Updated: Aug 8
Today the PDF version of Cafer's Psychopharmacology was updated with four new medication mascots, including Tirzepatide (MOUNJARO).
Pronounced: tir ZEP a tide / mown JAHR OH
Mechanism: dual GLP-1/GIP receptor agonist
FDA-approved for: Type 2 diabetes
Mnemonic: “Tear zeppelin (over) Mount (Kiliman)jaro”
Cost: $1060 / mo
Strengths: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg (weekly subcutaneous injection)
Tirzepatide (Mounjaro) is the first “twincretin” for type 2 diabetes. It is a GLP-1 agonist like the other medications in this chapter, and also a glucose-dependent insulinotropic polypeptide (GIP) agonist. GIP is similar to GLP-1. Both are secreted in the gut in response to food.
Tirzepatide is injected subcutaneously on a weekly basis.
It appears to be superior to all predecessors in magnitude of weight gain and hemoglobin A1c reduction. It has not (yet) been approved for weight management.
Tirzepatide (when added to metformin) can reduce A1c by up to 2.3%. It can lead to weight loss of up to 25 pounds over 10 months in patients with diabetes.
Over 72 weeks patients without diabetes lost 15%, 19%, and 21% of body weight on the 5, 10, and 15 mg weekly SQ injections, respectively. About 90% of those who received the 10- or 15-mg dose achieved ≥5% weight loss.
Data on whether tirzepatide lowers cardiovascular outcomes is not expected until 2025.
The most common side effects are nausea (~15%), diarrhea (~15%), and other gastrointestinal complaints.
Cautions applicable to other GLP-1 agonists apply to tirzepatide. Serious hypersensitivity reactions such as anaphylaxis and angioedema have occurred with these drugs. It is contraindicated for use in patients with a personal or family history of medullary thyroid carcinoma and in those with multiple endocrine neoplasia type 2.
The label cautions about possible reduced efficacy of oral contraceptives due to delayed gastric emptying. Women of childbearing potential taking an oral hormonal contraceptive should add a barrier contraceptive for 4 weeks after starting tirzepatide and after each dose escalation.
Dosing: Start 2.5 mg injected SQ once weekly in the abdomen, thigh, or upper arm. After 4 weeks, the dose should be increased to 5 mg. If additional glycemic control is needed, the dose can be increased in 2.5-mg increments every 4 weeks to a maximum of 15 mg once weekly.
Check out the PDF version of Cafer's Psychopharmacology, now only $29.95.
Bonus mascots not found in the paperback include:
AUVELITY (DXM + bupropion)
AZSTARYS (dexmethylphenidate + serdexmethylphenidate)
DYANAVEL XR (amphetamine)
LYBALVI (olanzapine + samidorphan)
PLENITY "medical device" for weight management
QUILLICHEW ER (methylphenidate)
XELSTRYM (dextroamphetamine patch)
Exenatide (BYETTA, BYDUREON)
Lecanemab (LEQEMBI) on page 318
Liraglutide (VICTOZA, SAXENDA)
Semaglutide (OZEMPIC, RYBELSUS, WEGOVY)
Buspirone + melatonin combo
Samidorphan + buprenorphine combo