Important Safety Information

Please review the important safety information below for the prescription treatments available through Roen's platform. This information covers the treatments' intended uses, potential risks and side effects, considerations for use in specific populations, and possible drug interactions.

Roen encourages patients to report any adverse side effects of medications to their healthcare provider and the dispensing pharmacy. To report suspected adverse reactions to a medication, you can contact the FDA's MedWatch program at 1-800-FDA-1088 or online at www.fda.gov/medwatch.

In case of a medical emergency, call 911 or go to the nearest emergency room immediately.

Roen Advertisements

Advertisements from the Roen website are paid for by Roen for the purpose of marketing and educating about Roen's services. These advertisements may include paid actors or actor portrayals. Any advertisement featuring testimonials, endorsements, or real Roen users will be clearly identified as such. Individual results from Roen's programs or treatments may vary, and no specific outcome is guaranteed for any patient.

Roen Services

Roen offers a telemedicine platform that connects users with licensed healthcare providers for online consultations. These providers will evaluate the medical appropriateness of certain treatment plans and prescription medications advertised through Roen.

Roen may facilitate the fulfillment of prescriptions through a network of state-licensed pharmacies, including 503A and 503B compounding pharmacies. However, Roen does not provide medical advice, is not a licensed healthcare provider, and is not a pharmacy. Roen provides the software and technology that enable consultations with independent providers and coordinate prescription fulfillment.

For additional details, please refer to Roen's Terms of Service.

Special Advertising Offers

From time to time, Roen's advertisements may include special or introductory promotional offers for its services. All such advertised offers are available for a limited time and will typically expire 24 hours after being removed from the Roen website.

"Same price per dose" or similar promotional pricing offers are subject to the following terms:

Roen reserves the right to adjust pricing at any time in response to market or supply changes.
Price guarantees automatically expire within 24 hours of any pricing update.
Promotional offers such as a discounted first month are limited-time, one-use offers and are not subject to price matching beyond the introductory period.

Prescription Medications

Prescription medications available through Roen require a consultation with a licensed healthcare provider. The issuance of any prescription is determined solely by the independent medical professional based on their clinical judgment.

If a prescription is issued, it may be fulfilled through a state-licensed pharmacy partnered with Roen. All medications carry potential risks. Patients should carefully review the full safety information and speak with a medical provider about any concerns.

Compounded Medications

Medical providers may prescribe compounded medications when FDA-approved options are not clinically appropriate. Compounded medications are made by licensed compounding pharmacies to meet individual needs and are not reviewed by the FDA for safety, effectiveness, or quality.

Roen facilitates access to these medications through 503A and 503B state-licensed compounding pharmacies. These prescriptions are customized and may differ from commercially available products. FDA-approved options are used whenever appropriate, and compounded medications are only prescribed when medically necessary.

Ownership of Trademarks

Ozempic® and Wegovy® are registered trademarks of Novo Nordisk A/S. Zepbound® and Mounjaro® are registered trademarks of Eli Lilly and Company. Roen is an independent provider and is not affiliated with or endorsed by Novo Nordisk, Eli Lilly, or any other third-party trademark holders.
Any trademarks or brand-name medications mentioned on Roen’s website are the property of their respective owners and are referenced for identification and informational purposes only.

Inquiries

For questions related to Roen's advertisements, services, or safety information, contact our team at care@roenrx.com.

Semaglutide

Compounded semaglutide is an injectable GLP-1 receptor agonist used to improve blood sugar control and support weight loss.

Overview & Regulatory Disclaimer: Compounded semaglutide is not approved by the FDA for any specific use. It contains the same active ingredient as FDA-approved semaglutide medications, but as a compounded formulation, its safety, effectiveness, and quality have not been reviewed by FDA. Use of compounded semaglutide should follow a prescription and medical supervision, especially since FDA-approved alternatives exist for diabetes and weight management.

Who Should Not Use This Medication:

Individuals with a personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN2).
Anyone with a history of pancreatitis.
Those with severe kidney impairment or end-stage renal disease.
Patients with Type 1 diabetes or diabetic ketoacidosis (this medication is not a substitute for insulin).
Individuals who are pregnant or breastfeeding (use is not recommended due to potential risks and lack of study in these populations).
Anyone with a known hypersensitivity or allergy to semaglutide or any of the ingredients in the formulation.

Warnings & Precautions:

Thyroid Tumors: Semaglutide has caused thyroid C-cell tumors in animal studies. It is not known if this risk applies to humans, but caution is urged. Watch for symptoms like a lump in the neck, hoarseness, or trouble swallowing.
Pancreatitis: GLP-1 medications have been associated with inflammation of the pancreas. Seek medical attention if you experience severe, persistent abdominal pain (with or without vomiting).
Gallbladder Issues: Rapid weight loss and GLP-1 therapy can increase the risk of gallstones or gallbladder inflammation. Report any severe abdominal pain, especially in the upper right side, or yellowing of skin/eyes (jaundice).
Kidney Function: Dehydration from persistent nausea, vomiting, or diarrhea can worsen kidney function or lead to acute kidney injury. Stay hydrated and contact your provider if you cannot keep fluids down.
Diabetic Retinopathy: Rapid improvements in blood sugar (as can occur with semaglutide) may temporarily worsen diabetic eye disease. Individuals with diabetic retinopathy should use with caution and have appropriate eye monitoring.
Heart Rate: Semaglutide may cause a slight increase in heart rate. Use with caution if you have a history of cardiac issues.
Mental Health: Although uncommon, some weight-management medications have been linked to mood changes. Monitor for any new or worsening depression or suicidal thoughts and report them to your provider.

Common Side Effects:

Mild injection site reactions (redness, irritation at the injection area)
Nausea (especially when starting treatment)
Vomiting
Diarrhea
Constipation
Stomach pain or discomfort
Decreased appetite

Serious Risks:

Thyroid Cancer: A potential risk of thyroid tumors (seen in rodents) – report any neck mass or throat symptoms immediately.
Pancreatitis: Inflammation of the pancreas, which can be serious and lead to hospitalization.
Gallbladder Disease: Gallstone formation or gallbladder inflammation requiring medical treatment or surgery.
Kidney Injury: Severe dehydration from GI side effects can lead to kidney problems or worsen existing kidney disease.
Severe Allergic Reaction: Anaphylaxis is rare but possible. Symptoms may include swelling of the face or throat, difficulty breathing, rash, and rapid heartbeat. If these occur, seek emergency care.

Drug Interactions:

Using other GLP-1 receptor agonists at the same time is not advised (risk of additive effects and side effects).
If combined with insulin or sulfonylurea drugs (for diabetes), there is an increased risk of low blood sugar. A healthcare provider may need to adjust doses of those medications.
Semaglutide slows stomach emptying, which can affect absorption of oral medications. Medications like oral contraceptives, thyroid hormone replacements, or others with narrow therapeutic ranges (e.g. warfarin) should be monitored or timed appropriately to ensure effectiveness.
Limit or avoid excessive alcohol use, as it can increase the risk of low blood sugar and may exacerbate side effects like nausea.
Always inform your healthcare provider of all medications, supplements, or herbal products you are taking before starting semaglutide, so they can check for any potential interactions.

Tirzepatide

Compounded tirzepatide is an injectable dual incretin (GLP-1 and GIP) receptor agonist used to improve blood sugar control in type 2 diabetes and to support significant weight loss.

Overview & Regulatory Disclaimer: Compounded tirzepatide is not FDA-approved. It uses tirzepatide, the same active ingredient found in certain approved diabetes and weight-loss medications, formulated by a compounding pharmacy. As a compounded product, it has not been reviewed by the FDA for safety, effectiveness, or quality. Treatment with tirzepatide should be under the guidance of a licensed healthcare provider, especially since FDA-approved versions exist for specific indications.

Who Should Not Use This Medication:

Individuals with a personal or family history of medullary thyroid carcinoma (MTC) or MEN2 (due to potential thyroid tumor risk).
Anyone who has had pancreatitis in the past.
Those with severe renal impairment or on dialysis.
Patients with Type 1 diabetes or diabetic ketoacidosis (tirzepatide is not indicated for these conditions).
Women who are pregnant, planning to become pregnant, or currently breastfeeding (insufficient safety data and potential risk to fetus/infant).
Anyone with a known allergy to tirzepatide or any ingredient in the compounded formulation.

