| Name | Zofran (ondansetron) + Tirzepatide (dual GIP and GLP-1 receptor agonist), available in both branded (Mounjaro®/Zepbound®) and compounded forms. |
| Uses | Elective weight loss and metabolic optimization in adults with BMI ≥25. Zofran is adjunctive for nausea mitigation. Not indicated for diabetes management in this setting. |
| Route Of Administration | Tirzepatide: subcutaneous injection weekly. Zofran: oral tablet, taken PRN for nausea. |
| Frequency Of Use | Tirzepatide: once weekly. Zofran: maximum twice daily as needed. Reassess Tirzepatide dose every 4 weeks. |
| Concentration(s) | Branded: Mounjaro®/Zepbound® available in 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg auto-injectors. Compounded: typically 2.5–15 mg/mL. Zofran: 4 mg or 8 mg tablets. |
| Maximum Dosage (Day, Wk) | Tirzepatide max: 15 mg weekly. Start at 2.5 mg/week and titrate cautiously. Zofran max: 16 mg/day (8 mg BID). |
| Contraindications | Absolute: Personal/family history of medullary thyroid cancer or MEN2, pancreatitis, gastroparesis, pregnancy/lactation. Zofran: hypersensitivity, prolonged QT syndrome. Relative: gallbladder disease, renal insufficiency, electrolyte imbalances. |
| Possible Side Effects | Tirzepatide: nausea, vomiting, diarrhea, fatigue, constipation, reduced appetite. Rare: pancreatitis, gallbladder issues. Zofran: headache, dizziness, constipation, rare QT prolongation. |
| Compatibility With Other Treatments/Drugs | Use with caution alongside QT-prolonging drugs or insulin/sulfonylureas (risk of hypoglycemia). Zofran may be safely co-administered with Tirzepatide. |
| Allergies | Zofran: allergy to ondansetron or other 5-HT3 antagonists. Tirzepatide: hypersensitivity to medication components or excipients in compounded forms. |
| Administration Time | Tirzepatide: inject weekly, same day each week. Zofran: take 30–60 minutes before injection if nausea is anticipated. |
| Dosing/Settings | Tirzepatide: initiate at 2.5 mg/week for 4 weeks, increase by 2.5 mg every 4 weeks as tolerated. Zofran: 4–8 mg PO as needed, max 16 mg/day. |
| Test Spot Requirement | Not required. Begin at lowest dose and observe for side effects. First-time users should be closely monitored after first dose. |
| Pre-Treatment Guidelines | Ensure patient is well-hydrated and has had a light meal. Avoid alcohol or fatty meals prior to dosing. Recommend baseline labs (CBC, CMP, lipids, A1c optional). |
| Provider Clearance Guidelines | Proceed only if BMI ≥25, age ≥18, full GFE complete, and no contraindications. Zofran included for patients with moderate to severe nausea from prior injections. |
| Pre-Treatment Screening Workflow | 1. Confirm BMI ≥25 and adult age. 2. Exclude thyroid cancer risk, pancreatitis, GI dysmotility. 3. Verify no Zofran allergy. 4. Consent must include both medications. |
| What To Do If Adverse Reaction Occurs | 1) Stop Tirzepatide. 2) Administer Zofran 4–8 mg PO. 3) If signs of pancreatitis or allergic reaction, send to ER. 4) Document reaction and notify supervising MD/NP. |
| Clinic Implementation Guidelines | Front desk: verify intake, weight history, and consents. Supplies: compounded Tirzepatide or branded auto-injectors, Zofran tablets, injection kit. Provider: confirm GFE clearance and dose plan. |
| Photographic Documentation Protocol | Optional. For aesthetics or weight loss documentation, capture baseline and monthly photos with consent (front, side, back). |
| Post-Treatment Care | Hydration, low-fat meals, avoid overeating. Follow-up every 4 weeks for reassessment and dose adjustment. Encourage food journaling and symptom tracking. |
| Additional Documentation Requirements | Signed consents for Tirzepatide and Zofran, GFE documentation, EMR charting, injection log, weight and symptom monitoring, and adverse reaction records. |