Compounded semaglutide

*Compounded medications may be prescribed by physicians but have not been FDA regulated for safety, effectiveness, or quality. FDA-approved medicines containing semaglutide are available.

WARNING

Please contact your doctor ASAP and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea and/or vomiting resulting in dehydration—it is important to stay well hydrated and drink plenty of fluids while on this medication
  Kidney problems/kidney failure - vomiting, nausea, diarrhea can cause dehydration and kidney issues and make kidney problems worse in individuals who have pre-existing kidney conditions; may sometimes lead to the need for hemodialysis
• Thyroid C-Cell Tumor: Trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath (see black box warning below)
• Pancreatitis: Severe pain in your abdomen or back that will not go away
• Acute gallbladder disease - Pain in the middle or right upper stomach, fever, white parts of your eyes turn yellow or skin turns yellow, nausea/vomiting. If gallstones or inflammation of the gallbladder is suspected further studies are needed.
• Hepatitis/Elevated liver enzymes/Jaundice
• Diabetic retinopathy problems: Changes in vision in those with type II diabetes, particularly vision problems may worsen in those with a history of diabetic retinopathy
• Severe gastrointestinal disease - may cause gastrointestinal disease; do not use if you have a history of severe gastrointestinal disease
• Signs of low blood sugar (for example, dizziness, weakness, shakiness, jitteriness, headache, anxiety/mood changes, rapid heartbeat, confusion, slurred speech, sweating, or lightheadedness). While this is rare with GLP-1s, if it occurs, please seek in-person care immediately. If you have these symptoms, try having liquid or food containing sugar (around 15-20 grams) —drinking juice, having regular soda, or eating some hard candies right away, as this will help raise your blood sugar quickly. If taken with insulin or an insulin secretagogue (i.e. sulfonylurea such as Glipizide, glimepiride, and glyburide) it is best to talk to your healthcare provider about possibly lowering the dose of these medications to lower the risk of hypoglycemia.
• Increasing heart rate
• Worsening depression, behavior changes, or suicidality

Never share the semaglutide with other people

Drug Interactions

As with other medications, compounded semaglutide can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of hypoglycemia is increased when combined with insulin or insulin secretagogues such as sulfonylureas. Compounded semaglutide delays gastric emptying and may impact the absorption of oral medications. If you are on papillary hormone medication, prior to starting compounded semaglutide, please review the timing of taking your papillary hormone medication with the doctor who prescribes it as it may need to be adjusted. The drug levels of medications with narrow therapeutic windows (ie warfarin) should be monitored closely while on compounded semaglutide.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information.

To report suspected adverse reactions to compounded semaglutide, contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

Note: The above statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

BLACK BOX WARNING

GLP-1s are contraindicated in individuals with a history of medullary thyroid carcinoma, a family history of such, or in patients with multiple endocrine neoplasia syndrome type 2. Do not take them if you have ever had thyroid cancer. In studies with rodents, GLP-1s caused thyroid tumors, including thyroid cancer; it is not known if they will cause thyroid tumors or cancer in humans. Please notify your doctor ASAP if you develop trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath.

If you experience a medical emergency, call 911 or go to the nearest emergency room.

Tell your healthcare provider about your medical history prior to taking semaglutide.

Avoid alcohol while taking this medication. If you’re taking diabetes medications, please discuss this with your prescribing doctor before starting semaglutide, as your diabetes medications may need to be adjusted as you lose weight.

Use adequate contraception while taking this medication. Do not take this medication if pregnant, trying to get pregnant or breastfeeding. If you plan to become pregnant, this medication needs to be stopped at least 2 months before trying. This medication may cause fetal harm.

Notify your doctor if you have kidney, liver, or pancreas problems.

Stop using semaglutide and call your healthcare provider immediately if you have severe stomach or abdomen pain that will not go away, with or without vomiting.

Stop using semaglutide and get medical help right away if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; or very rapid heartbeat.

Serious hypersensitivity reactions (e.g., anaphylaxis and angioedema) have been reported. Discontinue semaglutide if suspected and promptly seek medical advice.

Compounded tirzepatide

*Compounded medications may be prescribed by physicians but have not been FDA regulated for safety, effectiveness, or quality. FDA-approved medicines containing trizepatide are available.

WARNING

Compounded tirzepatide usage has been associated with the potential development of thyroid tumors, including thyroid cancer. Watch for any potential symptoms, such as neck lumps or swelling, hoarseness, difficulty swallowing, or breathlessness. Should any of these symptoms arise, it is imperative to inform your healthcare provider promptly.

Avoid using compounded tirzepatide if you or any family members have a history of medullary thyroid carcinoma (MTC), a specific type of thyroid cancer. Similarly, refrain from its use if diagnosed with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), or if you've previously experienced a severe allergic reaction to tirzepatide or any of its components.

