Medical Consent

• You have a personal or family history of Medullary thyroid carcinoma, MTC, (a specific, rare type of thyroid cancer)
• Multiple Endocrine Neoplasia syndrome type 2 (MEN-2, a rare, genetic disorder that can cause tumors in the thyroid gland and other glands)
• In light of the potential risk for MTC with use of GLP-1 medications (like semaglutide, tirzepatide or retatrutide), patients should be aware of symptoms of thyroid tumors (e.g. a mass in the neck, elevation of calcitonin, difficulty swallowing (dysphagia), difficulty breathing (dyspnea), persistent hoarseness, or other; and to seek appropriate evaluation for such signs or symptoms if present.
• You are pregnant or plan to become pregnant while taking this medicine. GLP-1 medications may cause fetal harm. When pregnancy is recognized, discontinue GLP-1 medications. Discontinue GLP-1 medications at least 2 months before a planned pregnancy. 
• You are a are diabetic and/or taking any medications related to lowering your blood sugar levels without speaking with your licensed, The Remedy Realm provider clinician.  GLP-1 medications lower blood glucose and can cause hypoglycemia, but even more so when combined with other blood sugar lowering medications. As a result, we need to know if you are prescribed Insulin (or other “hypoglycemic agent” medication (blood sugar lowering medication), because combining blood sugar lowering medication with GLP-1 medication may increase your risk of hypoglycemia (low blood sugar), and dosage adjustments by your provider to your medications may be necessary.   If you develop symptoms of hypoglycemia (light headedness, anxiety, shaking, sweating, rapid heartbeat, irritability or confusion, hunger, other), consume at least 15 grams of carbohydrate and, if possible, check blood glucose after 15 minutes to make sure it is over 70 mg / dL. If it is not, have another serving of carbohydrate. Once blood glucose is over 70 mg / dL, a meal should be consumed.
• You have a history of Pancreatitis or have a condition that may make Pancreatitis more likely to occur. Acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis, has been observed in patients treated with GLP-1 receptor agonists (like semaglutide, tirzepatide and retatrutide). Symptoms of acute pancreatitis could include severe abdominal pain, sometimes radiating to the back, and which may or may not be accompanied by vomiting. If acute pancreatitis is suspected, discontinue any GLP-1 medication (i.e. semaglutide, tirzepatide or retatrutide) medication promptly and seek urgent medical attention for a proper pancreatitis evaluation including exam, blood tests, and potentially imaging studies. If acute pancreatitis is confirmed, do not restart GLP-1 medication.
• You have a history of gallbladder disease. While not an an absolute “contra-indication” to GLP-1 medications, treatment with GLP-1 medications (i.e. semaglutide, tirzepatide or retatrutide) was associated with an increased occurrence of cholelithiasis (gallstones) and cholecystitis (gallbladder inflammation). For example, in clinical trials in adult patients, cholelithiasis was reported by 1.6% of Wegovy® (semaglutide) patients and 0.7% of placebo patients. The incidence of cholelithiasis (gallstones) and cholecystitis (gallbladder inflammation) was higher in Wegovy® (semaglutide) treated pediatric patients (aged 12 years and older) than in Wegovy® (semaglutide) treated adults. Cholecystitis was reported by 0.6% of Wegovy® (semaglutide) patients and 0.2% of placebo patients. Substantial or rapid weight loss can increase the risk of cholelithiasis (gallstones); however, the incidence of acute gallbladder disease greater in Wegovy® (semaglutide) patients than in placebo patients, even after accounting for the degree of weight loss. If cholelithiasis (gallstone disease) is suspected, gallbladder studies and appropriate clinical follow-up are indicated.
• You have kidney disease or are on dialysis. There have been post-marketing reports of acute kidney injury and worsening of chronic kidney failure, which in some cases required hemodialysis, in patients treated with semaglutide. Patients with renal (kidney) impairment may be at a greater risk of acute kidney injury, but some events have been reported in patients without underlying kidney (renal) disease. A majority of the events occurred in patients who experienced nausea, vomiting, or diarrhea, leading to volume (fluid) depletion. Renal (kidney) function will be monitored prior to starting a GLP-1 medication and along your weight loss journey as needed and more frequently if reporting any adverse reactions that could lead to volume depletion.
• You are allergic to any GLP-1 agonist such as: Adlyxin®, Byetta®, Bydureon®, Mounjaro®, Ozempic®, Rybelsus®, Trulicity®, Victoza®, Wegovy®, or “compounded” semaglutide,  tirzepatide or retatrutide.
• You are taking any other GLP-1 agonist medication.
• You have other concerning allergies. Serious hypersensitivity (allergic) reactions (e.g. anaphylaxis, angiodedema) have been reported with GLP-1 medication. These medications may contain inactive ingredients, which can cause allergic reactions or other problems. If hypersensitivity (allergic) reactions occur, discontinue use of GLP-1 medication and seek treatment promptly as well as monitoring until symptoms resolve.
• You have a history of diabetic retinopathy or diabetes: In a trial of adult patients with type 2 diabetes, diabetic retinopathy was reported by 4% of Wegovy® (semaglutide) patients and 2.7% of placebo patients. Rapid improvement in glucose control has been associated with a temporary worsening of diabetic retinopathy. Patients with a history of diabetic retinopathy on GLP-1 medications should be monitored for progression of diabetic retinopathy by their ophthalmologist.
• Pediatric populations: Although pediatric adverse reactions were not thoroughly studied in every GLP-1 medication, adverse reactions with semaglutide (a GLP-1 medication) in pediatric patients aged 12 years and older were similar to those reported in adults. Pediatric patients 12 years and older treated with semaglutide (Wegovy®) had greater incidences of cholelithiasis (gallstones), cholecystitis (inflammation of the gallbladder), hypotension, rash, and urticaria (hives from an allergic reaction to medication) compared to adults treated with semaglutide (Wegovy®).

• Serious allergic reaction, including rash, itching/swelling (especially of the face/tongue/throat)
• Swelling of the feet, ankles, or lower legs
• Severe dizziness
• Trouble breathing
• Pancreatitis
• Heart problems, including palpitations
• Symptoms of de-hydration, including extreme thirst, very dry mouth or skin, decreased urination, dizzy with standing, etc.