Tirzepatide.

• Staying onweight loss was maintained through three years, the longest published randomised obesity follow-up
• Stoppingabout half the weight came back within a year

Nobody has tested tapering, or stopping once the weight is off.

Out of 100 people assigned 15 mg, at any point over 72 weeks. Mostly mild to moderate; 6 in 100 stopped over side effects, against 3 in 100 on placebo.

Out of 100 people assigned this dose, over 72 weeks, counting everyone who stopped early. Alongside a reduced-calorie diet and an activity target.

Weight against starting weight. Both groups kept the same diet and activity coaching the whole time — only the drug stopped.

72 weeks, both titrated to the highest dose each person tolerated. Neither side was blinded.

That trial compared weight loss, not protection from heart attacks or strokes. Semaglutide has direct evidence and an FDA indication for reducing cardiovascular risk in certain adults with obesity and established cardiovascular disease.

Each molecule is sold under two names: one licensed for weight, one for type 2 diabetes. Wegovy and Ozempic are the same semaglutide; Zepbound and Mounjaro are the same tirzepatide.

Both on tirzepatide. On placebo it was 1.3% of women. Shedding often settles three to six months after weight stabilises; no trial participant stopped treatment because of it. Patchy hair loss is not typical and warrants medical evaluation.

• Medullary thyroid cancer, or MEN2 personal or family history — this is the boxed warning
• Previous pancreatitis not an FDA contraindication; a history of pancreatitis requires individual medical review
• Severe gastroparesis not recommended in the FDA label because tirzepatide slows stomach emptying
• Type 1 diabetes tirzepatide may be used for weight loss, but insulin adjustments require specialist diabetes management
• A serious allergic reaction to tirzepatide or to any ingredient in the formulation — an FDA contraindication
• Pregnant, trying, or breastfeeding do not use during pregnancy; discuss when to stop before trying, or whether to use while breastfeeding
• Already taking another GLP-1 medicine the FDA label does not recommend using them together
• Unstable or severe mental illness needs individual review to confirm that treatment and medication use can be managed safely

Lean mass is not the same as muscle: it also includes organs, water and other tissue. Each bar is the change within that compartment, not its share of the weight lost.

Shaded steps are the doses the label says you can stay on. The others are rungs on the way up.

No new common side-effect pattern appeared through three years. The four-year evidence is in people with type 2 diabetes, measured against another drug rather than placebo.

The label says it is not known whether this happens in people. A personal or family history of medullary thyroid cancer, or MEN2, rules you out. Report a lump in the neck, hoarseness, or trouble swallowing.

• The pharmacyUS, state-licensed in 48 states and DC, NABP-accredited and LegitScript-certified
• Every batchsterility and endotoxins, by an accredited US lab independent of the pharmacy
• The active ingredientbase form, 99.4% pure on the supplier’s certificate. Compounded in the US; the ingredient itself is made abroad, at FDA-registered plants

Every trial on this page studied the branded drug. What we dispense is compounded under Section 503A: not FDA-approved, and never trialled on its own.

Pharmacy licences, accreditation records, and batch certificates are held on file and available on request.

• One named patientmade on a prescription, for you, not for stock
• Not a routine copy of the brandthe prescriber must document a patient-specific clinical difference when required

The exact requirements depend on the prescription and applicable federal and state law. Compounded medicines are not FDA-approved, and the FDA does not review them for safety, effectiveness or quality before they are dispensed.

Compounding lets me prescribe the dose a patient needs instead of limiting them to the fixed strengths available in single-dose brand pens. That flexibility can matter when someone needs to increase more slowly or stay at a lower dose.

• Tirzepatide in every vial
• plus one of these, depending on the prescription
• Glycine an inactive ingredient
• Vitamin B12 an approved medicine for other uses

Neither combination was studied in the major tirzepatide trials. Glycine appears in FDA-approved injectable products. Hydroxocobalamin is approved separately for other uses.

The supplier’s certificate reports 99.4% purity for the tirzepatide starting material. Each finished lot is tested for sterility and endotoxins.

The additives are not what makes tirzepatide work. Glycine is used in approved injectable medicines, and hydroxocobalamin is a form of vitamin B12. I go through the exact formulation with each patient so they know what is in their vial and why.