Mounjaro in Canada

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Mounjaro (tirzepatide) is a novel medication approved for the treatment of type 2 diabetes mellitus (T2DM). It belongs to a class of drugs known as dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonists. ^[1]

Mounjaro works by mimicking the effects of two key incretin hormones, GIP and GLP-1, which play important roles in regulating blood sugar and appetite. By activating these receptors, Mounjaro stimulates insulin secretion, reduces the production of glucagon (a hormone that raises blood sugar levels), slows down the stomach from emptying and contributes to a feeling of fullness. ^[2] This multifaceted mechanism helps lower blood sugar levels and can also contribute to significant weight loss. Mounjaro is administered as a once-weekly subcutaneous (under the skin) injection at any time of the day.

Mounjaro is primarily used to improve glycemic control, which is the way the body manages blood sugar, in adults with T2DM, alongside diet and exercise. ^[1] It addresses the underlying metabolic dysfunction in T2DM by enhancing insulin sensitivity and reducing insulin resistance. By targeting both glucose metabolism and weight management, Mounjaro’s dual-action mechanism provides an effective tool for managing blood sugar levels and reducing body weight in individuals who are overweight or obese as classified by Health Canada. ^[3] [6] The medication’s ability to impact both glycemic control and body weight makes it an especially valuable option for patients with T2DM who are experiencing obesity or other weight-related conditions.

Before you start taking Mounjaro, it’s important to know if it’s right for you. Some health conditions and medications don’t mix well with Mounjaro, so always check with your doctor first. Mounjaro shouldn’t be taken by individuals:

• With a personal or family history of medullary thyroid carcinoma (MTC), a rare type of thyroid cancer that produces excess of the hormone calcitonin
• Diagnosed with Multiple Endocrine Neoplasia syndrome type 2 (MEN2), a genetic disorder that increases the risk of developing tumors in the endocrine glands
• With a known hypersensitivity to tirzepatide (sold under the brand names Mounjaro and Zepbound) or any of the product’s ingredients ^[1] 

With a history of pancreatitis or severe gastrointestinal diseases ^[5]

Like most medications, Mounjaro can cause side effects. It’s good to know what to expect, and if something doesn’t feel right, you should reach out to your doctor. Common side effects of Mounjaro may include: 

• Nausea
• Diarrhea
• Vomiting
• Constipation
• Abdominal pain
• Dyspepsia 
• Decreased appetite ^[1] 

More serious side effects associated with Mounjaro may include: 

• Pancreatitis (the inflammation of the pancreas)
• Hypoglycemia (low blood sugar) when used with insulin or sulfonylureas 
• Potential risk of thyroid C-cell tumors, including medullary thyroid carcinoma (MTC) ^[3]
• Increased risk of acute kidney injury, particularly in patients who experience severe gastrointestinal side effects such as vomiting or diarrhea ^[5]
• Severe gastrointestinal disease
• Diabetic retinopathy complications Patients with a history of diabetic retinopathy
• Acute gallbladder disease

The most critical information about Mounjaro is the potential risk of thyroid C-cell tumors, including medullary thyroid carcinoma, which is a rare type of thyroid cancer. Although this risk has only been observed in animal studies, patients should be aware of symptoms such as a lump in the neck, trouble swallowing, or persistent hoarseness, and should contact their healthcare provider if these symptoms occur. ^[1] Additionally, Mounjaro can interact with other medications that affect blood sugar levels, increasing the risk of hypoglycemia. It’s important to monitor blood sugar closely, particularly when starting or adjusting the dose of Mounjaro. ^[3]

Mounjaro is administered as a once-weekly subcutaneous injection. The recommended starting dose is 2.5 mg once weekly for four weeks, followed by an increase to 5 mg once weekly. After at least four weeks at each dose, the dosage can be increased by 2.5 mg increments, up to a maximum of 15 mg once weekly, depending on the patient’s needs and tolerance. ^[1] The injection can be administered in the abdomen, thigh, or upper arm and can be taken with or without food. The day of administration can be changed if needed, as long as the last dose was given at least three days prior. ^[5]

Mounjaro begins working shortly after injection, with peak plasma concentrations (highest concentration of a drug in the bloodstream) reached within 8 to 72 hours. ^[1] Its long half-life of approximately five days allows for convenient once-weekly dosing. The medication’s effects on blood sugar regulation and appetite suppression persist throughout the week, but the full benefits—particularly with regard to blood glucose control and weight loss—may take several weeks or even months to fully manifest. ^[3]

When taken regularly as prescribed, Mounjaro has demonstrated significant improvements in glycemic control and weight reduction in clinical trials. Over time, patients have seen sustained reductions in HbA1c levels (a key marker of long-term blood glucose control) and meaningful weight loss. ^[3] Long-term use of Mounjaro doesn’t appear to result in tolerance or a loss of effectiveness. However, like all medications, patients should be monitored regularly to assess for any potential side effects or changes in efficacy. ^[5]

Yes, Mounjaro, like all medications, has an expiration date. It should be stored in a refrigerator and is typically effective for up to 24 months from the date of manufacture if stored correctly. ^[7] Once opened, the pen can be stored at room temperature (up to 30°C) for up to 21 days. After the expiration date has passed, Mounjaro may become less effective and shouldn’t be used. ^[1]

In addition to Mounjaro, several other medications are commonly used to treat T2DM, depending on a patient’s specific needs. Some of these include:

• Metformin
• Sulfonylureas
• DPP-4 inhibitors
• SGLT2 inhibitors
• GLP-1 receptor agonists (such as semaglutide or dulaglutide)
• Insulin

Each of these medications has a unique mechanism of action and may be used alone or in combination with others to achieve optimal blood glucose control. ^[3]

Mounjaro isn’t available over the counter in Canada. It’s a prescription-only medication due to its potency, potential side effects and the need for close monitoring. To obtain Mounjaro, patients must consult with a healthcare provider who will assess their condition and determine whether Mounjaro is an appropriate treatment option. ^[1]

In Canada, Mounjaro can be prescribed by:

• Family physicians
• Endocrinologists
• Internal medicine specialists
• Certain nurse practitioners, depending on provincial regulations

Patients should consult with a healthcare provider experienced in diabetes and weight management to determine whether Mounjaro is appropriate for their treatment. ^[5]

If you’re interested in Mounjaro, talk to a doctor or nurse practitioner on Maple today. If they determine an online prescription for Mounjaro is right for you, you can get a prescription at their discretion and have it sent to your local pharmacy or delivered to your home. We connect you with our network of doctors and nurse practitioners in minutes online, any time, 24/7, for medical advice, diagnosis and treatment. 

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10159347/
[2] https://academic.oup.com/jes/article/7/Supplement_1/bvad114.128/7290694?login=false
[3] https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2023.1033492/full
[5] https://www.ncbi.nlm.nih.gov/books/NBK585056/
[6] https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/healthy-weights/canadian-guidelines-body-weight-classification-adults/questions-answers-public.html#a2

[7] https://www.accessdata.fda.gov/drugsatfda_docs/appletter/2022/215866Orig1s000ltr.pdf