Zepbound, Weygovy, Mounjaro and other GLP-1 medications

Has anyone had luck in getting their medication recently? My local pharmacy substituted a box of Mounjaro for me. (It's also tirzepatide, just marketed for diabetes instead of obesity.)

This seemed quite informative & a way to kick off some conversation, so I’m crossposting from Reddit’s /r/zepbound sub.

I have worked on this over time in the Mounjaro sub but thought I would post it as it might help a few people.

These are not set rules, but rather a guide that has been found helpful by myself and others. In the early stages of taking the drug, the following steps may prove to be helpful: Taking the Medicine

Wait several weeks after picking up the prescription prior to starting. This will give you buffer for supply shortages in the future. These are very real and very impactful so while not required this is highly recommended.
Go buy the OTC meds listed below in the side effects. These are for just in case they are needed.
Store your pens in the box and keep inside your refrigerator. Remember vibration, light, extreme cold or heat above 80 degrees Fahrenheit will reduce the effectiveness of your drug.
Read the booklet inside the box before you do anything. Seriously read it!
Be intentional about selecting your shot day. For example, doing it on a Friday means experiencing maximum effect over the weekend when tendency to indulge is typically high Re: selecting injection day. Or, you may wish to inject on a Wednesday or Thursday if you experience side effects for a day or two after injection. (so, by the weekend, you’re feeling great and hunger suppression is still strong enough to counter any temptation to over-indulge) Make a choice that works for your life.
If you need to move your shot day you may do so as long as you don’t take two doses in under 4 days or more than 14 days apart. Under 4 may result in too much medicine in your system. Over 14 days and Eli Lilly recommends starting over from 2.5mg. Either way consult your doctor prior for either scenario.
Select an injection site location and be sure to rotate between several locations. The injection is hardly noticeable but if you let the pen come to room temp for 30 minutes prior to the shot you will not get a burning sensation from the cold.
If the pen malfunctions or you have any issues / questions post injection then call Eli Lilly ASAP. Number on the box! KEEP THE PEN. Don’t discard as Eli Lilly may offer to exchange the pen.
Process a refill as soon as you use pen #3 in each box. Note: If you have a prescription that allows for a 3 month supply then get all 3 months. This will help you manage through potential shortages.

Lifestyle Changes

Drinking 32oz of water three times a day helps regulate digestion.
Incorporating lean meats and green vegetables in meals provided essential nutrients and fiber while protein helps alleviate tiredness, and vegetables regulated constipation.
It’s advisable to minimize fat, sugar, and carbs during this period for better results.
Purge your house of highly processed or sugary foods, and avoid artificial sweeteners as they interfere with the medicine’s glucagon impact.
Pick a weigh-in day and maintain regularity. Don’t be surprised or discouraged by stalls that occasionally last weeks or even a month as they are normal. Aim for slow, healthy weight loss of around 2 pounds per week.
Track calories and macros using an app of your choice. Use this journey to change the way you eat, learn about your nutritional needs, and focus on eating healthier, decreasing the loss of lean muscle mass.
Get into a fitness routine or some sort. This does not have to be drastic are rigorous but again success with Mounjaro is about changing your lifestyle and health trajectory of which weight loss is just one key metric.

As Your Journey Progresses

Be ready to titrate up but not too eagerly. One does not have to get to 15mg unless their doctor advises otherwise. Work with your doctor to find the correct dosage, and avoid rushing to the top. This also helps keep weight loss in the 2lb range, preventing loose skin, hair loss, and other side effects of rapid weight loss.
Start planning for what life looks like at the end of the weight loss journey. This process is called maintenance, and it is vital to keep sight of what happens afterward. It’s essential to avoid being a statistic and gaining back 80% of the lost weight.
Regularly test your fasting Glucose, A1C, blood pressure, heart rate and cholesterol panel. This may be needed in the future to support insurance claims or future PAs.

Managing Side Effects:

Taking Pepto as needed may help reduce (sulfur) burps. This may turn you tongue black which is normal.
Taking a Pepcid Complete as needed may help alleviate heartburn.
Taking Imodium as need for for diarrhea.
Taking stool softeners as needed aids with constipation early.