Serious Side Effects

Compounded tirzepatide carries the risk of severe side effects, which include:

• Gastrointestinal Issues: Reports indicate the possibility of severe stomach problems associated with compounded tirzepatide usage. Notify your healthcare provider if you experience persistent or severe stomach discomfort.
• Kidney Complications: Diarrhea, nausea, and vomiting may lead to dehydration, potentially resulting in kidney problems. Adequate fluid intake is crucial to mitigate this risk.
• Gallbladder Concerns: Some individuals may encounter gallbladder problems while using compounded tirzepatide. Seek immediate medical attention if symptoms such as upper abdominal pain, fever, jaundice, or changes in stool color occur.
• Pancreatitis: Discontinue use and contact your healthcare provider if you experience persistent abdominal pain, with or without vomiting, as it could indicate inflammation of the pancreas.
• Allergic Reactions: Cease compounded tirzepatide usage and seek urgent medical assistance if you develop symptoms of a severe allergic reaction, including facial swelling, breathing difficulties, rash, or rapid heartbeat.
• Hypoglycemia: The risk of low blood sugar may increase when using compounded tirzepatide alongside medications that lower blood sugar levels. Recognizable symptoms include dizziness, sweating, confusion, and rapid heartbeat.
• Vision Changes: Notify your healthcare provider of any alterations in vision observed during tirzepatide treatment.
• Depression or Suicidal Thoughts: Pay close attention to changes in mood or mental state while using tirzepatide, and promptly report any concerns to your healthcare provider.

Common Side Effects

The most frequently reported side effects of compounded tirzepatide include:

• Nausea
• Diarrhea
• Vomiting
• Constipation
• Abdominal pain
• Indigestion
• Injection site reactions
• Fatigue
• Allergic reactions
• Belching
• Hair loss
• Heartburn

These side effects are not exhaustive. Should you experience any persistent or bothersome side effects, discuss them with your healthcare provider for appropriate management.

Tell your healthcare provider if you have any side effects.

To report suspected severe side effects or adverse reactions to compounded trizepatide, contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. In case of emergencies, please call 911 or go to the nearest emergency room.

Drug Interactions

As with other medications, compounded trizepatide can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of hypoglycemia is increased when combined with insulin or insulin secretagogues such as sulfonylureas. Compounded trizepatide delays gastric emptying and may impact the absorption of oral medications. If you are on papillary hormone medication, prior to starting compounded trizepatide, please review the timing of taking your papillary hormone medication with the doctor who prescribes it as it may need to be adjusted. The drug levels of medications with narrow therapeutic windows (ie warfarin) should be monitored closely while on compounded trizepatide.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information.

Tirzepatide may alter the efficacy of birth control pills. Talk with your doctor before starting tirzepatide if you are on birth control. Your healthcare provider may recommend another type of birth control for 4 weeks after you start tirzepatide and for 4 weeks after each increase in your dose.

Note: The above statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

Everyday+

Safety Information

Side effects are typically mild and go away over time.

What are the most common side effects?

• Nausea
• Vomiting
• Decreased appetite
• Dizziness
• Headache
• Diarrhea
• Gastritis

Full side effect profile:

• Low dose Naltrexone: nausea/vomiting, decreased appetite. Dizziness, headache, insomnia (can resolve in 2 weeks), vivid dreams, joint pain, muscle cramps, tooth pain, and anxiety which are all more commonly seen at higher doses
• Inositol: nausea, vomiting, diarrhea, abdominal pain/cramps, gastritis, dizziness, high BP, decreases absorption of Iron, Ca, and Zn in bloodstream, hypoglycemia—all usually mild and go away over time. All typically seen at higher doses of 1,000-4,000mg per day.
• L-Carnitine: nausea, vomiting, diarrhea, abdominal pain/cramps, gastritis, body odor—all usually mild and go away over time. All typically seen at higher doses of 1,000-3,000mg per day. At high doses (1,000mg-3000mg) L-Carnitine may affect the efficacy of warfarin or dicumarol.

Everyday+ Weight

Safety Information

Side effects are typically mild and go away over time during the first 3 to 5 days.

What are the most common side effects?

• Nausea
• Vomiting
• Decreased appetite
• Dizziness
• Headache
• Diarrhea
• Gastritis
• Bloated feeling or passing gas
• Stomach pain
• Oily stools
• Loss of bowel control
• (see full list below)

Side Effect Profiles

• Low dose Naltrexone: nausea/vomiting, decreased appetite, dizziness, headache, insomnia (typically resolved within 2 weeks). Vivid dreams, joint pain, muscle cramps, tooth pain, and anxiety can be seen at higher doses.
  See a complete list of side effects for Naltrexone (LDN) here.‍
• Inositol: nausea, vomiting, diarrhea, abdominal pain/cramps, gastritis, dizziness, high BP, decreased absorption of Iron, Ca, and Zn in bloodstream, hypoglycemia can be seen at higher doses.
  See a complete list of side effects for Inositol here.‍
• L-Carnitine: nausea, vomiting, diarrhea, abdominal pain/cramps, gastritis, and body odor can be seen at higher doses.
  See a complete list of side effects for L-Carnitine here.‍
• Acarbose: Abdominal or stomach pain, bloated feeling or passing as, diarrhea.
  See a complete list of side effects for Acarbose here.

Acarbose safety information and drug interactions: 
Mayo Clinic || National Institutes of Health

Unlike sulfonylureas, this group of drugs does not cause hypoglycemia. However, combination therapy with sulfonylureas or insulin poses the risk of hypoglycemia; in that case, the patient should understand the need to keep glucose with them. 

