your individual response.

3.If a missed dose is more than 12 hours late, the missed dose should not be taken and the next dose should be taken at the normal time.

4.It is essential to combine eating, exercise and behavioral modifications with Saxenda.

5.Saxenda should not be used in combination with another GLP-1 receptor agonist, insulin or insulin secretagogues (such as sulfonylureas)due to the risk of hypoglycaemia.

6.Upon initiation of liraglutide treatment in patients on warfarin or other coumarin derivatives more frequent monitoring of International Normalised Ratio (INR) is recommended.

7.Saxenda® causes a delay of gastric emptying, and has the potential to impact the absorption of concomitantly administered oral medications. Monitor for potential consequences of delayed absorption of oral medications concomitantly administered with Saxenda®

8.There are several special warnings and precautions for use of Saxenda including warnings on pancreatitis, cholelithiasis and cholecystitis, thyroid disease, heart rate, dehydration and hypoglycaemia in people with type 2 diabetes.

9.Thyroid adverse events, such as goitre have been reported in particular in patients with pre-existing thyroid disease. Saxenda should therefore be used with caution in patients with thyroid disease.

10.A higher rate of cholelithiasis and cholecystitis(gallstone and gallbladder disease)has been observed in patients treated with liraglutide. Cholelithiasis and cholecystitis may lead to hospitalisation and cholecystectomy(surgery to remove the gallbladder). Patients should be aware of the characteristic symptoms of cholelithiasis and cholecystitis.

11.Signs and symptoms of dehydration, including renal impairment and acute renal failure, have been reported in patients treated with Liraglutide. Patients treated with liraglutide should be advised of the potential risk of dehydration in relation to gastrointestinal side effects and take precautions to avoid fluid depletion. Patients should also be aware of the symptoms of increased heart rate.

12.Acute pancreatitis has been observed with the use of Liraglutide. Patients and their carers should be told how to recognise signs and symptoms of acute pancreatitis and advised to seek immediate medical attention if symptoms develop. If pancreatitis is suspected, liraglutide should be discontinued; if acute pancreatitis is confirmed, liraglutide should not be restarted.

13.Liraglutide may cause dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures in both genders of rats and mice. It is unknown whether Saxenda® causes thyroid C-cell tumors, including medullary thyroid carcinoma(cancer, MTC), in humans, as the human relevance of liraglutide-induced rodent thyroid C-cell tumors has not been determined. Patients should be aware of symptoms of thyroid tumours(such as a mass in the neck, difficulty swallowing, difficulty breathing or shortness of breath, persistent hoarseness).

Side Effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.
Serious side effects
Cases of inflammation of the pancreas (pancreatitis) have been reported uncommonly in patients using
Saxenda®. Pancreatitis is a serious, potentially life-threatening medical condition.
Stop taking Saxenda® and contact a doctor immediately if you notice any of the following serious
side effects:
• Severe and persistent pain in the abdomen (stomach area) which might reach through to your
back, as well as nausea and vomiting, as it could be a sign of an inflamed pancreas
(pancreatitis).

Other side effects
Very common: may affect more than 1 in 10 people
• Feeling sick (nausea), being sick (vomiting), diarrhoea, constipation, headache – these usually
go away after a few days or weeks.

Common: may affect up to 1 in 10 people
• Problems affecting the stomach and intestines, such as indigestion (dyspepsia), inflammation in
the lining of the stomach (gastritis), stomach discomfort, upper stomach pain, heartburn, feeling
bloated, wind (flatulence), belching and dry mouth
• Feeling weak or tired
• Changed sense of taste
• Dizziness
• Difficulty sleeping (insomnia). This usually occurs during the first 3 months of treatment
• Gallstones
• Injection site reactions (such as bruising, pain, irritation, itching and rash)
• Low blood sugar (hypoglycaemia). The warning signs of low blood sugar may come on
suddenly and can include: cold sweat, cool pale skin, headache, fast heartbeat, feeling sick,
feeling very hungry, changes in vision, feeling sleepy, feeling weak, being nervous, being
anxious, confusion, difficulty concentrating and shaking (tremor). Your doctor will tell you
how to treat low blood sugar and what to do if you notice these warning signs
• increase of pancreatic enzymes, such as lipase and amylase.

Uncommon: may affect up to 1 in 100 people
• Loss of fluids (dehydration). This is more likely to occur at the start of treatment and may be
due to being sick (vomiting), feeling sick (nausea) and diarrhoea
• Delay in the emptying of the stomach
• Inflamed gall bladder
• Allergic reactions including skin rash
• Feeling generally unwell
• Faster pulse.

Rare: may affect up to 1 in 1,000 people
• Reduced kidney function
• Acute kidney failure. Signs may include reduction in urine volume, metallic taste in mouth and
easily bruising.