Note: Some people have no side effects and some people have a lot. Each person is different. If you don’t have indigestion, don’t the med but have it on hand. Some people have diarrhea instead of constipation, so be prepared but see if you have a side effect before assuming you will have it and taking another medication. Don’t be afraid of side effects or giving shots or any of the other fear thoughts that are stopping you from opening that box and changing your life. You got this!

From a doctor in an online obesity clinic. They have a lot of clinical experience with semaglutide and tirzepitide. This is a link to their online practice. (Note that I am not a member or affiliated in any way.)

For the podcast, you can search "Beyond the Scale with Dr. Spencer Nodolsky" in your favorite app, and it's available on YouTube as well.

I have listened to several episodes, and keep coming across interesting tidbits from their clinical practice. It isn't entirely focused on GLP-1 medication, but you can pull out the ones with "GLP-1" in the title. It looks like they have been on a break since November, but they were using all of the current GLP-1s in their practice as of last Oct-Nov.

A few perspectives I have picked up from listening:

• It is important to eat enough on these meds. It's healthier (from a psychological change-your-relationship-to-food perspective and from a physical health perspective) to get good nutrition and lose weight at a sustainable pace of <= 1.5% body weight per week. Use the med to help you eat smaller portions and avoid snacking, not to avoid eating all day.
• "Food Noise" reduction is a thing for most people they've seen. Although none of the meds were on-label for binge eating disorder, they have found that GLP-1's are an excellent treatment for that, and they tied it to "food noise".
• Most of the advice I've seen in this subreddit for side-effects is covered, and they offer some additional details, so worth a listen.
• They have seen both ends of the bell curve with hypo-and-hyper-responders to the meds. They usually try a different med to resolve that, but insurance can be a hassle in that case. Worth a listen if you are seeing good results with 2.5mg, or if you're titrating up & results are still suboptimal.

I have only listened to a handful of episodes, but they have all had useful information. If you listen to podcasts (I like them while doing housework or working out), I recommend this one.

Another of my posts from Reddit in recent weeks:

Does anyone else experience an increase in DOMS (delayed-onset muscle soreness) after starting zepbound? I have ramped up the intensity of my workouts lately, and it seems like muscle soreness has gotten much worse.

I'm thinking I should dial it back a bit, because it is also stimulating quite a bit of appetite. Not really what I want when I'm trying to cut calories and weight. 🤔

Addendum: The consensus was that a lot of people experienced more difficulty completing endurance workouts, but not specifically weight training (which is where DOMS usually comes from).

...and here is what I posted on Reddit in January on this subject:

I feel less of a sense of shame about my eating habits now

For most of my adult life, I have held a core belief that I am just "weak-willed". My weight and eating habits were at the core of this belief. After all, eating is an intentional act - an effort of will. If you eat sugary carbohydrates, or just very large portions of anything when you're already overweight, it's just a failure of willpower, right?

Zepbound is changing that for me. The effect was immediate and dramatic in my first week using it. I wasn't hungry and felt full quickly, as expected. The surprise was that I didn't even think about food. I understood immediately what people meant by "food noise" abating when on a GLP-1 medication.

And that's what is causing this sense of shame to abate. If a drug can eliminate thought patterns that I have engaged in for 30 years, do those thoughts really have anything to do with willpower? I think not. I see those thoughts now as being purely physiological at their source, and people who don't (or rarely) have food cravings aren't stronger willed than I am, they were just fortunate in the genetic lottery.

It's a good feeling to drop that shame. Or it will be, when I can finally let most of it go. I have consciously and unconsciously carried this feeling around for decades. I'm still carrying some around now, even though the rational part of my mind is already convinced.

If you have felt ashamed of being overweight (and I expect that nearly all of us have), consdier what I'm saying, and see if you can cut yourself some slack.

I checked the other communities in this space, and they're completely inactive and (apparently) unmoderated. Since I'm a few months into this journey, and I love to really dig in to topics, I decided to create a community & see if others are interested in it.