MOUNJARO FOR WEIGHT LOSS

O

OVERWEIGHTPILOT

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Mounjaro was recently approved for A1C reduction in patients with type II diabetes.

Like other drugs in it's class it causes weight loss (in a good way), and does so in such an effective way that I would expect this to be THE weight loss drug being prescribed in coming years.

The weight reductions are impressive to say the least. And as a fat guy pilot I WANT SOME! But can I have it?

At this point most providers will be keeping their T2D patients on Ozempic because its covered by most insurance/ has a good coupon/ working pretty well for t2D.

Most prescribing of Monaro will be off label prescribing for weight loss. At least for the first 18 months I would expect this to be the case.


So my question maybe for a knowledgeable AME is... does it matter if it is prescribed off label for weight loss and not Type 2 DM or since it is technically approved for T2D will I need to go through whatever the process is for T2D?
 
From Wikipedia...

Tirzepatide, sold under the brand name Mounjaro, is a medication used for the treatment of type 2 diabetes. Tirzepatide is given by subcutaneous injection (under the skin). Common side effects may include nausea, vomiting, diarrhea, constipation, upper abdominal discomfort, and abdominal pain.

Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) are hormones involved in blood sugar control.Tirzepatide is a first-in-class medication that activates both the GLP-1 and GIP receptors, which leads to improved blood sugar control. Tirzepatide was approved for medical use in the United States in May 2022.
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A search of the medical databases for both AMAS and AOPA turned up no mentions nor guidance. Likely because approval is so recent, the FAA hasn't shared any findings. (but I'm completely guessing on that).

I'll leave the question of "can you use it for weight loss" to our resident AME's.... Pinging Doctor Lou and Doctor Bruce for their input. @lbfjrmd @bbchien
 
AggieMike88 said:
From Wikipedia...

Tirzepatide, sold under the brand name Mounjaro, is a medication used for the treatment of type 2 diabetes. Tirzepatide is given by subcutaneous injection (under the skin). Common side effects may include nausea, vomiting, diarrhea, constipation, upper abdominal discomfort, and abdominal pain.

Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) are hormones involved in blood sugar control.Tirzepatide is a first-in-class medication that activates both the GLP-1 and GIP receptors, which leads to improved blood sugar control. Tirzepatide was approved for medical use in the United States in May 2022.
​
A search of the medical databases for both AMAS and AOPA turned up no mentions nor guidance. Likely because approval is so recent, the FAA hasn't shared any findings. (but I'm completely guessing on that).

I'll leave the question of "can you use it for weight loss" to our resident AME's.... Pinging Doctor Lou and Doctor Bruce for their input. @lbfjrmd @bbchien
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The general rule is that new drugs are "do not issue" until a year after FDA approval. So this may be a question to start asking in May 2023.
 
Wegovy which is same type of stuff is FAA approved fyi.
works same way. Might be more effective. This issue is getting on it. There are shortages in the device that is used to inject it. And right now they’re not allowing any new starts for the medication until the shortage gets figured out
 
Right Wegovy=Ozempic except dosing schedule is different and FDA labeled indication is different.

I see the potential aeromedical issues that come along with having diabetes and I can see why that would require evaluation to keep a medical. But I, as a pharmacist, cannot see any aeromedical issues from taking the drug per se and the approval of Wegovy indicates to me that that is probably accurate.

So is it the drug or diagnosis that the FAA cares about. For example, say your insurance does not cover Wegovy so your doctor says lets use Ozempic off label instead. Aero medically there is not a difference but since Ozempic is only labeled for diabetes does the airman have to jump through all of the hoops as if they were being treated for diabetes?
 
That’s a fair question. Off label use of meds is quite commonplace but I don’t think the FAA really recognizes that

The wegovy device shortage should be resolved by end of year unless monkeypox has something to say about it
 
Tirzepatide: Not a chance of approval until after may 2023 :(

……the current moment, one of the drugs for rheumatoid arthritis is CACI-able for colitis, but is not CACI-able for rheumatoid arthritis!
 
benyflyguy said:
Wegovy which is same type of stuff is FAA approved fyi.
works same way. Might be more effective. This issue is getting on it. There are shortages in the device that is used to inject it. And right now they’re not allowing any new starts for the medication until the shortage gets figured out
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Other issue with Wegovy is insurance. Seems very few health insurance plans will cover and it’s something like ~$1300 per month out of pocket.
 
Fearless Tower said:
Other issue with Wegovy is insurance. Seems very few health insurance plans will cover and it’s something like ~$1300 per month out of pocket.
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It depends if your insurance is set up to allow for weight loss medicine. Some insurance, a lot actually, cover weight loss surgery and medicine. Some don’t. If it does often it needs to be at the direction of a weight loss specialist as opposed to your pcp. So pcp can’t write but weight loss doc can.
 