Warnings & Precautions:

Thyroid Tumors: Tirzepatide carries a Boxed Warning (based on animal studies) for thyroid C-cell tumors. Monitor for any neck swelling, lumps, or hoarseness.
Pancreatitis: There is a risk of pancreatitis. Stop using tirzepatide and seek medical care if you develop severe abdominal pain that does not go away.
Gallbladder Disease: Rapid weight loss can precipitate gallstone formation. Report any signs of gallbladder issues (such as upper abdominal pain, fever, or jaundice).
Kidney Concerns: Prolonged vomiting or diarrhea can lead to dehydration and worsen kidney function. Maintain fluid intake and contact a provider if you cannot keep fluids down.
Diabetic Retinopathy: Rapid improvements in glucose control can temporarily worsen diabetic eye disease. Regular eye exams are recommended for those with retinopathy.
Heart Rate: Tirzepatide may increase heart rate slightly. Use caution if you have cardiovascular disease.
Mood Changes: As with other weight management treatments, observe for any changes in mood or depression.

Common Side Effects:

Nausea
Vomiting
Diarrhea
Constipation
Decreased appetite
Indigestion or stomach discomfort
Injection site reactions (such as mild pain or redness)
Fatigue

Serious Risks:

Thyroid Cancer: A potential risk; though rare, it's serious – report any neck/throat symptoms immediately.
Pancreatitis: Can be severe and necessitate hospitalization.
Gallstones/Gallbladder Inflammation: May require discontinuation or medical intervention.
Severe Hypoglycemia: Particularly in combination with other glucose-lowering agents; can cause loss of consciousness or seizures if untreated.
Acute Kidney Injury: Resulting from severe dehydration due to vomiting/diarrhea.
Severe Allergic Reaction: Anaphylaxis or angioedema (swelling) could occur rarely; any signs of this demand emergency treatment.

Drug Interactions:

Avoid using Mounjaro together with other GLP-1 receptor agonists or similar medications intended for diabetes or weight loss (to prevent overlapping effects).
If you take insulin or sulfonylurea drugs, these doses may need to be reduced to lower the risk of hypoglycemia. Work with your healthcare provider on a diabetes management plan when starting tirzepatide.
Tirzepatide slows gastric emptying, which can impact how and when other oral medications are absorbed. You may need to adjust the timing of certain oral medications (like pain relievers, antibiotics, or thyroid hormone). Consult your provider for guidance.
Warfarin levels could be affected by major changes in weight or diet; if you are on warfarin, your doctor might monitor your INR more closely when starting or changing tirzepatide doses.
Limit alcohol intake. Heavy alcohol use can increase the risk of pancreatitis and low blood sugar episodes.
Always inform your healthcare provider about all medications and supplements you use. This allows proper assessment of any potential interactions with tirzepatide.

Liraglutide

Compounded liraglutide is an injectable GLP-1 receptor agonist used to help with chronic weight management and to improve blood sugar levels in type 2 diabetes.

Overview & Regulatory Disclaimer: Compounded liraglutide is not FDA-approved for any indication. Liraglutide is the active ingredient in certain approved medications (for obesity and diabetes), but in its compounded form it has not been evaluated by the FDA for safety or efficacy. Any use of compounded liraglutide should be based on a prescription and under medical supervision, keeping in mind that FDA-approved options are available.

Who Should Not Use This Medication:

Individuals with personal or family history of medullary thyroid carcinoma or MEN2.
Anyone with a history of pancreatitis.
Those with significant kidney disease (e.g., on dialysis).
Patients with Type 1 diabetes or diabetic ketoacidosis.
Women who are pregnant, trying to conceive, or breastfeeding.
Anyone allergic to liraglutide or any components of the formulation.

Warnings & Precautions:

Thyroid Tumor Risk: Liraglutide carries a warning for thyroid C-cell tumors based on animal studies. Be vigilant for neck swelling or persistent hoarseness.
Pancreatitis: Watch for signs of pancreatitis (severe abdominal pain) and stop the medication if it’s suspected.
Gallbladder: Weight loss from liraglutide can sometimes lead to gallstones. Inform your provider if you develop symptoms like intense stomach pain with nausea.
Kidney Health: Dehydration from vomiting or diarrhea can harm kidney function. Maintain hydration and contact a healthcare professional if severe GI symptoms occur.
Blood Sugar Changes: Rapid improvements in glucose control might temporarily affect eyesight in diabetic patients (diabetic retinopathy).
Heart Rate: Liraglutide may slightly raise resting heart rate. Use caution if you have cardiovascular disease.
Depression or Mood: Monitor mood and mental health. Report any notable changes in mood or new feelings of depression.

Common Side Effects:

Mild injection site reactions (redness, itching, or soreness at injection site)
Nausea (especially early in therapy)
Vomiting
Diarrhea
Constipation
Abdominal pain or discomfort
Reduced appetite

Serious Risks:

Thyroid Cancer: A rare potential risk; promptly report throat/neck symptoms.
Pancreatitis: Can occur and may be serious if not addressed quickly.
Severe Gastrointestinal Issues: Persistent vomiting or diarrhea can lead to serious dehydration or electrolyte imbalances requiring medical intervention.
Gallbladder Disease: Gallstone formation or cholecystitis (gallbladder inflammation) may require stopping the drug or surgery.
Renal Impairment: Acute kidney injury can result from severe dehydration.
Allergic Reaction: Though infrequent, serious allergic reactions (difficulty breathing, swelling, severe rash) can happen. Seek immediate help if these occur.

Drug Interactions:

Do not use alongside other GLP-1 agonists (to avoid compounded effects).
Insulin or sulfonylureas used with liraglutide can increase the risk of low blood sugar; dose adjustments to those medications may be necessary.
Slowed gastric emptying from liraglutide might influence absorption of oral medicines. For critical medications (such as thyroid pills or certain heart medications), discuss timing with your provider.
If you take oral medications like warfarin (a blood thinner), extra monitoring may be warranted when starting or changing liraglutide doses.
Limit alcohol consumption, as it may worsen blood sugar fluctuations and side effects like nausea.
Always check with a healthcare professional before combining liraglutide with any new medication or supplement.

Ozempic®

Ozempic is an FDA-approved once-weekly injectable form of semaglutide, indicated for adults with type 2 diabetes to improve blood sugar control. It also often leads to weight loss, although it is not specifically approved as a weight loss medication.

Overview & Regulatory Disclaimer: Ozempic® (semaglutide) is a prescription medication approved by the FDA for glycemic control in type 2 diabetes. It carries a Boxed Warning regarding thyroid C-cell tumor risk (observed in rodent studies). Ozempic should only be used under the supervision of a healthcare provider. It is not for treating type 1 diabetes or diabetic ketoacidosis. Patients taking Ozempic should be aware of its safety information and use it exactly as instructed by their provider.

Who Should Not Use This Medication:

Individuals with a personal or family history of medullary thyroid carcinoma (MTC) or MEN2.
Anyone who has had a serious allergic reaction to semaglutide or any of the ingredients in Ozempic.
Patients with Type 1 diabetes or in a state of diabetic ketoacidosis (inappropriate for this drug).
Women who are pregnant or planning to become pregnant. (Ozempic should be discontinued at least 2 months before a planned pregnancy due to potential harm to the fetus.)
Those who are breastfeeding (not recommended, as it's unknown if it passes into breast milk).

Warnings & Precautions:

Thyroid Tumors: [Boxed Warning] Risk of thyroid C-cell tumors has been noted in animal studies. While human risk is not confirmed, do not use Ozempic if you’re at risk for thyroid cancer. Report any neck swelling or difficulty swallowing immediately.
Pancreatitis: Cases of pancreatitis have been reported. Stop using Ozempic and seek medical care if you develop severe stomach pain that will not go away, with or without vomiting.
Gallbladder Issues: Rapid weight loss from Ozempic can sometimes trigger gallstones or gallbladder inflammation. Be alert to symptoms like upper-right abdominal pain, nausea, or yellowing of skin/eyes.
Diabetic Retinopathy: In some patients with diabetes, rapid improvements in blood sugar control have led to temporary worsening of diabetic eye disease. Regular eye exams are advised if you have retinopathy.
Kidney Function: Side effects like persistent vomiting or diarrhea can lead to dehydration and possible kidney injury. Use caution if you have existing kidney problems and stay hydrated.
Hypoglycemia with Others: Ozempic by itself has a low risk of causing low blood sugar, but when combined with other diabetes medications (especially insulin or sulfonylureas), it can cause hypoglycemia. Know the signs of low blood sugar and have a plan with your doctor to manage it.
Allergic Reactions: If you’ve had any hypersensitivity to similar drugs (GLP-1 agonists), use caution. Stop immediately and seek help if you have symptoms of an allergic reaction.
Lifestyle: Avoid excessive alcohol consumption while on Ozempic, as it can increase the risk of low blood sugar and stomach side effects. Also, continue to follow dietary and exercise guidance as provided by your healthcare team for best results.

