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peaks during dose escalation, typically mild-moderate Diarrhea -- 10-20%, usually transient Constipation -- 8-15% Vomiting -- 5-15%, more frequent at higher doses Injection site reactions -- 5-10%, mild erythema and pruritus Decreased appetite -- 5-12%, related to mechanism of action Pancreatitis -- rare but monitored (as with all GLP-1/amylin agents) Gallbladder events -- cholelithiasis reported, consistent with rapid weight loss Trial data describes dose titration as central to tolerability -- the 16-week escalation protocol substantially reduced GI adverse events

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Similarly, SURMOUNT 3 showed a mean BW reduction of 18.4% with tirzepatide titrated to the maximum tolerated dose (15 mg for 86% participants) after a 72-week follow-up 35

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They are often unregulated, full of fillers, and not tested for sterility