Orlistat

• back pain
• difficulty with moving
• gas with leaky bowel movements
• inability to hold bowel movement
• increases in bowel movements
• loss of bowel control
• oily bowel movements
• oily spotting of underclothes
• stomach pain or discomfort

See a complete list of Orlistat side effects here.

Special Considerations

Low Dose Naltrexone

You must stop taking low dose naltrexone at least 48 hours prior to any procedure that requires sedation. Ensure that your doctor knows that you are taking LDN prior to the procedure. It is recommended not to resume taking LDN until 48 hour after your last dose of medication that was 

prescribed for the procedure.It is important to notify your doctor if you are taking any thyroid medication. LDN may impact your thyroid levels. Stop taking LDN and notify your prescriber if you have any signs or symptoms of hyperthyroidism such as excess sweating,  fast heart rate, hyperactivity, issues with sleeping, or restlessness.

Orlistat

Because orlistat may decrease the amount of some vitamins that your body absorbs from food, you will need to take a multivitamin supplement once a day. Take the vitamin supplement at least 2 hours before or after taking orlistat. 

You may also take your multivitamin supplement at bedtime.

When using orlistat, your diet should contain no more than 30% of calories as fat. More fat in your diet will increase the side effects of this medicine. Your diet should be nutritionally balanced, and your daily intake of fat, carbohydrates, and protein should be distributed over three main meals.

Carefully follow your doctor's instructions for a reduced-calorie diet plan and regular exercise. Talk with your doctor before starting any exercise program.

For a full list of side effects, interactions, and other safety information, click here to visit mayoclinic.org. 

Note: The above statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

MIC+B12

Safety Information:

Side effects are typically mild and go away over time.

Common side effects:

• Discomfort or redness at the injection area
• Skin itching or sensations of overall swelling  
• Muscular cramps and weakness
• Nausea and issues with urination
• Swelling around the ankles or feet  
• Excessive fatigue

Precautions:

• Avoid using MIC+B12 if you are pregnant, nursing, or if you are planning to become pregnant or to breastfeed.
• Should itching/irritation persist, consider using an over-the-counter anti-itch cream containing hydrocortisone, or stop using the product altogether.
• In the uncommon event of more severe reactions, such as an irregular heartbeat or difficulty breathing, cease usage immediately and consult your healthcare provider.

Note: The statements above have not been reviewed by the Food and Drug Administration. This product is not designed to diagnose, treat, cure, or prevent any condition.

Methylene Blue

BLACK BOX WARNING

WARNING: SEROTONIN SYNDROME WITH CONCOMITANT USE OF SEROTONERGIC DRUGS Methylene blue may cause serious or fatal serotonergic syndrome when used in combination with serotonergic drugs.

• Serotonin Syndrome Risk:
  • Mechanism: Methylene blue can inhibit the enzyme monoamine oxidase A (MAO-A), which is responsible for breaking down serotonin. In patients taking medications that increase serotonin levels (such as
    SSRIs, SNRIs, MAOIs, tricyclic antidepressants, and other serotonergic drugs), the additional inhibition of serotonin metabolism by methylene blue can lead to serotonin syndrome.
  • Symptoms of serotonin syndrome:‍
    • Agitation or restlessness
    • Confusion
    • Rapid heart rate
    • High blood pressure
    • Dilated pupils
    • Loss of muscle coordination or twitching muscles
    • Muscle rigidity
    • Heavy sweating
    • Diarrhea, nausea, or vomiting
    • Severe cases may lead to high fever, seizures, or loss of consciousness.
• Contraindications:‍
  • Methylene blue is contraindicated in patients who are on serotonergic drugs unless it is an emergency situation where the benefits outweigh the risks, and proper monitoring for serotonin syndrome can be done.
• Special Considerations:‍
  • It is advised to discontinue serotonergic medications 2 weeks before dministering methylene blue if possible, and monitoring is essential if it must be given.

This black box warning is critical to ensure patient safety, particularly in avoiding life-threatening serotonin syndrome in vulnerable populations.

Common side effects:

The side effects of low-dose methylene blue are generally mild, but can include several notable adverse reactions.

• Headache
• Blue/green urine or other bodily secretions
• Hhypokalemia (lowpotassium levels)
• Diarrhea
• Hypomagnesemia (low magnesium levels)
• Myoclonus (sudden, brief, involuntary muscle contractions/jerks)
• Nausea
• Seizure-like phenomena.

Other potential side effects include hemolytic anemia, particularly in individuals with G6PD deficiency, and various gastrointestinal and respiratory symptoms such as abdominal pain, dry mouth, and nasal congestion. Additionally, methylene blue can interfere with in-vivo monitoring devices and laboratory tests, which is an important consideration for patients undergoing regular medical evaluations

Contraindications:

Do not use methylene blue if you have G6PD deficiency, or if you use of SSRIs, SNRIs, MAOIs, or ADHD stimulants. You should also avoid this medication if you have hypersensitivity to methylene blue or its components.

Storage:

Regular monitoring of serotonin levels is required for patients on certain antidepressants. Patients should also avoid excessive exposure to light, as methylene blue is photosensitizing.

Precautions:

Store in a cool, dry place away from direct sunlight. Do not freeze.

Note: The statements above have not been reviewed by the Food and Drug Administration. This product is not designed to diagnose, treat, cure, or prevent any condition.