Common Side Effects:

Mild injection site reactions (such as redness or soreness where you inject)
Nausea (very common, especially when first starting)
Vomiting
Diarrhea
Constipation
Stomach pain or upset
Reduced appetite
Fatigue or mild headache

Serious Risks:

Thyroid Cancer: A rare potential risk; monitor for symptoms like neck lumps or hoarseness.
Pancreatitis: Inflammation of the pancreas that can become a medical emergency.
Severe Hypoglycemia: Especially if combined with other diabetes medications; can cause confusion, seizures, or unconsciousness if not treated promptly.
Gallbladder Events: Gallstones or gallbladder inflammation requiring medical intervention.
Kidney Injury: From severe dehydration due to GI side effects. Dialysis has been required in rare cases.
Serious Allergic Reaction: Including anaphylaxis or angioedema (swelling under the skin). Any difficulty breathing, swelling of face/tongue, or severe rash needs emergency care.

Drug Interactions:

If you are on insulin or sulfonylurea drugs, a dose adjustment may be needed to prevent low blood sugar. Work closely with your healthcare provider when starting Ozempic.
Ozempic delays gastric emptying, which might affect absorption of oral medications. For example, if you take thyroid hormone (levothyroxine) in the morning, discuss with your doctor whether any timing adjustments are necessary.
Warfarin and other medications with tight dosing requirements should be monitored when starting Ozempic, as changes in how your body absorbs medications or in your weight could alter their effect.
Keep your healthcare provider informed about all medicines and supplements you take. This includes over-the-counter drugs and herbal supplements, so they can check for any possible interactions or adjustments needed.

Wegovy®

Wegovy is an FDA-approved once-weekly injectable form of semaglutide specifically indicated for chronic weight management in adults with obesity or overweight (with at least one weight-related medical condition).

Overview & Regulatory Disclaimer: Wegovy® is approved for use in adults with a BMI ≥30, or ≥27 if there are weight-related health issues (such as high blood pressure, type 2 diabetes, or high cholesterol). It contains semaglutide at a higher dose than Ozempic®. Wegovy carries the same Boxed Warning about thyroid C-cell tumors. It is a prescription medication to be used under medical guidance as part of a comprehensive weight management plan (including diet and exercise). Wegovy is not for treating type 1 diabetes or as a substitute for insulin.

Who Should Not Use This Medication:

Individuals with a personal or family history of medullary thyroid carcinoma or MEN2.
Anyone who has had a serious allergic reaction to semaglutide or any ingredient in Wegovy.
Patients with Type 1 diabetes or those experiencing diabetic ketoacidosis (not an appropriate therapy for these conditions).
Women who are pregnant or trying to become pregnant. (Weight loss medications like Wegovy must not be used during pregnancy; discontinue at least 2 months prior to a planned conception.)
Breastfeeding mothers (not recommended, due to unknown effects on the infant).
It is not intended for pediatric use unless specifically prescribed in a specialized setting (adult-focused medication).

Warnings & Precautions:

Thyroid Tumors: [Boxed Warning] Semaglutide may increase the risk of thyroid C-cell tumors (observed in rodents). Avoid Wegovy if you’re at risk, and promptly report any signs such as a lump in the neck or voice changes.
Pancreatitis: Monitor for pancreatitis. Severe abdominal pain that doesn’t resolve needs immediate medical evaluation.
Gallbladder Issues: Significant weight loss can lead to gallstone formation. Be cautious of symptoms like sudden upper stomach pain, which could indicate gallbladder problems.
Diabetic Management: Wegovy is not a diabetes medication, but if you have type 2 diabetes and are using Wegovy, be aware that it can lower blood sugar. If you take other diabetes medications, especially insulin or sulfonylureas, the combination can cause low blood sugar – discuss this with your doctor.
Retinopathy: If you have diabetes, rapid weight loss and improved glycemic control could temporarily worsen diabetic eye disease. Eye monitoring is recommended for diabetic patients on Wegovy.
Kidney Health: Nausea, vomiting, or diarrhea can lead to dehydration which may affect kidney function. Contact your provider if you experience prolonged gastrointestinal symptoms.
Mood Monitoring: As with any weight loss regimen, observe for depression or mood changes. Report any significant psychological symptoms.
Contraception: Because of the risks in pregnancy, ensure effective contraception while using Wegovy if you are of childbearing potential.

Common Side Effects:

Nausea (very common, especially when dosage is increased)
Vomiting
Diarrhea
Constipation
Abdominal cramping or pain
Heartburn or indigestion
Headache
Fatigue
Dizziness
Mild injection site reactions (bruising, soreness, or rash at injection site)

Serious Risks:

Thyroid Cancer: Potential (though not confirmed in humans) risk; any throat/neck symptoms should be investigated immediately.
Pancreatitis: Can occur and may result in hospitalization if severe.
Severe Hypoglycemia: If combined with other glucose-lowering agents, it can cause dangerously low blood sugar. Symptoms like confusion, slurred speech, or loss of consciousness require urgent treatment.
Gallbladder Events: Gallstones or acute gallbladder inflammation that might require medication or surgery.
Kidney Injury: Resulting from severe dehydration; some cases have needed dialysis.
Serious Allergic Reactions: Including swelling (angioedema) and anaphylaxis, which are medical emergencies.

Drug Interactions:

Wegovy should not be used in combination with other semaglutide-containing products or additional GLP-1 agonists.
If you are on insulin or sulfonylureas for diabetes, your doctor may adjust those medications due to the added blood sugar-lowering effect of Wegovy.
Slowed stomach emptying may affect how you absorb oral medications (for example, you might need to take oral medicines like thyroid hormone or birth control at a different time of day). Consult your healthcare provider for personalized advice.
There is no significant interaction with contraceptives themselves aside from the absorption timing noted, but due to potential vomiting, if you vomit soon after taking an oral contraceptive, follow the guidance for missed doses of that contraceptive.
Inform your provider about all other weight loss supplements or medications you are taking. The concurrent use of multiple weight loss products is generally not recommended due to increased risk of adverse effects.

Mounjaro®

Mounjaro is an FDA-approved once-weekly injectable medication (tirzepatide) for adults with type 2 diabetes, used to improve blood sugar control. It is a dual-action glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptor agonist, which often results in significant weight loss as well.

Overview & Regulatory Disclaimer: Mounjaro® is approved for glycemic control in type 2 diabetes. It has a Boxed Warning for thyroid C-cell tumors (as observed in rodent studies). While not officially approved for obesity treatment, weight loss is a common effect. Mounjaro should be prescribed by a healthcare provider familiar with its profile, and it is not a substitute for insulin in type 1 diabetes or for ketoacidosis management. All use should adhere to medical guidance and the approved prescribing information.

Who Should Not Use This Medication:

Individuals with a personal or family history of medullary thyroid carcinoma or MEN2 (due to the thyroid tumor risk).
Anyone who has had a serious hypersensitivity reaction to tirzepatide or any of Mounjaro’s components.
Patients with Type 1 diabetes or those with diabetic ketoacidosis (Mounjaro is not indicated in these situations).
Women who are pregnant or planning to become pregnant. (Due to potential risk to the fetus, it should be stopped at least 2 months before trying to conceive.)
Breastfeeding mothers, since it is not known if tirzepatide passes into breast milk and could affect the infant.

