What can help with constipation?

Fiber and hydration are the best first line treatment for constipation.  There is a wide variety of over-the-counter fiber supplements and not everyone responds the same to each.  So, experiment with the different varieties until you find what works best for you. Fiber supplements can cause bloating, this is often lessened by getting fiber from natural food sources.  

 

Foods that are high in fiber include: fresh fruit, cooked vegetables, prunes, raisins, beans, bran, oatmeal, whole wheat, and brown rice. It is important to increase your water intake as you increase your fiber intake to help the fiber bulk up and move through the digestive tract. 

 

Colace, a stool softener, can be taken to help with constipation and is a medication that can be taken daily if needed. 

 

Should constipation continue, laxatives can help but should not be used routinely/daily to treat constipation.  Everyone responds differently to each laxative so again it may take some experimentation to find what works best for you. 

 

Common over the counter laxatives in general order of tolerance include:

Docusate, Senna, Dulcolax, Milk of Magnesia, Polyethylene glycol 

 

Because GLPs slow the time that food moves through the digestive tract, bulk forming laxatives (Metamucil, Fibercon, Benefiber) are likely to make constipation worse. 

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Will the stages of nausea and fatigue end?

Yes. The common side effects of the medication including nausea are usually greatest in the first couple days after the injection.  As you spend more time on the medication the feelings of nausea generally improve. Some patients may require medication to help manage nausea when first starting the medication. IV hydration can help lessen the side effects of nausea. 

 

Many different factors can cause fatigue. Decreased caloric intake, especially inadequate complex carbohydrate intake, as well as dehydration can lead to or worsen fatigue.  If you are losing more than the recommended 1-2 pounds per week, you are likely to experience fatigue. MIC fat burner can reduce fatigue. Utilizing all the tools at your disposable while working closely with your physician can help minimize fatigue during your weight loss journey. 

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Does injection site matter?

Injection site should not matter in terms of drug efficacy or side effects.  We recommend utilizing the injection site that is most comfortable for you.

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Is drinking alcohol okay while on GLPs

In general, we do not recommend consuming alcohol while on these medications. Alcohol consumption will likely decrease weight loss, lead to worsening dehydration and associated side effects. Also, absorption rates are different on the medications due to decreased intestinal transit, and decreased tolerance for alcohol with weight loss can lead to unintended consequences if drinking alcohol while on GLPs

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Should patients with eating disorders be on this medication?

Patients with a history of eating disorders should not be on these medications without the direct supervision of their primary care and mental health providers. 

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Is hair loss normal?

With any significant weight loss, hair loss can occur.  This can be minimized with gradual weight loss and adequate protein intake.  Some patients may benefit from nutritional supplements to minimize hair loss.

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How can I maintain muscle mass while on these medications?

Adequate protein intake will be required to not lose muscle mass during weight loss.  You can utilize your dietary planning app to measure your appropriate macro intake through your weight loss journey. 

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How does the medication need to be stored?

The medication is sensitive to light and temperature change.  It needs to be stored in a dark container (for example a thermos or lunch pail) and needs to be refrigerated. 

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How does the medication effect the gallbladder?

With any weight loss, there can be an increase in gallstone formation.  There is an increased risk of gallbladder disease while on these medications.  Fevers with severe abdominal pain, vomiting and jaundice should receive immediate medical attention. It should not negatively impact people without a gallbladder. 

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Can these drugs be used while pregnant?

No. Anyone who is pregnant, trying to become pregnant or breastfeeding should not use these medications. 

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How should the medication be dosed? 

This varies for each individual and is determined by the amount of weight loss and the drug tolerance.  The medication distributed will depend at what dosage you are at, typically to last for a month at a time. 

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What does the medication cost?

In office injections are $600 for Semaglutide and $800 for Tirzepatide

 

In home injection costs vary by dosage, and are as follows:

Semaglutide 

Tier 1              0.25-0.75 mg $100/week 

Tier 2              1-1.75 mg       $125/week

Tier 3              2-2.5.              $150/week

 

Tirzepatide 

Tier 1              2.5-5 mg       $150/week

Tier 2              5.5-7.5          $175/week

Tier 3              8-10              $200/week

 

Please discuss pricing for doses higher than 10 mg per week with IWC staff

 

 

Does the amount of dosage change appetite? 

Yes. Studies have shown that different doses have different effects on appetite and total weight loss. There is no standard “optimal” dosing, as this will vary from patient to patient. 

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Why are other people losing weight faster with different dosages?

Everyone responds differently to medications.  An appropriate dose for one person may not work for another.  Additionally, the use of these medications is intended to be combined with diet and exercise for optimal results. 

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What kind of supplies are needed and where can I get them?

Supplies will be provided for patients choosing to do their own home injections

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How to dispose of used needles?

Needles should be kept in a disposable sharps container that can be purchased online or at any retail pharmacy.  When the container is full it can be deposited in a sharps Kiosk. Shasta county locations can be found on the Shasta County Health and Human Services website. 

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What happens if a week is missed?

If a single week is missed, you can take your dose on your regularly scheduled day at the same dose as before.  If multiple doses are missed, you should schedule an in-office injection to reevaluate whether your dosage should be adjusted.

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How to help with increased appetite?

The effect of the drug is strongest in the first 4-5 days following injection.  In the 2-3 days before your next injection you may notice an increase in your appetite. If you are utilizing this as a tool in conjunction with a healthy diet and exercise you will continue to lose weight.  If you are experiencing increased appetite sooner than 4-5 days, you may need a dose adjustment.  

 

 

How to help with no appetite?

Often this is a desired effect but needs to be managed appropriately for safe and effective long term weight loss.  If your appetite is suppressed to the point that you are dehydrated or losing more than 2 pounds a week you may need to decrease your dosage. 

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When will the effects be noticed?

Typically 5-10% of your starting weight is when you will likely notice “significant changes” to your body. We can help set a goal date in your weight loss journey and will help catalogue your progress with photos and body composition.