Mounjaro^®

Safety Information

Do not use if you have been diagnosed with the following:

• Diabetic ketoacidosis
• Type 1 diabetes
• Diabetic retinopathy
• Kidney disease
• Multiple endocrine neoplasia syndrome type 2 (MEN 2)
• Thyroid cancer
• Pancreatitis

Some side effects may occur that do not require medical attention, as they may lessen as your body adjusts to the medication. You may experience more gastrointestinal (GI) side effects when you increase your dose, however it should be less over time. Reach out to your healthcare provider if you experience any unwanted side effects as there may be ways to prevent or reduce side effects. You may always reach out with any additional questions regarding your medication therapy and side effects.

More common side effects:

• acid or sour stomach
• belching
• constipation
• diarrhea
• stomach discomfort or upset
• stomach pain
• hypoglycemia (low blood sugar)
• injection-site reactions
• gallbladder disease
• hypersensitivity reactions

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

For a full list of side effects: https://www.mayoclinic.org

Mounjaro® Safety Information

Mounjaro® (mown-JAHR-OH) is an injectable medicine for adults with type 2 diabetes used along with diet and exercise to improve blood sugar (glucose).

• It is not known if Mounjaro can be used in people who have had inflammation of the pancreas (pancreatitis). Mounjaro is not for use in people with type 1 diabetes. It is not known if Mounjaro is safe and effective for use in children under 18 years of age.

Warnings

Mounjaro® may cause tumors in the thyroid, including thyroid cancer. Watch for possible symptoms, such as a lump or swelling in the neck, hoarseness, trouble swallowing, or shortness of breath. If you have any of these symptoms, tell your healthcare provider.

• Do not use Mounjaro if you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC).
• Do not use Mounjaro if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
• Do not use Mounjaro if you are allergic to it or any of the ingredients in Mounjaro.

Mounjaro® may cause serious side effects, including:

• Inflammation of the pancreas (pancreatitis). Stop using Mounjaro and call your healthcare provider right away if you have severe painin your stomach area (abdomen) that will not go away, with or without vomiting. You may feel the pain from your abdomen to your back.
• Low blood sugar (hypoglycemia). Your risk for getting low blood sugar may be higher if you use Mounjaro with another medicine that can cause low blood sugar, such as a sulfonylurea or insulin. Signs and symptoms of low blood sugar may include dizziness or light-headedness, sweating, confusion or drowsiness, headache, blurred vision, slurred speech, shakiness, fast heartbeat, anxiety, irritability, or mood changes, hunger, weakness and feeling jittery.
• Serious allergic reactions. Stop using Mounjaro and get medical help right away if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue or throat, problems breathing or swallowing, severe rash or itching, fainting or feeling dizzy, and very rapid heartbeat.
• Kidney problems (kidney failure). In people who have kidney problems, diarrhea, nausea, and vomitingmay cause a loss of fluids (dehydration), which may cause kidney problems to get worse. It is important for you to drink fluids to help reduce your chance of dehydration.
• Severe stomach problems. Stomach problems, sometimes severe, have been reported in people who use Mounjaro. Tell your healthcare provider if you have stomach problems that are severe or will not go away.
• Changes in vision. Tell your healthcare provider if you have changes in vision during treatment with Mounjaro.
• Gallbladder problems. Gallbladder problems have happened in some people who use Mounjaro. Tell your healthcare provider right away if you get symptoms of gallbladder problems, which may include pain in your upper stomach (abdomen), fever, yellowing of skin or eyes (jaundice), and clay-colored stools.

Common side effects

The most common side effects of Mounjaro® include nausea, diarrhea, decreased appetite, vomiting, constipation, indigestion, and stomach (abdominal) pain. These are not all the possible side effects of Mounjaro. Talk to your healthcare provider about any side effect that bothers you or doesn’t go away.

Tell your healthcare provider if you have any side effects. You can report side effects at 1-800-FDA-1088 or www.fda.gov/medwatch.

Before using Mounjaro®

• Your healthcare provider should show you how to use Mounjaro before you use it for the first time.
• Talk to your healthcare provider about low blood sugar and how to manage it.
• If you take birth control pills by mouth, talk to your healthcare provider before youuse Mounjaro. Birth control pills may not work as well while using Mounjaro. Your healthcare provider may recommend another type of birth control for 4 weeks after you start Mounjaro and for 4 weeks after each increase in your dose of Mounjaro.

Review these questions with your healthcare provider:

• Do you have other medical conditions, including problems with your pancreas or kidneys, or severe problems with your stomach, such as slowed emptying of your stomach (gastroparesis) or problems digesting food?
• Do you take other diabetes medicines, such as insulin or sulfonylureas?
• Do you have a history of diabetic retinopathy?
• Are you pregnant, plan to become pregnant, breastfeeding, or plan to breastfeed? It is not known if Mounjaro will harm your unborn baby or pass into your breast milk.
• Do you take any other prescription medicines or over-the-counter drugs, vitamins, or herbal supplements?

How to take

• Read the Instructions for Use that come with Mounjaro®.
• Use Mounjaro exactly as your healthcare provider says.
• Mounjaro is injected under the skin (subcutaneously) of your stomach (abdomen), thigh, or upper arm.
• Use Mounjaro 1 time each week, at any time of the day.
• Do not mix insulin and Mounjaro together in the same injection.
• You may give an injection of Mounjaro and insulin in the same body area (such as your stomach area), but not right next to each other.
• Change (rotate) your injection site with each weekly injection. Do not use the same site for each injection.
• If you take too much Mounjaro, call your healthcare provider or seek medical advice promptly.