Warnings & Precautions:

Thyroid Tumors: [Boxed Warning] Tirzepatide has shown a risk of thyroid C-cell tumors in animal studies. Be mindful of any neck masses or throat symptoms. Do not use if you’re susceptible to thyroid cancers.
Pancreatitis: There is a noted risk of pancreatitis. If severe abdominal pain occurs (especially with vomiting), discontinue Mounjaro and seek medical evaluation.
Gallbladder Disease: Weight loss induced by Mounjaro may precipitate gallstones. Recognize signs like sudden, intense abdominal pain or yellowing of the eyes/skin.
Gastrointestinal Reactions: Mounjaro often causes gastrointestinal side effects. Use caution if you have severe gastrointestinal conditions; tirzepatide is not recommended in patients with serious GI diseases like severe gastroparesis.
Eye Health: Rapid improvements in blood sugar can temporarily worsen diabetic retinopathy. If you have diabetic eye disease, ensure you have appropriate eye monitoring.
Kidney Function: Dehydration from prolonged nausea/diarrhea can affect kidney function. Maintain fluid intake and monitor kidney health if you have any kidney issues.
Hypoglycemia Risk: When added to other diabetes medications, tirzepatide can increase the risk of low blood sugar. Know how to recognize and manage hypoglycemic symptoms, especially if you are on insulin or sulfonylureas.
Mental Health: Monitor for any mood changes or feelings of depression. Significant changes should be reported; while no direct causal link is established, staying aware of mental well-being is important.

Common Side Effects:

Nausea
Diarrhea
Decreased appetite
Vomiting
Constipation
Indigestion or stomach discomfort
Injection site reactions (such as mild pain or redness)
Upper abdominal pain
Fatigue

Serious Risks:

Thyroid Cancer: A potential risk; though rare, it's serious – report any neck/throat symptoms immediately.
Pancreatitis: Can be severe and may require hospitalization.
Gallstones/Gallbladder Inflammation: May require medical intervention.
Severe Hypoglycemia: Particularly in combination with other glucose-lowering agents; can cause loss of consciousness or seizures if untreated.
Acute Kidney Injury: Resulting from severe dehydration due to vomiting/diarrhea.
Severe Allergic Reaction: Anaphylaxis or angioedema (swelling) could occur; any signs of this demand emergency treatment.

Drug Interactions:

Avoid using Mounjaro together with other GLP-1 receptor agonists or similar medications intended for diabetes or weight loss (to prevent overlapping effects).
If you take insulin or sulfonylurea drugs, these may need dose adjustments to avoid low blood sugar episodes.
Tirzepatide slows gastric emptying, which can impact how and when other oral medicines are absorbed. You may need to adjust the timing of certain oral medications (like pain relievers, antibiotics, or thyroid hormone). Consult your healthcare provider for guidance.
Warfarin levels could be affected by major changes in weight or diet; if you are on warfarin, your doctor might monitor your INR more closely when starting or changing Mounjaro doses.
Limit alcohol intake. Heavy alcohol use can increase the risk of pancreatitis and low blood sugar episodes.
Always inform your healthcare provider about all medications and supplements you use. This allows proper assessment of any potential interactions with Mounjaro.

Zepbound®

Zepbound is an FDA-approved once-weekly injectable form of tirzepatide indicated for chronic weight management in adults with obesity or overweight (with at least one weight-related condition). It is also approved to help manage obesity-related complications such as obstructive sleep apnea.

Overview & Regulatory Disclaimer: Zepbound® is approved for use in adults with a BMI ≥30 (obese), or ≥27 (overweight) with a related health issue (for example, high blood pressure, type 2 diabetes, or sleep apnea). It contains tirzepatide, which targets GIP and GLP-1 receptors to reduce appetite and improve metabolic control. Like other tirzepatide products, it carries a Boxed Warning for thyroid C-cell tumors observed in animal studies. Zepbound is not for treating type 1 diabetes or as a substitute for insulin, and it should be prescribed by a qualified healthcare provider specialized in weight management.

Who Should Not Use This Medication:

Individuals with a personal or family history of medullary thyroid carcinoma or MEN2.
Anyone with a known serious allergy to tirzepatide or any component of Zepbound.
Patients with Type 1 diabetes or those in diabetic ketoacidosis (not indicated for these conditions).
Women who are pregnant or planning to become pregnant. (Weight management therapy with Zepbound is contraindicated in pregnancy; discontinue at least 2 months before attempting to conceive.)
Breastfeeding women, as it is unknown if tirzepatide passes into breast milk and it’s generally advised to avoid weight loss medications during this period.
Zepbound is not approved for use in children at this time.

Warnings & Precautions:

Thyroid Tumors: [Boxed Warning] Tirzepatide has been linked to thyroid C-cell tumors in rodents. While human relevance is uncertain, avoid use if you are at risk, and watch for symptoms like neck swelling or throat pain.
Pancreatitis: Monitor for pancreatitis. If you experience severe, unrelenting abdominal pain (with or without vomiting), stop Zepbound and seek medical care.
Gallbladder Disease: Rapid weight loss can increase the risk of gallstones. Be aware of gallbladder-related symptoms (right-sided abdominal pain, nausea, fever, jaundice).
Hypoglycemia in Diabetics: Zepbound is not a diabetes drug, but if you have type 2 diabetes and are on medications such as insulin or sulfonylureas, adding tirzepatide can cause low blood sugar. Coordinate with your doctor to adjust diabetes medications and learn how to manage potential hypoglycemia.
Eye Disorders: If you have diabetes, quick improvements in control and weight might transiently worsen retinopathy. Regular eye check-ups are advisable for diabetic patients using Zepbound.
Kidney Concerns: Side effects like vomiting or diarrhea can cause dehydration, which may impact kidney function. Use caution and maintain adequate fluid intake.
Mental Health: Track any changes in mood. Though not commonly reported, significant depression or suicidal thoughts should be taken seriously and addressed immediately.
Sleep Apnea: If you are using Zepbound for sleep apnea, do not stop your primary sleep apnea therapy (like CPAP) without consulting your doctor. Weight loss can improve OSA, but it may not eliminate the need for other treatments immediately.

Common Side Effects:

Nausea
Diarrhea
Vomiting
Constipation
Stomach pain or indigestion
Decreased appetite
Injection site reactions (such as redness, itching, or tenderness)
Dizziness
Fatigue

Serious Risks:

Thyroid Cancer: A potential risk that warrants prompt attention if any signs appear.
Pancreatitis: Could become a medical emergency; early detection is key.
Severe Hypoglycemia: In patients concurrently using insulin or other diabetic medications – watch for confusion, sweating, or fainting.
Gallbladder Events: Gallstones or gallbladder inflammation requiring medical intervention or surgery.
Kidney Injury: Possible if severe dehydration occurs; in rare cases acute kidney failure has been reported with similar medications.
Serious Allergic Reactions: Rare but severe reactions like anaphylaxis can happen. Any swelling of tongue/throat or difficulty breathing requires emergency care.

Drug Interactions:

Zepbound should not be used alongside other GLP-1 or GIP/GLP-1 agonist medications. Avoid combining it with any other weight-loss drugs unless directed by a physician, as safety and efficacy of such combinations haven’t been established.
If you are on insulin or sulfonylureas, these may need dose adjustments to avoid low blood sugar episodes.
Tirzepatide’s slowing of stomach emptying can affect absorption of oral medications. If you take medications for thyroid, birth control, or other conditions, discuss optimal timing with your healthcare provider.
There are no specific food restrictions, but limit alcohol consumption. Alcohol can exacerbate the risk of pancreatitis and hypoglycemia.
Always review your medication list (including supplements and vitamins) with your provider when starting Zepbound. This ensures any potential interactions or timing issues can be managed proactively.

NAD+

This is a compounded injectable form of NAD+, a coenzyme naturally found in the body that plays a key role in cellular energy, metabolism, and repair.

Overview & Regulatory Disclaimer: Compounded NAD+ injections are not FDA-approved. This formulation is prepared by licensed compounding pharmacies and used in wellness settings to support energy production, cognitive function, and cellular health. The safety, effectiveness, and quality of compounded NAD+ have not been reviewed by the FDA. Use should only occur under the direction of a licensed medical provider.

Who Should Not Use This Medication:

Individuals with known allergies to NAD+ or any ingredients in the compounded injection.
Pregnant or breastfeeding individuals.
Children or adolescents, unless specifically prescribed by a qualified healthcare provider.
Those with a history of severe asthma or allergies to vitamin B3 derivatives should consult their provider before use.

