Weight Management

• Mild nausea in the first 24–48 hours is expected, especially during dose escalation weeks — it typically improves by day 3
• Eat 4–6 small meals rather than 3 large ones
• Choose bland, low-fat foods: plain crackers, toast, rice, broth-based soups, boiled chicken, plain oatmeal
• Avoid fatty, fried, greasy, or very spicy foods — these are the primary nausea triggers
• Eat slowly and stop immediately when you feel full — do not push through early satiety
• Stay upright for 30–60 minutes after eating — avoid lying down immediately after meals
• Sip water consistently throughout the day — aim for 8–10 glasses minimum
• Ginger tea or ginger chews can reduce nausea intensity; peppermint tea may ease nausea and bloating
• Injection site care: apply a cool compress for 10–15 minutes if needed. Do not rub or massage the site
• Avoid intense exercise on days 1–2 if nausea or fatigue are significant — light walking is fine

• Inject on the same day each week — consistent timing maintains stable drug levels and reduces peak side effects
• Missed dose: take it within 5 days of your scheduled day. If more than 5 days have passed, skip it and resume on your next scheduled day. Never double-dose
• Log your injection site each week and rotate systematically
• Weigh yourself weekly (same day, time, and conditions) and bring records to follow-up appointments

Pen Storage

• Unopened pens: refrigerate at 36–46°F (2–8°C). Never freeze
• Semaglutide (Wegovy/Ozempic) after first use: room temperature up to 86°F for up to 56 days
• Tirzepatide (Zepbound/Mounjaro) after first use: room temperature up to 86°F for up to 21 days

Eating on a GLP-1

• Eat smaller portions — overeating causes significant nausea and discomfort due to slowed gastric emptying
• Eat slowly and mindfully — stop at the first fullness signal
• Prioritize protein at every meal — target 1.2–1.6 g per kg of body weight daily to preserve muscle mass (e.g., 84–112 g/day for a 155 lb person)
• Best protein sources: eggs, Greek yogurt, cottage cheese, chicken, salmon, legumes, protein shakes
• Aim for 25–35 g fiber daily from vegetables, fruits, whole grains, and legumes — this prevents constipation
• Drink 64–80 oz water daily on a schedule — GLP-1 medications can blunt thirst signals
• Avoid or limit: fatty/fried foods, ultra-processed snacks, sugary beverages, very large portions

Managing Nausea

• Choose cold or room-temperature foods — hot food aromas can trigger nausea
• Small, frequent snacks on difficult days are better than large meals
• Bland carbohydrates (crackers, toast, rice, plain pasta) are easiest to tolerate
• Ginger in any form and peppermint tea are helpful
• Avoid eating within 2 hours of bedtime

Preventing Constipation

• Increase fiber gradually (too fast causes bloating)
• Consistent hydration is essential for fiber to work
• Daily movement — even 15–20 minute walks stimulate the colon
• Probiotics: yogurt, kefir, and fermented foods support gut motility
• OTC options if needed (with provider guidance): Metamucil, MiraLAX, or Colace

Exercise is a critical component of your weight management program — both for results and for preserving lean muscle mass.

• Target 150 minutes/week of moderate aerobic exercise: brisk walking, cycling, swimming, or elliptical
• Include 2–3 days/week of resistance training — this is the most important factor for preserving lean muscle. Without it, up to 25–40% of weight lost can come from lean tissue
• Best compound movements: squats, lunges, push-ups, rows, overhead press, deadlifts
• If new to exercise: start with 2–3 walks of 20–30 minutes per week and build gradually
• Avoid intense training on days 1–2 after a new dose increase if nausea is significant
• Hydrate extra on exercise days — GLP-1s blunt thirst signals, and exercise increases fluid loss
• Protein + resistance training work together — both are needed to protect muscle mass during weight loss

Alcohol

• Alcohol is strongly discouraged during GLP-1 therapy — it worsens nausea, dehydration, and pancreatitis risk
• If drinking occasionally: limit to 1 drink, eat first, and choose low-sugar options
• Many patients naturally find reduced alcohol cravings on GLP-1 therapy — this is a documented secondary benefit

Important Drug Interactions

• Insulin or sulfonylureas: hypoglycemia risk increases — your provider will adjust doses
• Oral contraceptives (Tirzepatide): use backup contraception for 4+ weeks after each dose increase
• Thyroid medications, blood thinners, and other narrow-therapeutic-window drugs: slowed gastric emptying may alter absorption timing — inform all your prescribers that you are on a GLP-1 medication
• Blood pressure medications: weight loss naturally lowers blood pressure — doses may need reduction over time

• Nausea for 1–3 days after injection, especially at each dose escalation
• Reduced appetite and early fullness throughout the day
• Loose stools or diarrhea in the first few weeks of a new dose
• Constipation — common and manageable with dietary adjustments
• Mild fatigue in the first week of a new dose
• Small injection site bump, mild redness, or brief itching — resolves in 24 hours
• Burping, acid reflux, or a feeling of slow digestion
• Temporary hair thinning — a response to rapid weight loss, not the medication. Resolves with adequate protein intake
• Weight plateaus after several months of consistent loss — this is normal physiology