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Key timing considerations: Broader Tmax window (8 to 72 hours) means less precision in predicting peak effects Dual GIP/GLP-1 mechanism may produce a different side effect timing pattern than pure GLP-1 agonists Body aches and muscle pain may peak later than GI symptoms, around 24 to 48 hours post-injection Consider how tirzepatide affects metabolism throughout the weekly cycle The appetite suppression timeline may differ from semaglutide due to the dual mechanism Dose escalation timing: Tirzepatide starts at 2.5mg weekly, escalating to 5mg after 4 weeks

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Ask about hormonal context: discuss menopausal status, contraceptive use, and pregnancy plans before initiating agents with systemic metabolic effects

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STEP Program (Obesity / Weight Management) STEP 1 (Wilding et al., 2021) Once-Weekly Semaglutide in Adults with Overweight or Obesity N=1,961