Ozempic / Wegovy

Ozempic
This link will take you to the information leaflet that comes with the product.
https://www.medicines.org.uk/emc/files/pil.9748.pdf

The main benefits may include:

1.Ozempic (Semaglutide) is 94% similar to natural human GLP-1 and therefore acts as a physiological regulator of appetite and thereby reducing food intake by reducing feelings of hunger and increasing feelings of fullness/satiety. The exact underlying mechanism of action is not entirely clear.

2.Ozempicis a newly licensed medication indicated for the treatment of type-2 diabetes. It is currently undergoing clinical trial to gain a license for the treatment of obesity. In the mean time, your medical practitioner may prescribe this medication for you ‘off-label’

3.For long term success the treatment needs to be combined with lifestyle changes including nutritional, exercise and behavioural habits.

You should understand that:
1.Alternatives to Ozempic therapy are surgical procedures, oral medical treatments(including Orlistat) and / or dietary and lifestyle changes alone.

2.Several weeks to months of treatment may be required depending on your individual response.

3.If a missed dose is more than 5 days late, the missed dose should not be taken, and the next dose should be taken at the normal time.

4.It is essential to combine eating, exercise and behavioural modifications with Ozempic.

5.Ozempic should not be used in combination with another GLP-1 receptor agonist, insulin or insulin secretagogues (such as sulfonylureas) due to the risk of hypoglycaemia.

6.Upon initiation of Ozempic treatment in patients on warfarin or other coumarin derivatives more frequent monitoring of International Normalised Ratio (INR) is recommended.

7.Ozempic causes a delay of gastric emptying and has the potential to impact the absorption of concomitantly administered oral medications. Monitor for potential consequences of delayed absorption of oral medications concomitantly administered with Ozempic A higher rate of cholelithiasis and cholecystitis (gallstone and gallbladder disease) has been observed in patients treated with semaglutide. Cholelithiasis and cholecystitis may lead to hospitalisation and cholecystectomy (surgery to remove the gallbladder). Patients should be aware of the characteristic symptoms of cholelithiasis and cholecystitis.

8.There are several special warnings and precautions with Ozempic including warnings on pancreatitis, chloelitious, cholecyctious, thyroid disease, heart rate, dehydration and hypoglycaemia in people with type 2 diabetes.

9.Thyroid adverse events, such as goitre have been reported in particular patients with pre-existing thyroid disease. Ozempic should therefore be used with caution in patients with thyroid disease.

10.thyroid disease. Ozempic should therefore be used with caution in patients with thyroid disease.9.Thyroid adverse events, such as goitre have been reported in particular in patients with pre-existing8.There are several special warnings and precautions for use of Ozempic including warnings on pancreatitis, cholelithiasis and cholecystitis, thyroid disease, heart rate, dehydration and hypoglycaemia in people with type 2 diabetes.

11.Signs and symptoms of dehydration, including renal impairment and acute renal failure, have been reported in patients treated with Semaglutide. Patients treated with semaglutide should be advised of the potential risk of dehydration in relation to gastrointestinal side effects and take precautions to avoid fluid depletion. Patients should also be aware of the symptoms of increased heartrate.

12.Acute pancreatitis has been observed with the use of Semaglutide. Patients and their carers should be told how to recognise signs and symptoms of acute pancreatitis and advised to seek immediate medical attention if symptoms develop. If pancreatitis is suspected, semaglutide should be discontinued; if acute pancreatitis is confirmed, semaglutide should not be restarted.

13.Ozempicmay cause dose-dependent and treatment-duration-dependent thyroid C-cell tumours at clinically relevant exposures in both genders of rats and mice. It is unknownwhetherOzempic causes thyroid C-celltumours, including medullary thyroid carcinoma (cancer, MTC), inhumans, as the human relevanceofsemaglutide-induced rodent thyroid C-celltumourshas notbeen determined. Patients should be aware of symptoms of thyroid tumours (such as a mass in theneck, difficulty swallowing, difficulty breathing or shortness of breath, persistent hoarseness).

Side Effects
(please read full Patient information leaflet for most up to date information –https://www.medicines.org.uk/emc/product/9750/pil)

Serious side effects
Common: may affect up to 1 in 10 peoplecomplications of diabetic eye disease (retinopathy) – you should inform your doctor if you experience eye problems, such as changes in vision, during treatment with this medicine.
Uncommon: may affect up to 1 in 100 peopleInflamed pancreas (acute pancreatitis) which could cause severe pain in the stomach and back which does not go away. You should see a doctor immediately if you experience such symptoms.
Rare: may affect up to 1 in 1,000 peoplesevere allergic reactions (anaphylactic reactions). You should seek immediate medicalhelp and inform your doctor straight away if you get symptoms suchas breathingproblems, swelling of face and throat and a fast heartbeat.

