GLP-1 Medications at Evolve Direct

Semaglutide & Tirzepatide

(Ozempic, Wegovy, Mounjaro & Zepbound)

What are Semaglutide (Ozempic/Wegovy) and Tirzepatide (Mounjaro/Zepbound)?

These medicines are once weekly injections which have been found to help control sugars for people with diabetes but also have been found to help people lose weight.

GLP-1 (Glucagon-Like Peptide 1) medications were originally approved for people with diabetes in 2017. These medicines work by:

1. Mimicking a gut hormone (GLP-1) to lower glucose levels after meals.
2. Block your liver from making glucose.
3. Help you feel full for a longer period of time.

Tirzepatide is a GLP-1 but also has a 2^nd action on GIP (glucose-dependent insulinotropic polypeptide) receptors.

The recommended start and titration of Semaglutide is the following:

• 0.25 mg per week for 4 weeks
• 0.5 mg per week for 4 weeks
• 1 mg per week for 4 weeks
• 2 mg once per week (maintenance)

The recommended start and titration of Tirzepatide is the following:

• 2.5 mg per week for 4 weeks
• 5 mg per week for 4 weeks
• 7.5 mg per week for 4 weeks
• 10 mg per week for 4 weeks
• 12.5 mg per week for 4 weeks
• 15 mg per week (maintenance)

How to Titrate Dosing

Take each dose for 4 weeks.

• If you reach a dose and you are losing weight, there is no need to titrate to a higher dose.
• If you are NOT losing weight and don’t have any side effects, after 4 weeks you can increase to the next dose up.
• BUT, If you have any bothersome or worrisome side effects, do NOT increase the dose and please contact your provider.

CAUTION:

 Please note the dose in mg (milligrams) is NOT the amount you will draw up on the insulin syringe.

For example:

0.25mg of Semaglutide in only 0.1ml or 10 units

1mg of Semaglutide will be 0.8ml or 80 units

How to administer the injections

Both Semaglutide and Tirzepatide are a once per week injection, just under the skin. We recommend you use a location on the abdomen, rotating through areas as show on the left.

How it works:

Evolve will send your prescription electronically to Preston’s pharmacy. The pharmacy takes care of payment and shipping straight to you. They ship anywhere within MD, DC or VA.

If you are interested in getting your medicine from Preston’s, let us know and we can send the prescription. We will need to know if you are currently taking it already, and at what dose. If you are new to these medicines, we will ask that you have an initial phone consultation with us (or virtual visit) to discuss risks/benefits and other specifics.

Once we send the prescription to Preston’s, they will contact you directly (usually via text) to confirm your address and to get a billing credit card.

Please note: If Preston’s is unable to get your medicine or there is a delay in shipping, please contact the pharmacy directly: (703) 522-3412

https://prestonspharmacy.com/

GLP Cost Calculator

Price estimates for compounded GLP medicines can be calculated using our tool (button on right). Or by clicking here. 

The weekly cost for the GLP medications can run as little as $25 per week. But pricing is highly dependent on whether you are using Semaglutide or Tirzepatide as well as what weekly dose you are taking — and how many vials you buy at a time.

Preston’s pharmacy GLP pricing is to the right.

You may find it easier to use Evolve’s Cost Estimator.

You can enter the specific medication, what weekly dose you are taking and how many vials you plan to purchase at one time to get a total cost estimate as well as the weekly cost estimate.

Storing Compounded GLP Medications

All of the compounded GLP medications from Preston’s are good for 120 days in the freezer, 90 days in the refrigerator and 30 days at room temperature. 

Who can NOT take these medicines?

If you have a personal history or family history of medullary thyroid cancer or multiple endocrine neoplasia, you cannot use any of these medications.

Side Effects

The most common side effect is nausea and diarrhea. These side effects are typically mild and usually resolve in a few days. But, if you do not improve, please let your provider know!

Side effects that you should report to us as soon as possible:

• Allergic reactions such as skin rash, hives, swelling of the face, lips, tongue, or throat
• Change in vision
• Signs of dehydration such as dry mouth, feeling faint or lightheaded, headache, dark yellow or brown urine
• Abdominal pain or prolonged vomiting
  
• Heart palpitations
• Thoughts of suicide or self-harm, worsening mood, feelings of depression
• Thyroid cancer or a new mass or lump in the neck.

Side effects that usually do not require medical attention (report to us if they continue or are bothersome):

• Diarrhea
• Loss of appetite
• Nausea
• Stomach pain
• Vomiting

Are there any foods or medications you should avoid while on GLP medications? 

In general, taking these medicines with other diabetes medications can increase the risk of dangerously low blood glucose. Examples of these include:

• Insulin
• Sulfonylureas

Certain foods and drinks may worsen potential side effects. We recommend avoiding:

• Spicy foods
• Greasy, fried foods
• Sugary foods and refined carbohydrates (like white bread)
• Alcohol

Warnings

If you have any of the following, please be sure to discuss whether GLPs are safe for you with one of Evolve’s providers:

• Endocrine tumors (MEN 2) or if someone in your family had these tumors
• Gallbladder disease
• History of depression or mental health disease
• History of pancreatitis
• Kidney disease
• Stomach or intestine problems
• Suicidal thoughts, plans, or attempt; a previous suicide attempt by you or a family member
• Thyroid cancer or if someone in your family had thyroid cancer
• An unusual or allergic reaction to Semaglutide, other medications, foods, dyes, or preservatives
• Pregnant or trying to get pregnant
• Breast-feeding

More Information

Harvard Health: https://www.health.harvard.edu/staying-healthy/glp-1-diabetes-and-weight-loss-drug-side-effects-ozempic-face-and-more