This is a very interesting (sometimes controversial?) AMA from an A&E doctor who is also on MJ herself (secret jabber).
https://www.reddit.com/r/mounjarouk/comments/1l0wqy5/ae_doctor_ama_answers/
For those that didn’t see the original post I’m a resident doctor in Emergency Medicine (A&E) and I’m also a Mounjaro user. This thread is just a few frequently asked questions or frequently noted issues that I’ve come across from people using MJ (Mounjaro).
Disclaimer: I'm a resident doctor in Emergency Medicine, meaning my specialist area is emergencies. I'm not a gastroenterologist, bariatric doctor, dietitian, or GP. If I don't think I know enough about your question I haven't answered it. I have no idea about the health systems or populations of other countries so this is purely for the UK. I have not provided individual medical advice – this is all very generic and likely already known if you read all the information sent to you by the pharmacies.
Also – I’m not going to give advice about when you should attend the Emergency Department. You need to make those decisions for yourself.
What has been the cause of the majority of Mounjaro-related ED attendances?
- vomiting +/- abdo pain +/- diarrhoea
- gallstones
What are people doing wrong that causes an ED attendance?
- continuing to take injections despite awful side effects
- not eating enough
- allowing themselves to get constipated
- losing weight too quickly
What’s the most shocking or unexpected diagnosis?
Nothing. It’s all banal and expected/common.
How many patients bought Mounjaro illegally or lied to get it?
None. Also, I’m not a detective and I generally don’t question the sources of where my patients acquire drugs.
What proportion of ED attendances are due to not using the medication properly?
None. All have been used as prescribed.
Are you more likely to get side effects/complications at higher doses?
I personally haven’t seen any correlation between worse side effects & higher doses. But it’s really a small amount of people I’ve seen myself. If you want a proper answer you should find studies which have actual statistics.
Is there anything that has caused the recent increase in patients attending ED?
I just think more people are taking it so more are showing up. It’s the same with any drug.
How many Mounjaro related side effects/complications are due to pre-existing conditions? How many have underlying health problems?
None so far
How many patients do you see with obesity related problems?
Waaaayyyyy more. It can be anywhere from a quarter to half of the patients I see on any shift (when not working minor injuries) – and that’s a conservative estimate. Heart disease, kidney disease, liver disease, mobility issues, falls, diabetes. Obesity is the biggest health crisis of our generation.
Should we be worried about more Mounjaro users attending ED?
No. Mounjaro is the same as any drug. It has side effects and complications and, by knowing what they are, we can try to reduce the r!sk of developing them but we can’t completely take the r!sk away. But we deal with r!sk everyday. I’m probably still far more likely to treat you as a result of a car accident than Mounjaro related issues but most people don’t let the r!sk of a car accident stop them from driving. Everything in healthcare is a balancing act of r!sk. What’s more r!sky – having uncontrolled high blood pressure which may cause a heart attack or stroke in 10 years or taking a drug which can sometimes affect kidney function? I see Mounjaro as the same – it’s the balance between the r!sk of obesity related complications vs Mounjaro related complications. The ultimate decision for the relative r!sk of any of these occurring needs to be by you and your GP (or pharmacist).
Common issue number 1 - nausea & vomiting
Nausea and vomiting are the main reasons Mounjaro users attend ED. It’s usually at its worst the day after injecting. For the majority it will then ease off but in some cases it just continues on and can last for days or even a week or two. This is because the drug takes a long time to be completely cleared from the body. It takes about 5 days for the drug to reduce by half in the body but it likely won’t be fully gone for 30 days.
The vomiting/nausea can start at any dose, even if it’s not the first injection of the higher dose (though that's most common). This is because the drug builds week on week so every week the peak of the drug is slightly higher.
How to manage this:
- if you’re due to inject and you can’t keep the minimum calories required down, don’t inject
- for vomiting - small sips of sugary juice + dry food (crackers/biscuits/toast), little and often through the day
- some people find that water makes them more likely to vomit, in this case juice or even fizzy drinks (small sips) can sometimes help. This is very individual-dependent. Ultimately the goal is some fluid intake. The exact type of fluid is less important than keeping some type of fluid down (in this instance).
- if you still can’t meet minimum calorie requirements after about 2 days you might need an antisickness to help – you can see your GP, or Buccastem can be bought over the counter from most pharmacies. I'd advise avoiding ondansetron because it slows gut motility.
