client submitted another initial form, she had a three weeks break and would like to goo back on medication as struggling with appetite control and gaining weight, with 3 weeks break advised to reduce dose, prescription for Wegovy 0.5mg issued,
follow up call, doing well on medication, occasional indigestion, manageable, no problems injection, noticed as was on and off medication that it is not working as well as before to reduce appetite but explained that it works but might require higher dose
client submitted follow up questionnaire, doing well on medication no side effects, loosing weight but slow, happy to stay in the same strength at the moment, no changes in medical history
follow up call completed, client happy to stay on the same strength, weight update
Medical history and current medication reviewed. Client reports occasional migraine, managed with naproxen and rizatriptan as required. Currently taking the oral contraceptive pill. BMI 28 kg/m² and waist circumference 90 cm. Assessment consistent with overweight with central adiposity. Client's weight-loss goal is 9 kg.
Discussed treatment with Wegovy (semaglutide) and mechanism of action, including appetite regulation and increased satiety. Benefits, risks and potential adverse effects discussed, including nausea, vomiting, diarrhoea, constipation, abdominal pain and reduced appetite. Advised regarding dietary measures, smaller portion sizes and adequate fluid intake.
Contraception reviewed and advice provided regarding continued effective contraception. Advised that vomiting or severe diarrhoea may affect absorption of the oral contraceptive pill and to follow contraceptive guidance regarding additional precautions if required.
Following discussion, client wishes to proceed with treatment. Wegovy 0.25 mg subcutaneously once weekly commenced as prescribed. Advised to continue dietary and lifestyle measures. Weight, waist circumference, treatment response and tolerability to be monitored, with review prior to dose escalation. Weight-loss target is 9 kg.
doing well on medication, appetite reduced , no side effects, no changes in medical history, happy to continue on the same strength, prescription for Mounjaro 12.5mg issued, going on holidays therefore request submitted a little earlier
no changes in medical history, current strength seem to be working well in maintain weight, no side effects, prescription for Mounjaro 2.5mg pen issued
follow up call following first injection, no answer message left
follow up call, client happy on the current strength, no changes in medical history, follow up form completed, current BMI 23 prescription for Mounjaro 10mg issued
follow up form completed, no side effects, no changes in medical history, not lost any weight and struggling with appetite control. Next pen dose increase Wegovy 1.7mg , if not successful consider switching to Monujaro
completed follow up form, doing well on medication and for the first time in a few months noticed weight loss, happy to continue on the same strenght, prescription for Mounjaro 15 mg issued
left message
left message
left message
due to holidays first dispensing passed onto borders aesthetics, will resume in the second month, Mounjaro 2.5mg x1 and sharps bin 1l provided
doing well on medication, no side effects, noticed difference when comes to appetite and lost weight, current strength seems to be working well, no changes in medical history, prescription for Mounjaro 10mg issued. Lost 5.8kg in the last 4 weeks
Diagnosis:
Overweight (BMI 28 kg/m²) with central adiposity (waist circumference 102 cm).
Clinical history and assessment:
Patient reviewed for ongoing weight-management treatment. Patient has previously used Mounjaro (tirzepatide) and reports that it was effective for weight loss/weight management. However, patient has been intermittently stopping and restarting the medication. Discussed the importance of consistent treatment and adherence to the prescribed dosing schedule to optimise efficacy and minimise tolerability issues associated with repeated interruptions and re-initiation.
Current medication: citalopram. No other regular medications reported. No known allergies. No contraindications to treatment identified from the information provided.
Treatment discussion:
Discussed restarting tirzepatide (Mounjaro), including its mechanism of action as a dual GIP and GLP-1 receptor agonist. Explained that it promotes glucose-dependent insulin secretion, reduces glucagon secretion, slows gastric emptying and increases satiety, thereby supporting reduced food intake and weight loss.
Potential adverse effects discussed, particularly gastrointestinal symptoms including nausea, vomiting, diarrhoea, constipation, abdominal discomfort and reduced appetite. Patient advised regarding adequate hydration and to seek medical advice if significant or persistent adverse symptoms occur. Importance of adherence and appropriate dose escalation was discussed.
Plan:
Restart Mounjaro (tirzepatide) 2.5 mg once weekly.
Prescription for Mounjaro 2.5 mg issued.
Continue citalopram as prescribed.
Patient advised to avoid stopping and restarting treatment without clinical advice.
Monitor weight, waist circumference, tolerability and response to treatment.
Review at follow-up and titrate dose according to clinical response and tolerability.
weight update
client got in touch asking is she could start treatment earlier and use friend pen, advice given on sharing injectable and risks involved, as well as prescription only statue amongst other factors like source, storage etc advised against it
follow up consultation, doing well on medication no problems with injecting, appetite reduced and loosing weight, no changes in medical history slight loose bowels but manageable, advice given on how to manage diahhorea, current strength works well, Prescription for Mounjaro 5mg issued
starting weigh 84kg
current weight 78kg (-6kg since start and -3kg in the last 4 weeks)
doing well on medication, slight nausea on a day after the injection, manageable, no other side effects, appetite reduced and loosing weight,
starting weight 97kg
current weight 91kg (-6kg since start and -3kg in the last 4 weeks)
no changes in medical history
prescription for mounjaro 5mg inj issued
doing well on medication noticed big difference this month with significant weight loss, no side effects, no changes in medical history, appetite reduced
happy to continue on the same strength, prescription for mounjaro 10mg issued
starting weight 125.3kg
current weight 91kg (-34.3kg since start)
doing well on medication, no side effects, managing injections well, no changes in medical history, happy to continue on medication, appetite up an down, dose increase, next pen Wegovy 0.5mg prescription issued
doing well on medication, managing to maintain current weight, happy to continue on current strength, prescription for Mounjaro 7.5mg issued
doing well on medication, no changes in medical history, feels that current strength works well, managing injections ok, no side effects, prescription for Mounjaro 2.5mg issued