Other side effects

Very common: may affect more than 1 in 10 peoplefeeling sick (nausea) – this usually goes away over timediarrhoea – this usually goes away over time

Common: may affect up to 1 in 10 peoplebeing sick (vomiting)low blood sugar (hypoglycaemia) when this medicine is used with another antidiabeticmedicine.The warning signs of low blood sugar may come on suddenly. They can include: coldsweat, cool pale skin, headache, fast heartbeat, feeling sick (nausea) or very hungry, changes in vision, feeling sleepy or weak, feeling nervous, anxious or confused, difficulty concentrating or shaking. Low blood sugar is more likely to happen if you also take asulfonylurea or insulin. Your doctor may reduce your dose of these medicines before youstart using this medicine.indigestioninflamed stomach (‘gastritis’) –the signs include stomach ache, feeling sick (nausea) orbeing sick (vomiting)reflux or heartburn–also called ‘gastro-esophageal reflux disease’ (GERD)stomach painbloating of the stomachconstipationburpinggall stonesdizzinesstirednessweight loss , less appetitegas (flatulence)increase of pancreatic enzymes (such as lipase and amylase).Uncommon: may affect up to 1 in 100 peoplechange in the way food or drink tastesfast pulseinjection site reactions–such as bruising, pain, irritation, itching and rash

Mounjaro

This link will take you to the information leaflet that comes with the product.
https://www.medicines.org.uk/emc/files/pil.15481.pdf

What Mounjaro KwikPen is and what it is used for

Mounjaro is a medicine that contains an active substance called tirzepatide.
Mounjaro is used to treat adults with type 2 diabetes mellitus by reducing the level of sugar in the
body only when the levels of sugar are high.
Mounjaro is also used for weight loss and weight maintenance in adults. Mounjaro primarily works by
regulating your appetite, giving you a sense of satiety (‘fullness’), making you feel less hungry and
experience less food cravings. This will help you eat less food and reduce your body weight.

What Mounjaro is used for

In type 2 diabetes, Mounjaro is used:
– on its own when you can’t take metformin (another diabetes medicine).
– with other medicines for diabetes when they are not enough to control your blood sugar levels.
These other medicines may be medicines taken by mouth and/or insulin given by injection.
It is important to continue to follow the advice on diet and exercise given to you by your doctor,
pharmacist or nurse.

Mounjaro is also used together with reduced-calorie diet and increased physical activity for weight
loss and to help keep the weight under control in adults, who have:
– a BMI of 30 kg/m² or greater (obesity) or
– a BMI of at least 27 kg/m² but less than 30 kg/m² (overweight) and weight-related health
problems (such as prediabetes, type 2 diabetes, high blood pressure, abnormal levels of fats
in the blood, breathing problems during sleep called ‘obstructive sleep apnoea’ or a history
of heart attack, stroke or blood vessel problems)
BMI (Body Mass Index) is a measure of your weight in relation to your height.

What you need to know before you use Mounjaro KwikPen

Do not use Mounjaro KwikPen
– If you are allergic to tirzepatide or any of the other ingredients of this medicine (listed in
section 6).
Warnings and precautions
Talk to your doctor, pharmacist or nurse before using Mounjaro if:
– you have severe problems with food digestion or food remaining in your stomach for longer
than normal (including severe gastroparesis).
– you have ever had pancreatitis (inflammation of the pancreas which may cause severe pain in
the stomach and back which does not go away).
– you have a problem with your eyes (diabetic retinopathy or macular oedema).
– you are using a sulphonylurea (another diabetes medicine) or insulin for your diabetes, as low
blood sugar (hypoglycaemia) can occur. Your doctor may need to change your dose of these
other medicines to reduce this risk.
When starting treatment with Mounjaro, in some cases you may experience loss of fluids/dehydration,
e.g. due to vomiting, nausea and/or diarrhoea, which may lead to a decrease in kidney function. It is
important to avoid dehydration by drinking plenty of fluids. Contact your doctor if you have any
questions or concerns.
Children and adolescents
This medicine should not be given to children and adolescents under 18 years of age because it has not
been studied in this age group.
Other medicines and Mounjaro
Tell your doctor, pharmacist or nurse if you are using, have recently used or might use any other
medicines.
Pregnancy
This medicine should not be used during pregnancy as the effects of this medicine on an unborn child
are not known. If you are pregnant, think you may be pregnant or are planning to have a baby, ask
your doctor for advice before using this medicine. It is recommended to use contraception while using
this medicine.
If you are a woman with obesity or overweight and are using oral contraceptives, you should consider
also using a barrier method of contraception (e.g., a condom) or switching to a non-oral contraceptive
method for 4 weeks after starting Mounjaro and for 4 weeks after each increase in dose.
Breast-feeding
It is unknown whether tirzepatide passes into breast milk. A risk to newborns/infants cannot be ruled
out. If you are breast-feeding or are planning to breast-feed, talk to your doctor before using this
medicine. You and your doctor should decide if you should stop breast-feeding or delay using
Mounjaro.

