‘Most Advanced Weight Loss Drug Yet’ Reaches India: What is Tirzepatide?

How much do we know about Tirzepatide? How is it different from other weight-loss drugs? How much will it cost?

In the past 2 years, weight loss drugs have gained more mainstream attention than they ever have.

If you've been on the internet in the past couple of years, you've likely heard of Ozempic, a Semaglutide weight-loss drug that became so popular that there's been a global shortage since 2021.

Several celebrities from Elon Musk to Oprah have openly endorsed them.

While Ozempic hasn't been approved for sale in India yet, another similar drug is all set to enter the Indian market soon.

India’s Central Drug Standard Control Organisation (CDSCO) has approved Eli Lilly's Tirzepatide. Tirzepatide will make its debut in the Indian market under the brand name Mounjaro for the treatment of type 2 diabetes. Further, it is currently under review to be sold as an obesity drug under the name Zepbound, as well.

How much do we know about Tirzepatide? How it it different from other weight-loss drugs? How much will it cost?

FIT explains.

What is Tirzepatide, and How Does it Work?

Tirzepatide is a GLP1 (Glucagon-like peptide-1) + GIP (glucose-dependent insulinotropic polypeptide) receptor agonist combination drug that has been approved by India's CDSCO (Central Drugs Standard Control Organisation) for patients of type 2 diabetes mellitus (T2DM) and obesity.

GLP-1 is a hormone that attaches to the GLP-1 receptors in the body and promotes the feeling of satiety (fullness or satisfaction after meals) as well as helps in better absorption of glucose in the body.

According to a recent detailed review published in the medical journal, Gastroenterology, sustained GLP-1–receptor activation is associated with weight loss in both preclinical and clinical studies.

Explaining this further, Suryansh Kumar, Founder and CEO of Elevate Now – a doctor guided weight loss program, tells FIT, "The way it helps with better (glucose) absorption is by triggering the production of extra insulin in the body so that even if your insulin glucose absorption is inefficient the excess production of insulin will solve that. "

On the other hand, GIP, he says, helps increase the efficiency of existing insulin molecules in the bloodstream and the excess that is produced. "So, the efficiency levels on the glucose absorption side are a lot better because of GIP action along with GLP both in Tirzepatide."

How does this help diabetics, and how is it linked to obesity?

Insulin attaches to cell receptors where it allows glucose to go into the cells and helps it convert into various energy elements in our body.  

"When this equilibrium is broken, the pancreas gives up and says I cannot produce more insulin. And that’s the point in time where you become diabetic," says Kumar.

Insulin resistance is a precursor or early indicator of pre-diabetes and diabetes. However, according to Kumar, even people who don't hit the markers of pre-diabetes and diabetes can have insulin resistance, particularly if there are overweight.

"When you talk about insulin resistance you will find that people above a certain BMI of let’s say 30-32 have a very high likelihood of being insulin resistant. There this drug has a lot of legs for use."

Suryansh Kumar

What Makes Tirzepatide the ‘Most Advanced Weight-Loss Drug Out There’?

Tirzepatide isn't the first drug of its kind to be approved in India for use in patients with diabetes and clinical obesity.

Novo Nordisk's Rybelsus pill is another Semaglutide pill available in India that uses the same ingredients as Wegovy and Ozempic. Oral pills of Wegovy have also been approved in India.

However, according to Kumar, Tirzepatide results in a much higher weight loss than what the market has seen with any of these drugs till now.

Speaking to FIT, Dr G Moinuddin, Consultant - Bariatric & Advanced Laparoscopic Surgery, Manipal Hospitals Miller's Road, says that, unlike the other drugs that act on GLP-1 receptors alone, Tirzepatide is a GLP plus GIP agonist.

"When there is excess glucose in the blood, it converts to fat and is stored in the tissues in your body. Tirzepatide has an aspect of acting on preventing easy storage of fat."

Dr G Moinuddin

"At the same time, it also has an impact on the brain. We have hunger receptors in the hypothalamus. GLP-1 acts on those receptors in the brain and it results in the patients having decreased appetite and decreased hunger," explains Dr Sukhvinder Singh Saggu, Director Minimal Access, GI & Bariatric Surgery at the CK Birla Hospital, Delhi.

Furthermore, Kumar adds, "Tirzepatide helps in breaking the fatty acids, and not leading to fat formation in the adipose tissues as quickly as it was happening earlier."

"So, lifestyle modifications plus these drugs in that manner are a very potent combination for weight loss," he adds.

Does It Have Any Downsides?

While the experts FIT spoke to said that the drug can be a potential 'game-changer' for people who qualify for its intended use, they also underscore that it may not be for everyone.

According to Dr Moinuddin, something to keep in mind about the drug is that it requires a weekly dose of around 10 – 12 milligrams per week. "One injection can cost up to Rs 25,000 which is not sustainable for a long time for most people," he says.

Moreover, no standard time frame is given for its use, so how long one might have to take it will depend on their specific condition and the physician's discretion. "I wouldn't recommend it for longer than one year," adds Dr Moinuddin.

"Also, once you get off the medication, the patient can regain the weight that they lost and sometimes even more than what you lost. This is called rebound weight gain."

Dr G Moinuddin

Before You Proceed, A Word of Caution

"Any new drug that has a good effect will also have some side effects," says Dr Sukhvinder Singh Saggu.

Semaglutide weightloss drugs like Ozempic and Wegovy are known to have several gastro-intestinal side effects and in some cases, serious allergic reactions.

Similar side effects have also been recorded in the case of Tirzepatide, say experts. Some of the side effects listed by the US FDA (Food and Drug Administration) are:

• Nausea and vomiting

• Diarrhea

• Constipation

• Abdominal (stomach) discomfort and pain

• Fatigue

• Hair loss

• Gastroesophageal reflux disease (Acid reflux).

According to Kumar, these are typically temporary and should subside as your body adjusts to the drug. "For people whose body does not adapt, they should definitely connect with their doctor and understand this better whether they should continue with it."

Dr G Moinuddin, on the other hand, says, "With Tiraziptide, some cases of kidney injury have also been reported."

As per the US FDA this is a possibility. The US FDA also says that in rare cases, Tirzepatide has been linked to serious side effects like blurred vision, mental/mood changes and sudden drops in blood sugar, and signs of pancreas or gallbladder disease.

Dr Saggu says, because of these side effects and complications, "patients take these medications for 2-3 months and then discontinue which renders them ineffective."

The bottomline is that none of these drugs are magic bullets that will help you drop weight quickly and easily. Because improper use of the drug can lead to severe symptoms, experts advise only taking it under the supervision of a qualified medical practitioner.

"With the right medical and life style support these drugs can be very useful in your weight loss journey. Otherwise there is a lot of complications that can happen," says Kumar.