Jeff Mohler said:
So..do we wait for an "approval", or now that it's over a year, we need to a a specific DNI instruction?
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I have not yet heard if an aeromedical expert committee is scheduled to be convened as to Mounjaro...use wegovy, for now....it's approvable.
 
bbchien said:
I have not yet heard if an aeromedical expert committee is scheduled to be convened as to Mounjaro...use wegovy, for now....it's approvable.
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Im on the sidelines at the moment anyhow..when this hits, or is specifically disapproved, i'll move then. But so far im down 80lbs, and A1C is low 5's.
 
My AME said Wegovy would require a Special Issuance. Is that still the case?
 
Just curious, is Wegovy approved in combination with any other type 2 meds, I’m looking at adding it for diabetes and of course weight loss wouldn’t hurt.
 
Xem103 said:
My AME said Wegovy would require a Special Issuance. Is that still the case?
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Semaglutide (Ozempic) is approvable, for weight loss; initial observation time is 48hrs; If there HgA1c level is less than 6.5%, and they have no hypoglycemic events or other concerning symptoms- then we follow on a SI with an annual DCPN and HgA1c. If there HgA1c level is more than 6.5% - we will follow protocol for Diabetes.
 
This makes me curious. I am under basic med, how does weight loss medication apply?

Tim
 
bbchien said:
Semaglutide (Ozempic) is approvable, for weight loss; initial observation time is 48hrs; If there HgA1c level is less than 6.5%, and they have no hypoglycemic events or other concerning symptoms- then we follow on a SI with an annual DCPN and HgA1c. If there HgA1c level is more than 6.5% - we will follow protocol for Diabetes.
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Thank you very much for addressing my question. Do I understand you correctly that the FAA treats Ozempic and Wyegovy equally? (I know they are chemically). And that an applicant with a HgA1c<6.5% without any hypoglycemic event/concerning symptoms would require a special issuance?

Thank you again.
 
Nov 22, applied for a class 3
Feb 23, kicked back asking for all diabetes medications as I'm not diabetic had Dr. fill out for stating it was for weight management.
Sept 23, denied "The medication Mounjaro (tirzepatide) is allowable by the FAA for the management of diabetes. However, your physician XXX denied diabetes and confirmed that Maounjar (tirzepatide) was used for weight management, in your case. Currently, the FAA does not allow Mounjaro (tirzepatide) for weight management."
So basically if there isn't a box to check these FAA "Dr.s" can't approve it. It's basically like saying you can take Ibuprofen for pain relief but NOT as an anti-inflammatory. So more forms from my Dr. to try for a Special. I'm about to let this one dream go.
Sept 23, sent real Dr's information back...............

Oh, down about 80lbs, not longer on blood pressure meds, and probably going to taper off Mounjaro towards the beginning of next year.
 
The FAA just released a revision to it's polices on weight loss. Mounjaro (tirzepatide) still isn't approved for use in weight loss, by metformin, liraglutide, semaglutide and orlistat are.
 
I wouldn't worry too much about mounjaro not being approved. In the real world there is not that much difference in efficacy. Ozempic (Wegocy/semaglutide) is very effective at weight loss. If you have access and it passes the FAA sniff test would be happy with that. It is cheaper, seems easier to get, and has a much much longer safety profile than tirzepatide. In multiple studies Semaglutide gives about a 15% reduction in body weight. One study suggests tirzepatide may do a little better, but in other studies the same 15% as semaglutide was seen.
 
I have type 2 diabetes and take Mounjaro. My A1C dropped from 9.1 to 6.3 and I lost 25 pounds without any application of discipline (from 184 to 159). Mounjaro is great, but until it is easier to get, I hope it is not approved for weight loss. One of the most popular dosing levels is often not in stock, so I have had to change the dosing level a few times to keep on the medication. Right now, my pharmacy at Walmart has been out of my regular dosing level for at least a month and they can't assure me that it will be in stock soon. The supply chain is just over stressed and would really need to be beefed up if the medication is approved for non diabetic weight loss.
 
What if I have a class 3 medical with several years remaining and get an Rx for Wegovy for weight-loss/pre-diabetes/metabolic syndrome? What do I need to do/when?
 
I'm curious. Now that Tirzepatide (Mounjaro/Zepbound) has been approved for weightloss, how long will the FAA take to approve Tirzepatide for pilots who don't take it for Type 2 diabetes?
 
tomski12 said:
I'm curious. Now that Tirzepatide (Mounjaro/Zepbound) has been approved for weightloss, how long will the FAA take to approve Tirzepatide for pilots who don't take it for Type 2 diabetes?
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Pure conjecture here, but I doubt the FAA will allow Tirzepatide for weight loss (without diabetes) until the FDA approves it for that purpose. It has received approval for FDA Fast Track approved based on it's supposed efficacy, so that might come sooner than it would take until the routine approval process.
 