Warnings & Precautions:

NAD+ injections have not been evaluated in large-scale clinical trials. Individual results may vary.
Administering the injection too quickly may cause flushing, chest tightness, or dizziness.
Use caution if you have underlying kidney, liver, or heart conditions, as safety in these groups has not been fully established.
Stay well hydrated before and after use, especially during high-dose regimens.
Always ensure injections are administered using sterile technique to avoid infection.

Common Side Effects:

Mild headache
Nausea
Flushing or warmth
Injection site redness or irritation
Temporary fatigue
Mild dizziness or lightheadedness

Serious Risks:

Allergic reaction, including rash, swelling, or difficulty breathing
Chest discomfort or palpitations during infusion (rare)
Infection at the injection site if not administered properly

Drug Interactions:

NAD+ is generally well tolerated with most medications, but high-dose supplementation with niacin or similar compounds may increase side effects.
Always inform your healthcare provider of all medications and supplements you are taking before starting NAD+ therapy.

NAD+ (Nasal Spray)

This is a compounded nasal spray formulation of NAD+, a naturally occurring coenzyme involved in cellular energy, metabolism, and neurological function.

Overview & Regulatory Disclaimer: Compounded NAD+ nasal spray is not FDA-approved. It is prepared by licensed compounding pharmacies and used in wellness settings as a non-invasive alternative to injectable NAD+. The safety, effectiveness, and quality of this compounded therapy have not been evaluated by the FDA. Use should be supervised by a licensed healthcare provider.

Who Should Not Use This Medication:

Individuals with known allergies to NAD+ or ingredients in the nasal spray.
Those with chronic nasal conditions (e.g., frequent nosebleeds, nasal polyps, or sinus infections).
Pregnant or breastfeeding individuals.
Children or adolescents unless specifically directed by a licensed provider.
Those who recently had nasal surgery or trauma.

Warnings & Precautions:

Nasal irritation, dryness, or congestion may occur with repeated use.
Use caution if you have asthma or a reactive airway condition.
Avoid use if you experience persistent nasal discomfort or symptoms of sinus infection.
Use only as directed by a licensed provider; improper technique may reduce effectiveness or increase side effects.
Keep the spray bottle clean and do not share it with others to prevent contamination.

Common Side Effects:

Mild nasal burning or irritation
Sneezing
Headache
Throat irritation or mild cough
Runny nose
Fatigue

Serious Risks:

Allergic reaction (rash, facial swelling, difficulty breathing)
Severe nosebleeds or nasal pain
Infection from improper use or contamination

Drug Interactions:

No well-documented interactions exist, but avoid using other nasal sprays at the same time without provider guidance.
Always inform your healthcare provider of all medications and supplements you are using.

Glutathione

Compounded glutathione injection provides glutathione, a potent antioxidant produced in the body, directly into the bloodstream or muscle. It is used in functional and integrative medicine to support liver detoxification, improve skin complexion, reduce oxidative stress, and promote overall wellness.

Overview & Regulatory Disclaimer: Glutathione injections are not FDA-approved for any medical treatment. They are prepared by compounding pharmacies and used off-label in wellness clinics. The quality and concentration can vary by provider, and the FDA has issued warnings about the unproven safety of IV glutathione for uses like skin lightening. Patients should approach glutathione therapy with caution, under the supervision of a knowledgeable healthcare provider. This treatment is supplementary and not a replacement for any standard medical therapies.

Who Should Not Use This Medication:

Individuals with a known allergy to glutathione or any ingredients in the injection formulation. (Signs of allergy could include prior reactions like rash or breathing trouble after glutathione or similar supplements.)
Patients currently undergoing chemotherapy or radiation therapy for cancer, unless approved by their oncologist. (Glutathione’s antioxidant properties might interact with the intended oxidative mechanism of some cancer treatments.)
People with asthma should avoid inhaled glutathione (it can worsen bronchospasm). For injections, asthma isn’t a direct contraindication, but such patients should be monitored closely since any severe allergic reaction could affect breathing.
Women who are pregnant or breastfeeding, due to insufficient information on safety for the fetus or infant.
Use in minors is not established and generally not recommended unless part of a clinical treatment plan by a specialist.

Warnings & Precautions:

Quality and Purity: Ensure glutathione is obtained from a reputable source. There have been reports of adverse reactions (fever, chills, nausea) due to contaminated or improperly compounded glutathione products.
Monitoring: Start with a test dose if possible. Some individuals might be sensitive to glutathione. If you feel faint, nauseous, or unwell during an injection or IV infusion, inform the administering professional immediately.
Liver and Kidney Function: While glutathione is meant to support detoxification, its effects on individuals with severe liver or kidney disease are not well studied. If you have significant liver or kidney problems, use glutathione injections only under medical supervision and with periodic lab monitoring.
Overuse and Frequency: High-frequency or high-dose glutathione injections have not been well studied. Using more than recommended could theoretically upset the body’s antioxidant balance. Stick to the regimen prescribed and discuss any plans to increase dosage with a doctor.
Signs of Adverse Reaction: Because glutathione is usually well-tolerated, any strong adverse symptom (like severe abdominal pain, difficulty breathing, or rapid heartbeat) during or after the injection should be taken seriously. Stop the infusion/injection and seek medical care if this occurs.

Common Side Effects:

Injection site pain, swelling, or bruising
Headache
Nausea or mild stomach upset
Bloating or gassiness
Diarrhea (some individuals experience changes in bowel habits)
Skin rash or mild itching (transient)
Feeling flushed or lightheaded for a short time after injection
Fatigue or dizziness shortly after the infusion (often transient)

Serious Risks:

Allergic Reactions: Severe allergic responses are rare but possible. These could include hives; swelling of face, lips, or throat; wheezing or difficulty breathing; and anaphylaxis. This requires immediate emergency treatment.
Breathing Difficulties: There have been rare reports of people experiencing chest tightness, shortness of breath, or even bronchospasm during glutathione IV infusions. This may be more likely if infused rapidly. Any trouble breathing associated with the treatment is an emergency.
Kidney or Liver Injury: Although glutathione is usually thought to protect organs, there are isolated cases (often abroad) of acute liver or kidney problems following unregulated high-dose glutathione drips. This may relate to impurities or dose, but it underscores the need for caution.
Infection or Sepsis: If the injection is not sterile or if proper technique is not used, there’s a risk of infection entering the bloodstream, which can be life-threatening. Always ensure injections are done with sterile equipment by a trained professional.
Electrolyte Imbalance or Low Zinc: Some experts caution that long-term glutathione use could potentially lower certain minerals like zinc. While not acutely serious in the short term, it’s something to be mindful of over long durations.

Drug Interactions:

Chemotherapy/Radiation: Glutathione’s antioxidant effect might interfere with cancer treatments that rely on oxidative damage to kill cells. Patients on such treatments should only use glutathione if their oncologist specifically approves it (in some cases oncologists do use glutathione to mitigate side effects, but this should be coordinated).
Alcohol: Avoid consuming alcohol around the time of glutathione injections. Alcohol puts oxidative strain on the liver; combining it with glutathione therapy could alter its intended effect and increase nausea.
Other Antioxidants: If you are taking high doses of other antioxidants (vitamins C, E, alpha-lipoic acid), inform your provider. Synergistic effects might increase the risk of side effects like upset stomach or, conversely, reduce the oxidative signals that some treatments rely on.
Medications Metabolized by Liver: Glutathione is involved in liver detox pathways (Phase II metabolism). While boosting glutathione might help process certain toxins or drugs, it could also potentially alter how certain medications are metabolized. It’s wise to review all medications with your provider – especially acetaminophen, which relies on glutathione in the liver, or any drugs with narrow therapeutic windows.
Always keep your healthcare providers informed about any supplements or therapies like glutathione injections that you are using, so they can manage your overall care and watch for any interactions or lab changes.

Sermorelin

Sermorelin offered by Roen is a compounded peptide therapy used to stimulate the body’s natural production of growth hormone. It is prescribed in wellness and age-related care settings to support recovery, metabolism, sleep, and body composition. This medication is not FDA-approved.

