Nurses Compass
Drug Guide
Tirzepatide
Classification
Therapeutic: Antidiabetic agent
Pharmacological: Dual GIP and GLP-1 receptor agonist
FDA Approved Indications
- Type 2 diabetes mellitus
Mechanism of Action
Tirzepatide is a dual incretin receptor agonist that mimics the effects of GIP and GLP-1, leading to increased insulin secretion, decreased glucagon secretion, delays in gastric emptying, and appetite suppression, thereby improving glycemic control.
Dosage and Administration
Adult: Start with 2.5 mg once weekly, titrate up to 15 mg weekly based on glycemic response and tolerability.
Pediatric: Not approved for pediatric use.
Geriatric: Use with caution, starting at lower doses due to potential for renal impairment or other comorbidities.
Renal Impairment: Adjust dose cautiously in severe renal impairment.
Hepatic Impairment: Use with caution; no specific dose adjustment recommended.
Pharmacokinetics
Absorption: Absorbed slowly following subcutaneous injection.
Distribution: Distributed in plasma and tissues, volume of distribution approximately 12 L.
Metabolism: Metabolized via proteolytic cleavage as a peptide. Minimal hepatic metabolism.
Excretion: Excreted primarily via the kidneys as metabolites.
Half Life: Approximately 5 days, allowing for once-weekly dosing.
Contraindications
- Personal or family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2.
Precautions
- Use with caution in patients with a history of pancreatitis. Monitor for gastrointestinal side effects.
Adverse Reactions - Common
- Nausea (Common)
- Diarrhea (Common)
- Vomiting (Common)
- Decreased appetite (Common)
Adverse Reactions - Serious
- Pancreatitis (Serious)
- Hypoglycemia (when used with insulin or insulin secretagogues) (Serious)
- Thyroid C-cell tumors (risks observed in animal studies) (Serious)
Drug-Drug Interactions
- Insulin or insulin secretagogues (increase risk of hypoglycemia)
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor blood glucose levels regularly. Assess for signs of gastrointestinal side effects and pancreatitis.
Diagnoses:
- Ineffective health management related to medication regimen.
- Risk for hypoglycemia.
Implementation: Administer once weekly via autoinjector. Educate patient on proper injection technique and storage.
Evaluation: Effective glycemic control and management of side effects.
Patient/Family Teaching
- Take medication exactly as prescribed.
- Rotate injection sites.
- Recognize signs of hypoglycemia and pancreatitis.
- Report persistent gastrointestinal symptoms or any signs of thyroid tumors.
Special Considerations
Black Box Warnings:
- Thyroid C-cell tumors observed in animal studies
Genetic Factors: Patients with family history of medullary thyroid carcinoma should not use.
Lab Test Interference: May increase amylase and lipase levels, monitoring recommended.
Overdose Management
Signs/Symptoms: Severe nausea, vomiting, dehydration.
Treatment: Supportive care; no specific antidote. Discontinue tirzepatide and manage symptoms accordingly.
Storage and Handling
Storage: Store unopened autoinjector in refrigerator (36°F to 46°F). After first use, can be stored at room temperature up to 86°F for up to 28 days.
Stability: Stable for specified period at room temperature after first use.