Learn more

Mounjaro® is a prescription medicine. For more information, call 1-833-807-MJRO (833-807-6576) or go to www.mounjaro.com.

This summary provides basic information about Mounjaro but does not include all information known about this medicine. Read the information that comes with your prescription each time your prescription is filled. This information does not take the place of talking with your healthcare provider. Be sure to talk to your healthcare provider about Mounjaro and how to take it. Your healthcare provider is the best person to help you decide if Mounjaro is right for you.

Click here to visit the manufacturer's support page to make a report.

Oral semaglutide

*Compounded medications may be prescribed by physicians but have not been FDA regulated for safety, effectiveness, or quality. FDA-approved medicines containing semaglutide are available.

WARNING

Please contact your doctor ASAP and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea and/or vomiting resulting in dehydration -  it is important to stay well hydrated and drink plenty of fluids while on this medication.
• Kidney problems/kidney failure - vomiting, nausea, diarrhea can cause dehydration and kidney issues and make kidney problems worse in individuals who have pre-existing kidney conditions; may sometimes lead to the need for hemodialysis.
• Thyroid C-Cell Tumor: Trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath (see black box warning below).
• Pancreatitis: Severe pain in your abdomen or back that will not go away.
• Acute gallbladder disease - Pain in the middle or right upper stomach, fever, white parts of your eyes turn yellow or skin turns yellow, nausea/vomiting. If gallstones or inflammation of the gallbladder is suspected further studies are needed.
• Hepatitis/Elevated liver enzymes/Jaundice
• Diabetic retinopathy problems: Changes in vision in those with type II diabetes, particularly vision problems may worsen in those with a history of diabetic retinopathy.
• Severe gastrointestinal disease - may cause gastrointestinal disease; do not use if you have a history of severe gastrointestinal disease
• Signs of low blood sugar (for example, dizziness, weakness, shakiness, jitteriness, headache, anxiety/mood changes, rapid heartbeat, confusion, slurred speech, sweating, or lightheadedness). While this is rare with GLP-1s, if it occurs, please seek in-person care immediately. If you have these symptoms, try having liquid or food containing sugar (around 15-20 grams) —drinking juice, having regular soda, or eating some hard candies right away, as this will help raise your blood sugar quickly. If taken with insulin or an insulin secretagogue (i.e. sulfonylurea such as Glipizide, glimepiride, and glyburide) it is best to talk to your healthcare provider about possibly lowering the dose of these medications to lower the risk of hypoglycemia.
• Increasing heart rate
• Worsening depression, behavior changes, or suicidality
• Never share the semaglutide with other people

Drug Interactions

As with other medications, oral semaglutide can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of hypoglycemia is increased when combined with insulin or insulin secretagogues such as sulfonylureas. Oral semaglutide delays gastric emptying and may impact the absorption of oral medications. If you are on thyroid hormone medication, prior to starting oral semaglutide, please review the timing of taking your thyroid hormone medication with the doctor who prescribes it as it may need to be adjusted. The drug levels of medications with narrow therapeutic windows (i.e. warfarin) should be monitored closely while on oral semaglutide.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information.

To report suspected adverse reactions to o semaglutide, contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

Note: The above statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

Ozempic®

BLACK BOX WARNING:

GLP-1s are contraindicated in individuals with a history of medullary thyroid carcinoma, a family history of such, or in patients with multiple endocrine neoplasia syndrome type 2. Do not take them if you have ever had thyroid cancer. In studies with rodents, GLP-1s caused thyroid tumors, including thyroid cancer; it is not known if they will cause thyroid tumors or cancer in humans. Please notify your doctor ASAP if you develop trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath.

If you experience a medical emergency, call 911 or go to the nearest emergency room.

Tell your healthcare provider about your medical history prior to taking Ozempic®.

Avoid alcohol while taking this medication. If you’re taking diabetes medications, please discuss this with your prescribing doctor before starting Ozempic®, as your diabetes medications may need to be adjusted as you lose weight.

Use adequate contraception while taking this medication. Do not take this medication if pregnant, trying to get pregnant or breastfeeding. If you plan to become pregnant, this medication needs to be stopped at least 2 months before trying. This medication may cause fetal harm.

Notify your doctor if you have kidney, liver, or pancreas problems.

Stop using Ozempic® and call your healthcare provider immediately if you have severe stomach or abdomen pain that will not go away, with or without vomiting.

Stop using Ozempic® and get medical help right away if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; or very rapid heartbeat.

Serious hypersensitivity reactions (e.g., anaphylaxis and angioedema) have been reported. Discontinue Ozempic® if suspected and promptly seek medical advice.

