Important Safety Information
GLP-1 Medications (Semaglutide & Tirzepatide)
Boxed Warning
WARNING: RISK OF THYROID C-CELL TUMORS. In rodents, semaglutide and tirzepatide cause dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures. It is unknown whether GLP-1 receptor agonists cause thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans. Semaglutide and tirzepatide are contraindicated in patients with a personal or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
Contraindications
Do not use if you have a personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Do not use if you have a known hypersensitivity to semaglutide, tirzepatide, or any of the excipients.
Common Adverse Events
The most common adverse events (incidence >=5%) include nausea, diarrhea, vomiting, constipation, abdominal pain, headache, fatigue, dyspepsia, dizziness, abdominal distension, eructation, hypoglycemia in patients with type 2 diabetes, flatulence, gastroenteritis, and gastroesophageal reflux disease.
Additional Information
Tell your healthcare provider about all medical conditions, including if you have a history of pancreatitis, kidney problems, diabetic retinopathy, or depression/suicidal thoughts. Inform your provider of all medications you take, including insulin or other diabetes medications.
Estradiol (Bioidentical Estrogen Therapy)
Boxed Warning
WARNING: ENDOMETRIAL CANCER, CARDIOVASCULAR DISORDERS, BREAST CANCER, AND PROBABLE DEMENTIA. Estrogen-alone therapy has an increased risk of endometrial cancer. Adding a progestin to estrogen therapy has been shown to reduce the risk of endometrial hyperplasia, which may be a precursor to endometrial cancer. Estrogen-alone therapy should not be used in women with a uterus. Estrogen plus progestin therapy should not be used for the prevention of cardiovascular disease or dementia. The Women’s Health Initiative (WHI) estrogen-alone substudy reported increased risks of stroke and deep vein thrombosis (DVT). The WHI estrogen plus progestin substudy reported increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and DVT. The WHI Memory Study (WHIMS) estrogen-alone ancillary study reported increased risk of probable dementia in postmenopausal women 65 years of age and older. The WHIMS estrogen plus progestin ancillary study reported an increased risk of probable dementia in postmenopausal women 65 years of age and older. These risks should be assumed to be similar for other doses of estrogen and other dosage forms.
Contraindications
Do not use estrogen if you have undiagnosed abnormal genital bleeding, known or suspected breast cancer, known or suspected estrogen-dependent neoplasia, active deep vein thrombosis or pulmonary embolism, active or recent arterial thromboembolic disease (e.g., stroke, myocardial infarction), liver dysfunction or disease, known hypersensitivity to estradiol or any excipients, or known protein C, protein S, or antithrombin deficiency.
Common Adverse Events
The most common adverse events include headache, breast pain/tenderness, irregular vaginal bleeding or spotting, abdominal/stomach cramps or bloating, nausea and vomiting, and hair loss.
Additional Information
Estrogens should be prescribed at the lowest effective dose and for the shortest duration consistent with treatment goals. Your healthcare provider should evaluate you regularly to determine whether treatment is still necessary.