Zepatid-10 Injection

Once-weekly dual GIP/GLP-1 receptor agonist injection for:

• Type 2 diabetes in adults (with diet and exercise)
• Chronic weight management in adults with obesity (BMI ≥ 30) or overweight (BMI ≥ 27) with a weight-related condition
• Obstructive sleep apnoea with obesity (where approved)

Subcutaneous injection once weekly (abdomen, thigh or upper arm), on the same day each week, with or without food.

• Start 2.5 mg once weekly for 4 weeks (starter dose to improve tolerability).
• Increase by 2.5 mg every 4 weeks as needed: 5 mg → 7.5 mg → 10 mg → 12.5 mg → maximum 15 mg weekly.
• Usual maintenance: 5, 10 or 15 mg weekly.
• Missed dose: take within 4 days; otherwise skip and resume the next scheduled dose.
• When starting with insulin or sulphonylureas, their doses may need reducing.

• Personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2 (MEN2)
• Allergy to tirzepatide
• Type 1 diabetes, diabetic ketoacidosis

Very common: nausea, diarrhoea, vomiting, constipation, decreased appetite, indigestion, abdominal pain (mostly during dose increases).

Common: low blood sugar (with insulin/sulphonylureas), tiredness, hair loss, injection-site reactions, burping, bloating, fast heartbeat.

Rare but serious: pancreatitis, gallbladder disease (gallstones), acute kidney injury from dehydration, severe allergic reactions, worsening of diabetic retinopathy, aspiration risk during anaesthesia, possible thyroid tumours (seen in animals).

• Stop and seek help with severe persistent abdominal pain (with or without vomiting).
• Drink enough fluids to prevent dehydration when nauseated or vomiting.
• Tell the anaesthetist before surgery or endoscopy (delayed stomach emptying).
• Report a lump in the neck, hoarseness or difficulty swallowing.
• Not a substitute for insulin.

Do not use in pregnancy; stop at least 1 month before planned pregnancy. Oral contraceptive absorption may be reduced — use a barrier method or switch to non-oral contraception for 4 weeks after starting and after each dose increase. Not recommended while breastfeeding.

• Insulin, sulphonylureas (hypoglycaemia)
• Oral contraceptives (reduced absorption after dose escalation)
• Oral medicines needing rapid absorption or with a narrow safety margin (warfarin, levothyroxine) — monitor because stomach emptying is slowed
• Do not combine with other GLP-1 agonists

Severe nausea, vomiting and low blood sugar. Supportive care; observe for several days (long-acting).

Store in a refrigerator (2–8°C); do not freeze. May be kept unrefrigerated below 30°C for up to 21 days. Protect from light.