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Contact your GP or healthcare provider if you experience any of the following: Heartburn occurring more than twice weekly despite self-management strategies Symptoms persisting beyond 2 weeks of over-the-counter treatment Difficulty swallowing (dysphagia) at any age this requires urgent referral for endoscopy Pain when swallowing (odynophagia) Unintentional weight loss (distinct from expected weight reduction on tirzepatide) Persistent nausea or vomiting, particularly if you cannot keep down fluids Evidence of gastrointestinal bleeding, including vomiting blood, black tarry stools, or blood in vomit Severe or persistent abdominal pain Symptoms of anaemia such as unusual tiredness, breathlessness, or pale complexion If you are aged 55 or over with persistent or new-onset heartburn plus weight loss and upper abdominal pain/reflux/dyspepsia Seek urgent medical attention (contact 999 or attend A&E) if you experience: Severe chest pain, particularly if radiating to the jaw, neck, or arm (to exclude cardiac causes) Sudden, severe abdominal pain Persistent vomiting preventing fluid intake, risking dehydration Signs of severe dehydration including reduced urination, dizziness, or confusion For urgent but non-life-threatening concerns outside of GP hours, contact NHS 111 for advice

The international trial register clinicaltrials.gov was searched for published and unpublished studies by searching each of the individual drugs combined with the terms pregnancy, diabetes mellitus, reproduction and lactation
Patients with moderate to severe renal disease, pancreatitis history, or personal/family history of medullary thyroid cancer require careful risk-benefit assessment before tirzepatide initiationa decision best made collaboratively with a qualified medical provider
PT-141 stimulates melanocortin receptors in the brain, triggering sexual arousal and increasing desire without affecting hormones