WARNING

Please contact your doctor ASAP and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea and/or vomiting resulting in dehydration-  it is important to stay well hydrated and drink plenty of fluids while on this medication
• Kidney problems/kidney failure - vomiting, nausea, diarrhea can cause dehydration and kidney issues and make kidney problems worse in individuals who have pre-existing kidney conditions; may sometimes lead to the need for hemodialysis
• Thyroid C-Cell Tumor: Trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath (see black box warning below)
• Pancreatitis: Severe pain in your abdomen or back that will not go away
• Acute gallbladder disease - Pain in the middle or right upper stomach, fever, white parts of your eyes turn yellow or skin turns yellow, nausea/vomiting. If gallstones or inflammation of the gallbladder is suspected further studies are needed.
• Hepatitis/Elevated liver enzymes/Jaundice
• Diabetic retinopathy problems: Changes in vision in those with type II diabetes, particularly vision problems may worsen in those with a history of diabetic retinopathy
• Severe gastrointestinal disease - may cause gastrointestinal disease; do not use if you have a history of severe gastrointestinal disease
• Signs of low blood sugar (for example, dizziness, weakness, shakiness, jitteriness, headache, anxiety/mood changes, rapid heartbeat, confusion, slurred speech, sweating, or lightheadedness). While this is rare with GLP-1s, if it occurs, please seek in-person care immediately. If you have these symptoms, try having liquid or food containing sugar (around 15-20 grams) —drinking juice, having regular soda, or eating some hard candies right away, as this will help raise your blood sugar quickly. If taken with insulin or an insulin secretagogue (ie sulfonylurea) it is best to talk to your healthcare provider about possibly lowering the dose of these medications to lower the risk of hypoglycemia.
• Increasing heart rate
• Worsening depression, behavior changes, or suicidality
• Never share the Ozempic® pen with other people

Side Effects

Many people experience no side effects. Some of the most common or potential side effects include:

• Nausea
• Constipation
• Vomiting
• Diarrhea
• Abdominal Pain
• Headache
• Indigestion
• Injection site reactions
• Dizziness
• Back pain
• Increased Lipase or Amylase
• Altered taste
• Nasopharyngitis (common cold)
• Passing Gas
• Bloating
• Belching
• Gastroenteritis
• Decreased appetite
• Fatigue
• Gastroesophageal reflux disease
• Low blood sugar (hypoglycemia) in those with type II diabetes
• Upset stomach

These symptoms often subside as your body adjusts to the medications. Please notify your provider if side effects persist. For a complete list of side effects, review the medication packaging inserts.

Drug Interactions

As with other medications, Ozempic® can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of hypoglycemia is increased when combined with insulin or insulin secretagogues such as sulfonylureas. Ozempic® delays gastric emptying and may impact the absorption of oral medications. If you are on thyroid hormone medication, prior to starting Ozempic®, please review the timing of taking your thyroid hormone medication with the doctor who prescribes it as it may need to be adjusted. The drug levels of medications with narrow therapeutic windows (ie warfarin) should be monitored closely while on Ozempic®.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information.

To report suspected adverse reactions to Ozempic® contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

Sermorelin

Safety Information:

Side effects are typically mild and go away over time.

Common side effects:

• Pain, redness, or swelling at the place of injection

Rare side effects:

• Itching
• Trouble swallowing
• Dizziness
• Flushing
• Headache
• Sleepiness
• Trouble sitting still

You shouldn't use Sermorelin if:

• You have hypersensitivity to Sermorelin or any of its ingredients
• You're pregnant
• You're breastfeeding
• You have active cancer

Precautions:

Regular monitoring of growth hormone levels, blood sugar levels, and overall health by a healthcare provider is recommended.

Note: The statements above have not been reviewed by the Food and Drug Administration. This product is not designed to diagnose, treat, cure, or prevent any condition.

Vardenafil+Tadalafil

Common side effects:

• Headache
• Flushing
• Nasal Congestion
• Indigestion
• Back Pain (more common with tadalafil)
• Muscle Aches
• Visual Disturbances (blurred vision, changes in color vision)

More serious, but less common side effects:

• Hypotension: A significant drop in blood pressure, especially when combined with nitrates or certain other medications.
• Cardiovascular Events: Risk of heart attack, stroke, or arrhythmias, particularly in individuals with pre-existing heart conditions.
• Priapism: Prolonged erection lasting more than 4 hours, requiring medical attention.
• Hearing Loss: Sudden decrease or loss of hearing.
• Vision Loss: Rare cases of non-arteritic anterior ischemic optic neuropathy (NAION).

See an all inclusive list of side effects from Mayo Clinic.

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Monitoring Plan

To ensure your safety and the effectiveness of the treatment, regular monitoring will be required, including:

• Baseline Testing:
  • Evaluation of current medications to assess for potential drug interactions.
• Ongoing Monitoring:
  • Periodic assessments for side effects or adverse reactions.
• Symptom Assessment:
  • Monitoring for any cardiovascular symptoms during exercise.
  • Reporting any visual or hearing changes immediately.
• Follow-Up Visits:
  • Scheduled appointments to discuss your progress and address any concerns.

Contraindications:

Do not use Vardenafil or Tadalafil with nitrate medications, as this can cause a dangerous drop in blood pressure.  Do not use with other ED medications. Avoid use if you have serious heart conditions. Avoid use with NO boosters (separate use by at least 2 hours).

Precautions:

Consult your healthcare provider if you have cardiovascular disease, liver or kidney dysfunction, or a history of stroke.

Note: The statements above have not been reviewed by the Food and Drug Administration. This product is not designed to diagnose, treat, cure, or prevent any condition.