Overview & Regulatory Disclaimer: Sermorelin is prepared by licensed compounding pharmacies and has not been reviewed by the FDA for safety, effectiveness, or manufacturing standards. It is not approved for anti-aging or hormone optimization but may be prescribed when clinically appropriate under the supervision of a licensed medical provider. Sermorelin is not synthetic growth hormone but stimulates the pituitary to produce more natural growth hormone.

Who Should Not Use This Medication:

Individuals with active cancer or a history of hormone-sensitive tumors.
Those with known pituitary tumors or intracranial masses.
Patients with uncontrolled diabetes or diabetic retinopathy.
Pregnant or breastfeeding individuals.
Anyone allergic to sermorelin or ingredients in the compounded injection.

Warnings & Precautions:

Sermorelin may raise IGF-1 levels, which should be monitored by your provider.
May cause changes in blood sugar or fluid retention in some individuals.
Use caution if you have thyroid disorders, cardiovascular disease, or diabetes.
This therapy may require routine lab testing during use.
Not to be used in combination with growth hormone unless directed by a provider.

Common Side Effects:

Mild irritation or redness at the injection site
Headache
Flushing or warmth
Difficulty sleeping
Temporary fatigue or dizziness

Serious Risks:

Allergic reaction (e.g., rash, swelling, difficulty breathing)
Severe headaches or vision changes
Palpitations, chest tightness, or unusual swelling
Numbness or tingling in hands or wrists

Drug Interactions:

High-dose corticosteroids may reduce sermorelin’s effect.
Combining with growth hormone is not typically recommended.
Inform your provider of all medications and supplements before starting treatment.

MIC + B12

MIC+B12 is a compounded injectable solution containing methionine, inositol, choline (MIC), and vitamin B12. Compounded medications are not reviewed or approved by the FDA for safety or effectiveness. Use this treatment only as prescribed and directed by a licensed healthcare provider.

Common Side Effects:

Pain, redness, mild swelling, or itching at the injection site
Mild gastrointestinal discomfort (such as nausea or diarrhea)
Lightheadedness or dizziness

Precautions:

Pregnancy & Breastfeeding: Not recommended for use during pregnancy or while nursing unless specifically advised by your healthcare provider.
Allergies: Do not use if you have a known allergy to vitamin B12 (cobalamin/cobalt) or any other ingredient in the injection.
Medical Conditions: Inform your provider about any medical conditions (especially heart, liver, or kidney disease, or certain blood/metabolic disorders) before starting MIC+B12.
Other Medications: Tell your healthcare provider about all other medications or supplements you are taking to avoid potential interactions or adverse effects.

Note: MIC+B12 is a compounded product and has not been evaluated or approved by the FDA. This treatment is not intended to diagnose, treat, cure, or prevent any disease. Use only under medical supervision.

Methylcobalamin (Vitamin B12)

Compounded methylcobalamin B12 injection provides the active form of vitamin B12, essential for nerve health, red blood cell formation, and DNA synthesis. This compounded formulation is prepared by licensed pharmacies and has not been reviewed or approved by the FDA for safety, effectiveness, or manufacturing standards. Use only under the supervision of a licensed healthcare provider.

Common Side Effects:

Mild pain, redness, or swelling at the injection site
Headache
Dizziness or lightheadedness
Nausea or mild stomach upset
Temporary diarrhea

Precautions:

Pregnancy & Breastfeeding: Methylcobalamin is generally considered safe during pregnancy and lactation at appropriate doses. However, compounded formulations should be used only if specifically recommended by your healthcare provider.
Allergies: Do not use if you have a known allergy to vitamin B12 (cobalamin/cobalt) or any component of the compounded preparation.
Medical Conditions: Inform your provider about any medical conditions, particularly Leber's disease (a rare generic eye disorder), as methylcobalamin may worsen optic nerve damage in affected individuals.
Other Medications: Tell your healthcare provider about all other medications or supplements you are taking to avoid potential interactions or adverse effects.‍
Dosage: Use methylcobalamin injections exactly as prescribed. Excessive doses are typically well tolerated but could occasionally cause skin reactions or electrolyte imbalances.

Note: Compounded methylcobalamin B12 injections are designed for individuals needing customized dosing or alternative delivery methods. This treatment has not been evaluated or approved by the FDA and is not intended to diagnose, treat, cure, or prevent any disease. Use only as directed by a licensed healthcare provider.

Sildenafil (Viagra® and Generic)

Overview & Regulatory Disclaimer: Sildenafil is an FDA-approved prescription medication used to treat erectile dysfunction (ED) in adult men. It belongs to a class of drugs called phosphodiesterase-5 (PDE5) inhibitors and works by increasing blood flow to the penis to help achieve and maintain an erection during sexual stimulation. (A different formulation of sildenafil is also FDA-approved for pulmonary arterial hypertension, but this summary focuses on the ED indication.) Sildenafil (brand name Viagra® and generic) should be used only under the supervision of a healthcare provider. Always follow your provider’s instructions and use the medication as prescribed.

Who Should Not Use This Medication:

Nitrates or Nitric Oxide Donors: Do not use sildenafil if you are taking any nitrate medications (e.g. nitroglycerin, isosorbide) or recreational nitrites (“poppers”) for chest pain. The combination can cause a dangerous drop in blood pressure.
Riociguat (Adempas): Do not use sildenafil if you are taking riociguat (a medicine for pulmonary hypertension). Like nitrates, it can dangerously lower blood pressure when combined with sildenafil.
Allergy: Do not use sildenafil if you have a known allergy or hypersensitivity to sildenafil or any component of the product.
Serious Cardiovascular Conditions: Individuals with severe heart or circulation problems should not use sildenafil. This includes men who have had a recent heart attack, stroke, or life-threatening arrhythmia (typically within the last 6 months), or those with unstable angina (chest pain at rest). If sexual activity is inadvisable due to your heart condition, you should not take this medication.
Blood Pressure Issues: Do not use sildenafil if you have very low blood pressure (resting systolic BP <90 mmHg) or uncontrolled high blood pressure (BP >170/110 mmHg).
Liver or Kidney Disease: Men with severe liver or kidney impairment should not use sildenafil without medical supervision; dosage adjustments or alternative treatments may be necessary.
Pregnancy and Pediatrics: Sildenafil is not approved for use in women or children. Pregnant or breastfeeding women should not take this medication.
Retinitis Pigmentosa: Men with certain rare inherited eye conditions (such as retinitis pigmentosa) should avoid sildenafil unless a doctor says otherwise.

Warnings & Precautions:

Cardiovascular Risk: Use caution if you have cardiovascular disease. PDE5 inhibitors like sildenafil cause vasodilation (blood vessel dilation) and can lower blood pressure. Sexual activity itself can strain the heart, so sildenafil should not be used by men for whom sex is inadvisable because of underlying heart disease. Always consult your doctor before using sildenafil if you have any heart condition (e.g. recent heart surgery, severe heart failure, or chest pain with minimal exertion).
Hypotension: Sildenafil can cause a drop in blood pressure. Be careful when standing up quickly or if you have conditions like dehydration, bleeding, or autonomic dysfunction. If you take medications for blood pressure (especially alpha-blockers or antihypertensives), your doctor may start you on a lower sildenafil dose and monitor you closely to avoid dizziness or fainting.
Vision Changes: Rarely, sildenafil has been associated with sudden vision loss (non-arteritic anterior ischemic optic neuropathy, NAION) or other visual disturbances (such as a blue tint to vision). If you experience sudden vision problems or any new visual field loss, stop taking sildenafil and seek medical attention immediately. Patients with certain eye conditions or a history of NAION should discuss risks with their doctor.
Hearing Changes: Sudden hearing loss, sometimes accompanied by ringing in the ears (tinnitus) and dizziness, has been reported with PDE5 inhibitors. If you notice sudden decrease or loss of hearing, discontinue sildenafil and contact a doctor right away.
Priapism: An erection lasting longer than 4 hours (priapism) is a medical emergency. If you have an erection that persists beyond 4 hours, seek immediate emergency care to prevent permanent injury to the penis. Patients with conditions that may predispose to priapism (such as sickle cell anemia, multiple myeloma, or leukemia) should use sildenafil with caution and under close medical guidance.
Other Eye and Ear Conditions: If you have a history of certain eye disorders or any sudden visual or auditory symptoms, inform your doctor before taking sildenafil.
Other Precautions: Avoid excessive alcohol consumption when taking sildenafil; alcohol can increase the risk of side effects like low blood pressure and dizziness. Discuss all of your medical conditions with your provider (including liver or kidney disease, heart rhythm disorders, bleeding disorders, or any risk factors for cardiovascular events).

