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TRZ reduces of body weight by 20% and improves lipid profile in obese patients (Chavda et al

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This should include: Comprehensive medication review : Documenting all prescribed medications, over-the-counter products, and supplements to identify potential interactions, particularly noting fluoxetine's strong CYP2D6 inhibition Mental health evaluation : Assessing depression severity, suicide risk, and treatment response to fluoxetine Weight and metabolic parameters : Recording baseline weight, BMI, waist circumference, blood pressure, and relevant blood tests (HbA1c, lipid profile, liver function) Renal function and electrolytes : Particularly sodium levels, given the risk of SSRI-induced hyponatraemia Cardiovascular assessment : Particularly important given semaglutide's potential effects on heart rate Gastrointestinal and gallbladder history : Identifying pre-existing conditions that might be exacerbated Ophthalmological assessment : For patients with diabetes, as rapid improvement in glycaemic control may worsen diabetic retinopathy Ongoing monitoring should occur at regular intervals, typically: Monthly initially : During Wegovy dose escalation (following the standard titration schedule from 0.25 mg to 2.4 mg over 1620 weeks) Every 36 months : Once stable doses are achieved, monitoring weight, mental health status, side effects, and treatment adherence As clinically indicated : More frequent review if concerns arise Dose adjustments may be necessary based on individual response

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Additive gastrointestinal effects : Tirzepatide commonly causes nausea, vomiting, diarrhea, and constipation, particularly during dose escalation