- if you’re symptoms are bad enough to need antisickness tablets then you should seriously consider pausing Mounjaro or reducing the dose and going much slower with it (ie. longer than 4 weeks on each dose)
Note – you can also develop normal gastroenteritis. Because Mounjaro can make your symptoms worse the above management still applies.
Common issue number 2 - not eating enough
Not eating enough (over a sustained peiod of time, we're talking weeks not days here) is bad because:
- You develop electrolyte & nutrient deficiencies which, if untreated, can go on to cause a whole bunch of other problems. These can either happen gradually or suddenly once you start eating an appropriate amount again.
- You end up overweight yet physiologically very frail because you are essentially malnourished – fat is not the same as nourishment. Malnourished people are less able to fight off other diseases/ill states/injuries so if you come in with an issue completely unrelated to Mounjaro you’ll find your recovery journey is much harder.
- The prescribed electrolyte replacement tastes super gross and honestly you should save yourself the burden of having to suffer through it. Electrolyte replacement has been the second most common thing I’ve had to prescribe for Mounjaro patients (after antisickness).
Note – unless you’re genuinely not eating anything at all for a significantly prolonged period of time it’s highly unlikely you’d develop a starvation ketoacidosis as some people seem to mention on this subreddit. A starvation ketosis, on the other hand, is a normal part of losing weight.
How to manage this:
- but I’m sure there are others. (NOTE - this is not a target, but an absolute minimum)
- if nausea/bloating means you cannot achieve this then you need to go down a dose or pause and start again much slower (ie. longer than 4 weeks on each dose)
Common issue number 3 - abdo pain & gallstones (& pancreatitis)
The r!sk factors for developing gallstones is being fat, female and fertile (ie. of childbearing age). Mounjaro is also a r!sk factor. And so is losing weight too quickly. So, in essence, I’m fucked.
Many many people get gallstones irrespective of Mounjaro. My personal opinion is that I’m high r!sk for it regardless of whether or not I’m on Mounjaro, so I might as well use Mounjaro. What we should be trying to do is lose weight slowly because that’s the main r!sk factor we can modify at this time. 1-2lbs a week (or 0.5-1kg) is a safe amount to lose.
I would also recommend going as slowly up the injections as possible. For any drug we want to achieve the lowest possible dose (because that will give the fewest side effects) that achieves it's goal. Therefore if you're losing 1-2lbs a week on 2.5mg then stay on 2.5mg until you're consistently not achieving this. And do the same for every subsequent dose. This might mean some doses you stay on for a few months and others you just do the 4 weeks. Or you may not find any of them effective until 15mg. All our bodies will respond to the drug differently. But there's no point on being on a higher dose if you can achieve good results and fewer side effects on a lower dose. A good rule of thumb would be that if you're consistently losing <0.5kg a week then it's probably time to move up a dose. But again, it's ultimately a decision between you and your GP/pharmacist.
Gallstones – I’ve noticed people worrying about it because of ‘twinge’ in their abdomen. Gallstones isn’t a twinge. It’s severe pain. By severe I mean you’re doubled over, couldn’t physically make a cup of tea, can’t follow the storyline on the TV and can’t follow the game on your phone.
Pancreatitis – I’ve not seen anyone with pancreatitis who was on Mounjaro, but it is more rare than gallstones anyway. The studies show that it’s a possible complication of Mounjaro so it should be taken seriously. Gallstones themselves can also cause pancreatitis. Pancreatitis is nasty and you don’t want it. There’s not much you can do to reduce your r!sk other than limiting alcohol (or cutting it out completely). I still have alcohol (like two or three glasses every few weeks) but I’m much more cautious and I wouldn’t go on a binge. But that doesn’t mean it’s the correct thing to do. Essentially – you do you.
Common issue number 4 - constipation & diarrhoea
Constipation is a known side effect of Mounjaro. I’ve kept note of every time I’ve opened my bowels on my Shotsy app. Fun, I know. I just wanted to make sure I’m still going every day (which is normal for me but your normal might be every third day or even three times a day, we’re all different) and ready to start any constipation-relieving measures as needed. So far I haven’t had any problems and I haven’t needed any supplements.
