Mounjaro effective against diabetes, but no quick fix for weight loss, say doctors
Health experts say diet and exercise still matter as stopping the drug may lead to weight regain
A drug recently introduced in India is gaining popularity to achieve weight loss and to battle diabetes but experts warn that it should not treated as a quick fix for long-standing health issues.
Eli Lilly says Mounjaro (Tirzepatide), its diabetes and obesity management drug, can help people lose 15-22 per cent of their body weight. However, health experts say diet and exercise still matter as stopping the drug may lead to weight regain.
Costly drug
The affordability of the drug remains a major concern, priced as it is at Rs 3,500 for a 2.5 mg vial and Rs 4,375 for a 5 mg vial. It would cost approximately Rs 2 lakh a year.
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Tirzepatide is an anti-diabetic drug that is indicated as an adjunct to diet and exercise to improve the glycaemic index or the blood sugar control in adults with type 2 diabetes mellitus.
Because of this property, it can be used for weight management in obese and overweight individuals. By reducing weight, it also helps to control obstructive sleep apnea, which could be a precursor for conditions like heart failure.
The drug is now being sold under the brand name Mounjaro for diabetic treatment and Zepbound for weight loss management.
Weight loss and more
Senior diabetologist Dr V Mohan explains that there are two types of anti-diabetes drugs. One of these is GLP-1 receptor agonists (GLP-1 RAs). There are several drugs already in this category that are good for diabetes control, he told The Federal. And there is the drug Semaglutide (brands Ozempic and Wegovy), he added.
"Ozempic is used not only for weight loss but also as an anti-diabetes drug. Wegovy is for weight loss. Both have been used successfully in the US,” he said.
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“On the other hand, Tirzepatide is a dual GIP/GLP-1 receptor agonist, which activates the GLP and GIP hormones present in the intestine. GLP hormone enhances insulin release from the pancreas in response to glucose intake and decreases glucagon. The other hormone, called GIP, also helps to reduce weight by stimulating insulin release. While Semaglutide helps with about 10 per cent weight loss, Tirzepatide helps with about 20-25 per cent weight loss," Dr Mohan added.
Regaining weight
Mounjaro doesn't just help people address obesity. It is also stated to lower fat, diabetes levels and blood pressure, and increase good cholesterol.
However, the drug works on one's body only for as long as it is taken. "There are studies that show that when you withdraw the drug, you regain about half the weight lost," Dr Mohan told The Federal.
For example, if there is a weight loss of 20 kg, there can be a weight gain of 9 kg when the drug is stopped. Experts say the drug needs to be started with a smaller dosage and increased gradually.
Side effects
If the drug is taken more than once a week or a high dosage is given suddenly, there can be side effects such as nausea.
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"Since the drug works both on the intestine and pancreas, it reduces appetite and controls cravings. Bariatric surgery has only helped with such a high percentage of weight reduction," Dr Mohan added.
Prescription is must
Stating that the drug cannot be taken without prescription, Dr Pearlsy Grace Rajan, senior consultant of internal medicine at Rela Hospital, said it should not to be taken in patients with type 1 diabetes.
"There is also a black box warning coming along with the drug saying it's not to be used in patients with a family history of medullary carcinoma of the thyroid and in patients with multiple endocrine neoplasm syndrome type 2,” the doctor told The Federal.
“Tirzepatide is a gastric inhibitory polypeptide analog and a GLP-1 receptor agonist. Because of this, it has more gastrointestinal side effects like nausea, diarrhoea, vomiting, loss of appetite and constipation," Dr Pearlsy added.
Weekly regimen
The purported advantage of this drug is its once-weekly dose regimen. It is typically initiated with a low dose and gradually escalated. But this is to be used only under the supervision of a diabetologist or an endocrinologist.
According to Dr Anantha Krishnan, an internal medicine specialist and diabetologist at Prashanth Hospitals, it could be a breakthrough for obesity and weight-related health issues, potentially replacing surgery for some. However, long-term sustainability is still being studied.
The common side effects include nausea, vomiting, diarrhoea, constipation and fatigue. Some may also experience low appetite and hypoglycemia (especially diabetics).
Animal studies suggest a potential thyroid risk, although this has not been confirmed in humans.
Drug and insulin
It is important to note that the drug cannot be used primarily as a weight loss drug. Its long-term usage makes it useful for diabetics who are insulin dependent.
Additionally, the makers highlight that the drug works along with diet and exercise.
"It is not a quick fix to lose weight. It is to be used for a long term. Stopping may lead to weight regain. Since the drug is expensive, the affordability is still a question," reiterated Dr Anantha Krishnan.