WingmanMed said:
Pure conjecture here, but I doubt the FAA will allow Tirzepatide for weight loss (without diabetes) until the FDA approves it for that purpose. It has received approval for FDA Fast Track approved based on it's supposed efficacy, so that might come sooner than it would take until the routine approval process.
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Tomski12 had it right. Tirzepatide was just approved by the FDA for weight loss within the past few days. Eli Lily is marketing it for weight loss under the new brand name Zepbound.

FAA had just released a list of acceptable weight loss meds at the end of October. Tirzepatide was denied but the note just said that it was waiting on phase 3 trials/approval.

This seems to suggest that now that it’s approved by the FDA, FAA approval is soon to follow. We’ll see, though.
 
My take on miracle pills... At least as far as Ozempic is concerned. Ozempic was designed for diabetics and they found it mimics a hormone in your brain that slows digestion and makes you feel full longer. Essentially an appetite suppressant. So it works because we're eating less because your digestion has slowed and your full. So why use a magic pill to feel full and just kick the gluttany with good ol fashion will power...and no potential side effects. Aside from maybe being a little hungry. I can eat like Joey Chestnut. But when I decided enough is enough and cut back to 1500 calories a day, after 3 days the "hunger pains" went away. What helped with portion control was a meal service. Eat these 2 meals a day and drink water. No more soda. No more fast food. Which meant a huge carb reduction for me. Pounds shed off. Now, after wrestling for 12 years when I "cut", I'm a little OCD and weighed myself 4 times a day. Excessive? Absolutely. But that OCD is what kept me motivated, and thats the critical part about this journey.

My two cents...unless you have a medical condition...do it the old fashion way. If you're like me and have a problem with portion control and moderation when it comes to food....look into something like factor75. Can not recommend enough.
 
Racerx said:
My take on miracle pills... At least as far as Ozempic is concerned. Ozempic was designed for diabetics and they found it mimics a hormone in your brain that slows digestion and makes you feel full longer. Essentially an appetite suppressant. So it works because we're eating less because your digestion has slowed and your full. So why use a magic pill to feel full and just kick the gluttany with good ol fashion will power...and no potential side effects. Aside from maybe being a little hungry. I can eat like Joey Chestnut. But when I decided enough is enough and cut back to 1500 calories a day, after 3 days the "hunger pains" went away. What helped with portion control was a meal service. Eat these 2 meals a day and drink water. No more soda. No more fast food. Which meant a huge carb reduction for me. Pounds shed off. Now, after wrestling for 12 years when I "cut", I'm a little OCD and weighed myself 4 times a day. Excessive? Absolutely. But that OCD is what kept me motivated, and thats the critical part about this journey.

My two cents...unless you have a medical condition...do it the old fashion way. If you're like me and have a problem with portion control and moderation when it comes to food....look into something like factor75. Can not recommend enough.
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Why drink coffee to help you stay awake when you could just go to bed earlier? Better living through science.
 
These meds are seriously expensive. Wegovy is approved for weight loss if the patient has conditions to support it. Ozempic is approved for diabetes. You won’t get insurance to sign off outside their approvals. I suspect the same will apply to Monjouro.
 
Stewartb said:
These meds are seriously expensive. Wegovy is approved for weight loss if the patient has conditions to support it. Ozempic is approved for diabetes. You won’t get insurance to sign off outside their approvals. I suspect the same will apply to Monjouro.
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Agreed. Just like Wegovy and Ozempic are the same drug, just marketed for different use-cases, Mounjaro is the T2D brand for tirzepatide while Zepbound is the weight loss brand.
 
I spoke to the FAA medical office. They indicated that Mounjaro is not a hard no. They have not put in on the acceptable list, yet, but, rather, it's conditional.

I know there were a few posts above expressing their health advice regarding the use of Ozempic or Mounjaro, i.e. GLP-1 class drugs. Other weight loss modalities might be successful for you or others, however, as folks get older, say, in their fifties, what worked to lose weight in our 30's doesn't work anymore. However, for someone like me, who was about 200 lbs at 30 years old and got up to 250 at 55 years old, Mounjaro has been very helpful. If you think about it, that's an average of 2 lbs per year of weight gain. Fairly insignificant on a year over year basis. However, over 25 years, 50 lbs is a staggering amount. So, the 25 lbs that I have lost in the 3 months that I have been using Mounjaro has, allowed me to be more physically active because my knees and hips aren't killing me any more, caused my resting heart rate to go down, and caused a decrease in my blood pressure. Thus, while the methods that I used to lose weight at 30 (cutting sugars, beer, portion control) were good for then, they weren't working now. For now, this has worked and worked well. I anticipate it to continue working well. The cost sucks. But, I have a feeling that it will save me a lot of money in the long run.
 
NOoneIMPORTANT said:
Oh, down about 80lbs, not longer on blood pressure meds, and probably going to taper off Mounjaro towards the beginning of next year.
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Thanks for the report, and the inspiration.

And thanks to Dr. Bruce, for his continued contributions.
 
Wait until the late night cheap lawyers commercials start with “did you take Mounjaro“
 
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