I know people on here go on about magnesium and psyllium husk but I don’t know much about those. I wouldn’t go out of my way to recommend them but I think loads of people have found them helpful so, again, you do you. I would mostly advocate for you to get as much of your nutritional requirements from food itself. This means eating lots of fruit and veg. If you’re constipated then first I’d reach for berries and prunes and other high fibre fruits. If none of it is working then the laxative I mostly recommend is laxido (aka macrogol) which you can buy over the counter at the pharmacy. It works by increasing the water in your stool. Or you can see your GP or chat to the pharmacist about other options.
If you go from being very constipated to suddenly having diarrhoea you should continue your laxatives. This is because the sudden diarrhoea is actually liquid stool that’s found it’s way around the hard lump of faeces sitting in your bowel. That hard lump still needs to exit meaning you’re still constipated. Once that hard lump has softened and broken down the liquid will gradually turn into normal stool.
Dehydration is one of the most common causes of constipation. It’s said a lot on this sub but you need to drink. Depending on your size it’s anywhere from 2-4 litres a day. I’m aiming for 3 litres. I appreciate it’s hard – I often don’t meet my target. But you can bet that if I had even a whiff of constipation I’d be chugging like a student in fresher’s week.
How important is it to disclose to your doctor you’re on Mounjaro?
Very important. No diagnosis can be accurate unless you answer our questions honestly. That includes what meds you take. If you don’t tell us we might not run the right tests and that means your problem may go untreated.
Do Mounjaro patients have a lower BP?
I’m not aware of any studies specifically showing this, but losing weight is very likely to lower blood pressure. There’ll be less strain on your heart, the diet will be less salty, there’s likely to be more movement/activity. If you’re on blood pressure tablets you should definitely be seeing your GP about it while you lose weight.
If you find that you get lightheaded/dizzy for the first few minutes when standing then you are likely dehydrated and you need to drink more. Minimum 2 litres a day. If you’re still getting lightheaded then see your GP.
Are there any supplements you would recommend?
Boots A-Z general health multivitamin is the one I take. It contains all the main vitamins you need. Everyone in the UK should probably also be on a separate vitamin D supplement, especially in winter. See your GP about that one.
I wouldn’t recommend any others as a matter of course. Different people will find different things work for them and most of them are benign. My main recommendation is to try and get everything from actual food first before resorting to supplements. But that’s easier said than done.
I wouldn’t recommend electrolyte drinks instead of food that contains electrolytes. The drinks have a role, mostly in sport, but a healthy diet shouldn’t need to be supplemented by extra electrolytes. If you’re meeting your minimum calorie requirements then you’re getting enough electrolytes.
Can Mounjaro cause issues down the line?
Don’t know. It’ll take 10-20 years before we have some longitudinal studies to look over. We’re all the guinea pigs and it all comes back to how you balance the r!sks out for yourself.
How do you deal with negative comments about Mounjaro from other doctors/nurses/HCPs?
I don’t. I’m a secret jabber. If I manage to lose a good amount of weight I’ll probably be a lot more open about it and willing to chat to them then.
Do patients take your advice about healthy lifestyles less seriously because you’re fat?
I don’t know, you’d have to ask them. But I’d argue that fat patients are more likely to listen to my advice because I’m also fat and, therefore, clearly not fobbing them off.
Are there r!sks of hitting a blood vessel when injecting?
No
Why do I get bruises/red marks/spots/inflamed areas when injecting?
Bruises - you’ve probably torn through some miniscule capillaries (small blood vessels) or injecting the liquid has disrupted some. It’s common when injecting and nothing to worry about.
Red marks etc - all injections can cause local inflammation. It can occur in some areas but not others. It's nothing to worry about. Inflammatory molecules live in our tissues and small blood vessels. They're released at the site of injury (which is why injured areas/wounds get red, swollen and itchy). They're a normal part of your body working correctly and will go away by itself. If it's annoying you you can take an antihistamine (histamine is one of the inflammatory molecules).
What are the r!sks or chance of infection from using a pen beyond the 30 days?
Everytime you put a new needle on (or draw out with a insulin syringe) you’re introducing bacteria into the medication. The more you do it the more is introduced. The longer you leave the pen the more bacteria can grow. The r!sk of injecting bacteria into yourself is cellulitis (skin/soft tissue infection). Cellulitis is very common and even things like cannulas in hospital can cause it. I’m personally not going to test to see how r!sky using the pen after 30 days is, because I think it’s silly to increase your r!sk of something entirely preventable.