Common Side Effects:

Headache
Flushing (warmth or redness, especially of the face)
Indigestion (upset stomach)
Nasal congestion (stuffy or runny nose)
Dizziness
Visual changes (such as blurred vision or a blue/green tint to vision)
Back pain or muscle aches (less common)

These side effects are usually mild to moderate. If any side effect bothers you or does not go away, consult your healthcare provider. They may adjust your dose or recommend supportive measures.

Serious Risks:

Cardiac Events: Although rare, heart attacks, strokes, and other serious cardiovascular events have occurred in men taking sildenafil, sometimes during sexual activity. It is unclear whether sildenafil is directly responsible, but this risk is higher in men with pre-existing heart disease. Seek emergency care if you experience chest pain, irregular heartbeat, severe shortness of breath, or feeling faint.
Prolonged Erection (Priapism): As noted, untreated priapism can cause permanent damage. Do not ignore an erection lasting longer than 4 hours.
Permanent Vision Loss: A sudden loss of vision in one or both eyes can occur. This is usually due to NAION, a serious condition that can cause permanent blindness. If this happens, stop sildenafil and seek immediate care.
Hearing Loss: Permanent loss of hearing or severe auditory issues can occur. If you experience sudden hearing decrease or loss, go to an emergency department.
Severe Hypotension: Combining sildenafil with certain drugs (especially nitrates or alpha-blockers) or consuming large amounts of alcohol can lead to a dangerous drop in blood pressure, causing fainting or shock.
Allergic Reaction: Rarely, severe allergic reactions (rash, itching, swelling of the face or throat, difficulty breathing) can occur. Seek emergency help if you have any signs of a serious allergic reaction.

Drug Interactions:

Nitrates and Nitric Oxide Donors: Do NOT take any form of nitrates (e.g., nitroglycerin pills, patches, sprays, or isosorbide) or nitric oxide donors while using sildenafil. This combination can cause a life-threatening drop in blood pressure. Make sure all your doctors know if you use nitrates for any reason.
Riociguat (Adempas): Do NOT use sildenafil if you are on riociguat, a pulmonary hypertension medication. It has a similar effect to nitrates and can cause severe hypotension in combination with sildenafil.
Alpha-Blockers (e.g. tamsulosin, doxazosin): Taking sildenafil with alpha-blockers (used for enlarged prostate or high blood pressure) can cause low blood pressure and dizziness. If you are on an alpha-blocker, your doctor will usually start sildenafil at the lowest dose and monitor you while standing up slowly. Do not combine without medical advice.
Other ED Medications/PDE5 Inhibitors: Do not take sildenafil together with other erectile dysfunction drugs (such as tadalafil or vardenafil) or “PDE5” medications. Taking more than one PDE5 inhibitor can increase the risk of serious side effects without increasing benefit. Allow at least 24–48 hours between different ED meds as advised by your provider.
CYP3A4 Inhibitors (e.g., ketoconazole, ritonavir, erythromycin, grapefruit juice): These medications and substances can increase sildenafil levels in your blood, prolonging its effect and side effects. When using a strong CYP3A4 inhibitor, your doctor may prescribe a lower dose of sildenafil or adjust your treatment. Avoid excessive grapefruit or grapefruit juice while on sildenafil.
CYP3A4 Inducers (e.g., rifampin, phenytoin, carbamazepine): These can reduce sildenafil’s effectiveness by lowering its blood levels. If you take such medicines, discuss with your provider, as a dose adjustment may be needed.
Antihypertensive Drugs: Sildenafil can enhance the blood pressure-lowering effect of many blood pressure medications. Use caution when combining with anti-hypertensives; monitor for symptoms like dizziness or lightheadedness.
Alcohol: Drinking large amounts of alcohol with sildenafil can increase the chance of low blood pressure, dizziness, or fainting. Limit alcohol intake when using this medication.

Tadalafil (Cialis® and Generic)

Overview & Regulatory Disclaimer: Tadalafil is an FDA-approved prescription medication used to treat erectile dysfunction (ED) in men. It also treats the symptoms of benign prostatic hyperplasia (BPH) in men (relief of urinary difficulty). Like sildenafil, tadalafil is a PDE5 inhibitor that increases blood flow to the penis to help with erections during sexual stimulation. Tadalafil is unique in that it can be taken either as needed (about 30 minutes before sexual activity) or once daily (for continuous effect). Tadalafil (brand name Cialis® and generic) must be used under the guidance of a healthcare provider. Follow your prescription instructions carefully.

Who Should Not Use This Medication:

Nitrates or Nitric Oxide Donors: Do not use tadalafil if you are taking any nitrates or nitric oxide donors (for angina or heart conditions). Combining tadalafil with nitrates can cause a sudden and dangerous drop in blood pressure.
Riociguat (Adempas): Do not use tadalafil if you are taking riociguat. Like nitrates, this combination can dangerously lower blood pressure.
Allergy: Do not use tadalafil if you have a known allergy to tadalafil or any of its ingredients.
Cardiovascular Conditions: Men with serious heart problems should not use tadalafil. If you have had a recent heart attack, stroke, or life-threatening heart rhythm problem, or if you have unstable angina or severe heart failure, you should not take tadalafil. Also, if your doctor has told you to avoid sexual activity because of your heart condition, do not take tadalafil.
Blood Pressure Issues: Avoid tadalafil if you have very low blood pressure or uncontrolled high blood pressure (unless advised by your doctor under close supervision).
Retinitis Pigmentosa: Men with this rare inherited eye condition may have an increased risk of vision problems with PDE5 inhibitors; use only if a doctor approves.
Liver or Kidney Disease: Tadalafil should be used with caution in severe kidney or liver impairment. Patients with severe impairment may require a lower dose or should not use it.
Women and Children: Tadalafil is not indicated for use in women or children. Pregnant or breastfeeding women should not take this medication.

Warnings & Precautions:

Cardiovascular Risk: As with all PDE5 inhibitors, tadalafil can cause vasodilation and lower blood pressure. Men with heart disease should discuss with their doctor before using tadalafil, especially if sexual activity is not recommended due to their cardiac status. If you experience chest pain, dizziness, or fainting with intercourse, stop and seek medical help.
Priapism: Tadalafil can also cause priapism (prolonged erection). If an erection lasts more than 4 hours, seek emergency medical attention immediately to avoid permanent damage.
Vision/Hearing Changes: Sudden vision loss (NAION) and sudden hearing loss have been reported with tadalafil. If you experience any sudden loss of vision or hearing, stop taking tadalafil and seek prompt medical attention.
Hypotension: Tadalafil may lower blood pressure. Use caution if you are on blood pressure medications or have conditions that predispose you to hypotension (e.g. dehydration). Standing up slowly from a sitting/lying position can help prevent dizziness. Limit alcohol consumption as it can enhance this effect.
Muscle and Back Pain: Tadalafil (especially in the daily or high-dose form) is more likely than some other ED drugs to cause muscle aches, back pain, and limb pain. These side effects typically occur 12–24 hours after dosing and usually resolve within 48 hours. If discomfort is severe or persistent, consult your doctor.
Kidney and Liver Function: If you have significant kidney or liver disease, your doctor may prescribe a lower dose or monitor you closely, since tadalafil is processed by these organs.
Other Conditions: Inform your doctor if you have conditions like stomach ulcers, bleeding disorders, or any retinal disorders. Although tadalafil has not been shown to significantly affect bleeding, your provider will advise accordingly.

Common Side Effects:

Headache
Indigestion (heartburn) or stomach upset
Back pain and muscle aches
Nasal congestion (stuffy or runny nose)
Dizziness
Limb pain (arm or leg pain)
Flushing (warmth or redness of face)

These side effects are usually mild to moderate and often go away within a few hours. They are more likely at higher doses. If any side effect persists or worsens, contact your healthcare provider.