Wegovy^®

BLACK BOX WARNING:

GLP-1s are contraindicated in individuals with a history of medullary thyroid carcinoma, a family history of such, or in patients with multiple endocrine neoplasia syndrome type 2. Do not take them if you have ever had thyroid cancer. In studies with rodents, GLP-1s caused thyroid tumors, including thyroid cancer; it is not known if they will cause thyroid tumors or cancer in humans. Please notify your doctor ASAP if you develop trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath.

If you experience a medical emergency, call 911 or go to the nearest emergency room.

Tell your healthcare provider about your medical history prior to taking Wegovy®.

Avoid alcohol while taking this medication. If you’re taking diabetes medications, please discuss this with your prescribing doctor before starting Wegovy®, as your diabetes medications may need to be adjusted as you lose weight.

Use adequate contraception while taking this medication. Do not take this medication if pregnant, trying to get pregnant or breastfeeding. If you plan to become pregnant, this medication needs to be stopped at least 2 months before trying. This medication may cause fetal harm.

Notify your doctor if you have kidney, liver, or pancreas problems.

Stop using Wegovy® and call your healthcare provider immediately if you have severe stomach or abdomen pain that will not go away, with or without vomiting.

Stop using Wegovy® and get medical help right away if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; or very rapid heartbeat.

Serious hypersensitivity reactions (e.g., anaphylaxis and angioedema) have been reported. Discontinue Wegovy® if suspected and promptly seek medical advice.

WARNING

Please contact your doctor ASAP and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea and/or vomiting resulting in dehydration-  it is important to stay well hydrated and drink plenty of fluids while on this medication
• Kidney problems/kidney failure - vomiting, nausea, diarrhea can cause dehydration and kidney issues and make kidney problems worse in individuals who have pre-existing kidney conditions; may sometimes lead to the need for hemodialysis
• Thyroid C-Cell Tumor: Trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath (see black box warning below)
• Pancreatitis: Severe pain in your abdomen or back that will not go away
• Acute gallbladder disease - Pain in the middle or right upper stomach, fever, white parts of your eyes turn yellow or skin turns yellow, nausea/vomiting. If gallstones or inflammation of the gallbladder is suspected further studies are needed.
• Hepatitis/Elevated liver enzymes/Jaundice
• -Diabetic retinopathy problems: Changes in vision in those with type II diabetes, particularly vision problems may worsen in those with a history of diabetic retinopathy
• Severe gastrointestinal disease - may cause gastrointestinal disease; do not use if you have a history of severe gastrointestinal disease
• Signs of low blood sugar (for example, dizziness, weakness, shakiness, jitteriness, headache, anxiety/mood changes, rapid heartbeat, confusion, slurred speech, sweating, or lightheadedness). While this is rare with GLP-1s, if it occurs, please seek in-person care immediately. If you have these symptoms, try having liquid or food containing sugar (around 15-20 grams) —drinking juice, having regular soda, or eating some hard candies right away, as this will help raise your blood sugar quickly. If taken with insulin or an insulin secretagogue (ie sulfonylurea) it is best to talk to your healthcare provider about possibly lowering the dose of these medications to lower the risk of hypoglycemia.
• Increasing heart rate
• Worsening depression, behavior changes, or suicidality
• Never share the Wegovy® pen with other people

Side Effects

Many people experience no side effects. Some of the most common or potential side effects include:

• Nausea
• Constipation
• Vomiting
• Diarrhea
• Abdominal Pain
• Headache
• Indigestion
• Injection site reactions
• Dizziness
• Back pain
• Increased Lipase or Amylase
• Altered taste
• Nasopharyngitis (common cold)
• Passing Gas
• Bloating
• Belching
• Gastroenteritis
• Decreased appetite
• Fatigue
• Gastroesophageal reflux disease
• Low blood sugar (hypoglycemia) in those with type II diabetes
• Upset stomach

These symptoms often subside as your body adjusts to the medications. Please notify your provider if side effects persist. For a complete list of side effects, review the medication packaging inserts.

Drug Interactions

As with other medications, Wegovy® can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of hypoglycemia is increased when combined with insulin or insulin secretagogues such as sulfonylureas. Wegovy® delays gastric emptying and may impact the absorption of oral medications. If you are on thyroid hormone medication, prior to starting Wegovy®, please review the timing of taking your thyroid hormone medication with the doctor who prescribes it as it may need to be adjusted. The drug levels of medications with narrow therapeutic windows (ie warfarin) should be monitored closely while on Wegovy®.

Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information.

To report suspected adverse reactions to Wegovy® contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

In case of emergencies, please call 911 or go to the nearest emergency room.

Zepbound^®

Safety Information

Do not use if you have been diagnosed with the following:

• Diabetic ketoacidosis
• Type 1 diabetes
• Diabetic retinopathy
• Kidney disease
• Multiple endocrine neoplasia syndrome type 2 (MEN 2)
• Thyroid cancer
• Pancreatitis

Some side effects may occur that do not require medical attention, as they may lessen as your body adjusts to the medication. You may experience more gastrointestinal (GI) side effects when you increase your dose, however it should be less over time. Reach out to your healthcare provider if you experience any unwanted side effects as there may be ways to prevent or reduce side effects. You may always reach out with any additional questions regarding your medication therapy and side effects.