Driving and using machines

It is unlikely that this medicine will affect your ability to drive and use machines. However, if you use
Mounjaro in combination with a sulphonylurea or insulin, low blood sugar (hypoglycaemia) may
occur which may reduce your ability to concentrate. Avoid driving or using machines if you get any
signs of low blood sugar, e.g. headache, drowsiness, weakness, dizziness, feeling hungry, confusion,
irritability, fast heartbeat and sweating (see section 4). See section 2, ‘Warnings and precautions’ for
information on increased risk of low blood sugar. Talk to your doctor for further information.
Mounjaro KwikPen contains sodium
This medicine contains less than 1 mmol sodium (23 mg) per dose, that is to say essentially
‘sodium-free’.
Mounjaro KwikPen contains benzyl alcohol
Each multiple-dose pre-filled pen contains 5.4 mg Benzyl Alcohol [E1519] in each 0.6 ml dose.
Benzyl alcohol may cause allergic reactions.
Ask your doctor or pharmacist for advice if you have a liver or kidney disease. This is because large
amounts of benzyl alcohol can build-up in your body and may cause side effects (called “metabolic
acidosis”).

Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.
Serious side effects

Uncommon (may affect up to 1 in 100 people)
– Inflamed pancreas (acute pancreatitis) which could cause severe pain in the stomach and back
which does not go away. You should see a doctor immediately if you experience such
symptoms.

Rare (may affect up to 1 in 1 000 people)
– Severe allergic reactions (e.g. anaphylactic reaction, angioedema). You should get immediate
medical help and inform your doctor if you experience symptoms such as breathing problems,
rapid swelling of the lips, tongue and/or throat with difficulty swallowing and a fast heartbeat.
Other side effects

Very common (may affect more than 1 in 10 people)
– Low blood sugar (hypoglycaemia) when tirzepatide is used for the treatment of type 2 diabetes
with medicines that contain a sulphonylurea and/or insulin. If you are using a sulphonylurea or
insulin, the dose may need to be lowered while you use tirzepatide (see section 2, ‘Warnings
and precautions’). Symptoms of low blood sugar may include headache, drowsiness, weakness,
dizziness, feeling hungry, confusion, irritability, fast heartbeat and sweating. Your doctor
should tell you how to treat low blood sugar.
– Feeling sick (nausea) *
– Diarrhoea*
– Being sick (vomiting) – this usually goes away over time**
– Constipation**. *
These side effects are usually not severe. They are most common when first starting tirzepatide but
decrease over time in most patients.
**Constipation and vomiting are very common when used for weight management, but common when
used for type 2 diabetes.

Common (may affect up to 1 in 10 people)
– Low blood sugar (hypoglycaemia) when tirzepatide is used for type 2 diabetes with both
metformin and a sodium-glucose co-transporter 2 inhibitor (another diabetes medicine)
Symptoms of low blood sugar may include headache, drowsiness, weakness, dizziness, feeling
hungry, confusion, irritability, fast heartbeat and sweating. Your doctor should tell you how to
treat low blood sugar.
– Allergic reaction (hypersensitivity) (e.g., rash, itching, and eczema)
– Dizziness observed in patients treated for weight management
– Low blood pressure observed in patients treated for weight management
– Feeling less hungry (decreased appetite) observed in patients treated for type 2 diabetes
– Stomach (abdominal) pain
– Indigestion (dyspepsia)
– Bloating of the stomach
– Burping (eructation)
– Gas (flatulence)
– Reflux or heartburn (also called gastroesophageal reflux disease – GORD) – a disease caused by
stomach acid coming up into the tube from your stomach to your mouth
– Hair loss observed in patients treated for weight management
– Feeling tired (fatigue)
– Injection site reactions (e.g. itching or redness)
– Fast pulse1
– Increased levels of pancreatic enzymes (such as lipase and amylase2
) in blood. 1
Fast pulse is a common side effect when used for type 2 diabetes and uncommon when used for
weight management.
Increased levels of amylase is uncommon in weight management.

Uncommon (may affect up to 1 in 100 people)
– Low blood sugar (hypoglycaemia) when tirzepatide is used with metformin for type 2 diabetes.
Symptoms of low blood sugar may include headache, drowsiness, weakness, dizziness, feeling
hungry, confusion, irritability, fast heartbeat and sweating. Your doctor should tell you how to
treat low blood sugar.
– Gallstones
– Weight loss observed in patients treated for type 2 diabetes
– Injection site pain
– Increased calcitonin levels in blood
– Cholecystitis (infection of the gallbladder) observed in patients treated for weight management.