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Urgent medical review is required if patients experience: Severe or persistent vomiting or diarrhoea lasting more than 24 hours, which may lead to dehydration and electrolyte disturbances Signs of dehydration including dizziness, reduced urine output, extreme thirst, or confusion Severe abdominal pain , particularly if accompanied by fever or persistent vomiting, which could indicate pancreatitis (a rare but serious side effect of GLP-1 receptor agonists) if pancreatitis is suspected, stop tirzepatide immediately and seek urgent medical attention Symptoms of hypoglycaemia such as trembling, sweating, confusion, or palpitations, especially if taking other diabetes medications Allergic reactions including rash, swelling of the face or throat, or difficulty breathing call 999 or attend A&E for severe allergic reactions or severe breathing difficulties Worsening depression, emergence of suicidal thoughts , or significant changes in mood or behaviour Signs of serotonin syndrome (though rare) including agitation, confusion, rapid heart rate, high blood pressure, dilated pupils, muscle rigidity, or high fever Patients should contact their GP or diabetes team for routine concerns such as persistent nausea affecting quality of life, difficulty tolerating medication, questions about dose adjustments, or if they are not achieving adequate symptom control for either their diabetes or mental health condition

Their effects are additive, not opposing or interfering

doi: 10.1523/jneurosci.0226-14.2014

TNF-induced activation of the Nox1 NADPH oxidase and its role in the induction of necrotic cell death

Another one of my favorite questions to answer in our office is: What do the braces look like