More common side effects

• acid or sour stomach
• belching
• constipation
• diarrhea
• stomach discomfort or upset
• stomach pain
• hypoglycemia (low blood sugar)
• injection-site reactions
• gallbladder disease
• hypersensitivity reactions

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

For a full list of side effects: https://www.mayoclinic.org

Zepbound™ Safety Information:

Zepbound™ (ZEHP-bownd) is an injectable prescription medicine that may help adults with obesity, or with excess weight (overweight) who also have weight-related medical problems, lose weight and keep it off. It should be used with a reduced-calorie diet and increased physical activity.

Zepbound™ contains tirzepatide and should not be used with other tirzepatide-containing products or any GLP-1 receptor agonist medicines. It is not known if Zepbound is safe and effective when taken with other prescription, over-the-counter, or herbal weight loss products. It is not known if Zepbound can be used in people who have had pancreatitis. It is not known if Zepbound is safe and effective for use in children under 18 years of age.

Warning

Zepbound™ may cause tumors in the thyroid, including thyroid cancer. Watch for possible symptoms, such as a lump or swelling in the neck, hoarseness, trouble swallowing, or shortness of breath. If you have any of these symptoms, tell your healthcare provider.

• Do not use Zepbound if you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC).
• Do not use Zepbound if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
• Do not use Zepbound if you have had a serious allergic reaction to tirzepatide or any of the ingredients in Zepbound.

Zepbound™ may cause serious side effects, including:

• Severe stomach problems. Stomach problems, sometimes severe, have been reported in people who use Zepbound. Tell your healthcare provider if you have stomach problems that are severe or will not go away.
• Kidney problems (kidney failure). Diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration), which may cause kidney problems. It is important for you to drink fluids to help reduce your chance of dehydration.
• Gallbladder problems. Gallbladder problems have happened in some people who use Zepbound. Tell your healthcare provider right away if you get symptoms of gallbladder problems, which may include pain in your upper stomach (abdomen), fever, yellowing of skin or eyes (jaundice), or clay-colored stools.
• Inflammation of the pancreas (pancreatitis). Stop using Zepbound and call your healthcare provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without vomiting. You may feel the pain from your abdomen to your back.
• Serious allergic reactions. Stop using Zepbound and get medical help right away if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue or throat, problems breathing or swallowing, severe rash or itching, fainting or feeling dizzy, or very rapid heartbeat.
• Low blood sugar (hypoglycemia). Your risk for getting low blood sugar may be higher if you use Zepbound with medicines that can cause low blood sugar, such as a sulfonylurea or insulin. Signs and symptoms of low blood sugar may include dizziness or light-headedness, sweating, confusion or drowsiness, headache, blurred vision, slurred speech, shakiness, fast heartbeat, anxiety, irritability, mood changes, hunger, weakness or feeling jittery.
• Changes in vision in patients with type 2 diabetes. Tell your healthcare provider if you have changes in vision during treatment with Zepbound.
• Depression or thoughts of suicide. You should pay attention to changes in your mood, behaviors, feelings or thoughts. Call your healthcare provider right away if you have any mental changes that are new, worse, or worry you.

Common Side Effects

The most common side effects of Zepbound™ include nausea, diarrhea, vomiting, constipation, stomach (abdominal) pain, indigestion, injection site reactions, feeling tired, allergic reactions, belching, hair loss, and heartburn. These are not all the possible side effects of Zepbound. Talk to your healthcare provider about any side effect that bothers you or doesn’t go away.

Tell your healthcare provider if you have any side effects. You can report side effects at 1-800-FDA-1088 or www.fda.gov/medwatch.

Before using Zepbound™

• Your healthcare provider should show you how to use Zepbound before you use it for the first time.
• Tell your healthcare provider if you are taking medicines to treat diabetes including insulin or sulfonylureas which could increase your risk of low blood sugar. Talk to your healthcare provider about low blood sugar levels and how to manage them.
• If you take birth control pills by mouth, talk to your healthcare provider before you use Zepbound. Birth control pills may not work as well while using Zepbound. Your healthcare provider may recommend another type of birth control for 4 weeks after you start Zepbound™ and for 4 weeks after each increase in your dose of Zepbound.

Review these questions with your healthcare provider:

• Do you have other medical conditions, including problems with your pancreas or kidneys, or severe problems with your stomach, such as slowed emptying of your stomach (gastroparesis) or problems digesting food?
• Do you take diabetes medicines, such as insulin or sulfonylureas?
• Do you have a history of diabetic retinopathy?
• Do you take any other prescription medicines or over-the-counter drugs, vitamins, or herbal supplements?
• Are you pregnant, plan to become pregnant, breastfeeding, or plan to breastfeed? Zepbound™ may harm your unborn baby. Tell your healthcare provider if you become pregnant while using Zepbound. It is not known if Zepbound passes into your breast milk. You should talk with your healthcare provider about the best way to feed your baby while using Zepbound.

Pregnancy Exposure Registry: There will be a pregnancy exposure registry for women who have taken Zepbound™ during pregnancy. The purpose of this registry is to collect information about the health of you and your baby. Talk to your healthcare provider about how you can take part in this registry, or you may contact Lilly at 1-800-LillyRx (1-800-545-5979).

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

For a full list of side effects: https://www.mayoclinic.org