Serious Risks:

Cardiac Events: Similar to sildenafil, serious cardiovascular events (heart attack, stroke, irregular heartbeat) have occurred in men taking tadalafil. Many of these men had pre-existing heart disease. If you experience chest pain, severe dizziness, or fainting, seek emergency care.
Prolonged Erection (Priapism): Seek immediate medical attention for an erection lasting more than 4 hours, as this can cause permanent injury.
Sudden Vision Loss: As with other PDE5 inhibitors, tadalafil can rarely cause irreversible vision loss due to NAION. Stop taking tadalafil and seek medical care if you notice sudden vision changes.
Sudden Hearing Loss: If you experience sudden hearing decrease or loss (often with tinnitus), discontinue tadalafil and get medical help.
Severe Hypotension: Tadalafil can lead to severe low blood pressure if mixed with certain drugs or alcohol, causing fainting or shock.
Allergic Reactions: Though rare, severe allergic reactions to tadalafil (rash, itching, swelling, breathing difficulty) require immediate medical attention.

Drug Interactions:

Nitrates and Nitric Oxide Donors: NEVER take tadalafil with nitrates or nitric oxide donors. This combination can cause a life-threatening drop in blood pressure.
Riociguat (Adempas): Avoid combination; it can cause severe hypotension.
Alpha-Blockers (e.g. tamsulosin, doxazosin): Taking tadalafil with alpha-blockers or other antihypertensive medications can cause significant blood pressure drops. Your doctor may adjust your dosage or require supervision when combining these.
Other PDE5 Inhibitors: Do not use tadalafil with other ED medications (sildenafil, vardenafil, avanafil). Using more than one PDE5 inhibitor can increase side effects without extra benefit. Ensure at least 24–48 hours between different ED drugs as advised.
CYP3A4 Inhibitors (e.g. ketoconazole, ritonavir, erythromycin, grapefruit juice): These drugs/substances can increase tadalafil blood levels, prolonging effect and side effects. Your provider may lower your tadalafil dose if you take these. Avoid grapefruit products with tadalafil.
CYP3A4 Inducers (e.g. rifampin, phenytoin): These can decrease the effectiveness of tadalafil by lowering its levels. Inform your doctor if you are on such medications; dose adjustments may be needed.
Alcohol: Drinking large amounts of alcohol (more than 5 drinks) with tadalafil can increase the risk of side effects like dizziness, headache, and low blood pressure. Limit alcohol intake when using this medication.
Blood Pressure Medications: Because tadalafil can lower blood pressure, combining it with antihypertensive medications may cause additive effects. Monitor for symptoms like dizziness or fainting if you take blood pressure drugs.

Methylene Blue

Black Box Warning:
WARNING: RISK OF SEROTONIN SYNDROME WITH CONCURRENT USE OF SEROTONERGIC DRUGS

Methylene Blue may cause serious or potentially fatal serotonin syndrome when taken with serotonergic medications.

Serotonin Syndrome Risk:

Mechanism: Methylene Blue can inhibit monoamine oxidase A (MAO-A), an enzyme responsible for breaking down serotonin. In patients taking medications that raise serotonin levels—such as SSRIs, SNRIs, MAOIs, tricyclic antidepressants, and other serotonergic drugs—this interaction can significantly increase the risk of serotonin syndrome.

Symptoms of serotonin syndrome may include:

Agitation, restlessness, or confusion
Rapid heart rate and high blood pressure
Dilated pupils and muscle twitching
Muscle rigidity or loss of coordination
Heavy sweating
Nausea, vomiting, or diarrhea
In severe cases: high fever, seizures, or loss of consciousness

Contraindications:

Methylene Blue should not be used in patients taking serotonergic medications unless in a medically necessary situation where the potential benefit outweighs the risk and proper monitoring is in place.

Special Contraindications:

If medically appropriate, serotonergic drugs should be discontinued at least 2 weeks prior to initiating methylene blue. Close monitoring is essential when use cannot be avoided.

Common Side Effects:

Headache
Nausea or gastrointestinal upset
Blue or green discoloration of urine and bodily fluids (harmless)
Diarrhea
Myoclonus (brief, involuntary muscle jerks)
Seizure-like activity (rare)
Hypokalemia (low potassium)
Hypomagnesemia (low magnesium)
Dry mouth, nasal congestion, or abdominal discomfort

Additional Risks

Hemolytic Anemia: Especially in individuals with G6PD deficiency. This condition must be ruled out prior to treatment.
Lab Interference: Methylene Blue may affect results from certain laboratory or in-vivo monitoring devices. Inform your provider if you are undergoing regular testing.

Contraindications:

Do not use Methylene Blue if you:

Have a known G6PD deficiency
Are currently taking SSRIs, SNRIs, MAOIs, tricyclic antidepressants, or stimulant medications
Have a known allergy to methylene blue or any of its components

Storage

Store at room temperature in a cool, dry place. Protect from light and do not freeze. Methylene Blue may be photosensitizing, so avoid unnecessary exposure to sunlight while taking it.

Note

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Always consult your healthcare provider before starting any new treatment.

Metformin

Overview & Regulatory Disclaimer: Metformin is an FDA-approved prescription medication used to help control blood sugar levels in individuals with type 2 diabetes. It is often prescribed off-label to support metabolic function in patients with insulin resistance or polycystic ovary syndrome (PCOS). Metformin works by decreasing glucose production in the liver, improving insulin sensitivity, and enhancing the body's response to insulin. This medication should be used only under the supervision of a licensed healthcare provider. Always follow your provider’s instructions and use the medication exactly as prescribed.

Who Should Not Use This Medication:

Kidney Impairment: Do not use metformin if you have significantly impaired kidney function. The medication is cleared by the kidneys, and poor kidney function increases the risk of lactic acidosis.
Liver Disease: Use caution if you have liver problems, as this can affect the body’s ability to manage lactic acid and glucose.
Alcohol Use: Avoid excessive alcohol intake while taking metformin. Heavy drinking increases the risk of lactic acidosis, a rare but serious complication.
Heart or Respiratory Conditions: Individuals with unstable heart failure, recent heart attack, or respiratory issues such as hypoxia should use metformin cautiously or avoid it entirely.
Metabolic Acidosis: Do not use metformin if you have metabolic acidosis or diabetic ketoacidosis.
Allergy: Do not take metformin if you are allergic to metformin or any of its components.
Pregnancy and Pediatrics: Use during pregnancy should be discussed with your healthcare provider. Metformin is sometimes prescribed for PCOS-related fertility issues. It is not typically used in children under 10 years old without medical supervision.

Warnings & Precautions:

Lactic Acidosis: Although rare, metformin may cause a serious condition called lactic acidosis, especially in patients with kidney or liver problems. Seek emergency care if you experience unusual fatigue, muscle pain, trouble breathing, stomach pain, nausea, or slow heartbeat.
Kidney Function Monitoring: Your provider may test your kidney function (e.g., eGFR) before starting metformin and periodically during treatment.
Contrast Imaging Procedures: Inform your provider if you are scheduled for imaging with iodinated contrast dye, as metformin may need to be temporarily discontinued before and after the procedure.
Vitamin B12 Deficiency: Long-term use of metformin may lower vitamin B12 levels. Your provider may monitor this through blood work and recommend supplements if needed.
Surgery: Metformin may need to be paused before surgery involving anesthesia. Always inform your care team if you are taking metformin.
Dehydration or Illness: If you are experiencing vomiting, diarrhea, fever, or reduced food and fluid intake, contact your provider before continuing metformin to reduce the risk of dehydration and lactic acidosis.

Common Side Effects:

Nausea
Diarrhea
Gas or bloating
Stomach discomfort
Loss of appetite
Metallic taste in the mouth

These side effects are generally mild and may decrease over time. Taking metformin with food can help reduce stomach-related side effects. If symptoms persist or worsen, contact your healthcare provider.

Serious Risks:

Lactic Acidosis: This is a rare but life-threatening condition. Symptoms include weakness, difficulty breathing, drowsiness, muscle pain, and slow or irregular heartbeat. Stop taking metformin and seek emergency care immediately if you experience these symptoms.
Kidney Impairment: Use of metformin in patients with poor kidney function increases the risk of lactic acidosis. Kidney function should be checked regularly.
Severe Dehydration: Prolonged dehydration (from vomiting, diarrhea, or excessive sweating) can increase the risk of kidney problems and lactic acidosis.
Vitamin B12 Deficiency: Low B12 levels can cause anemia, nerve problems, and fatigue. This is more common with long-term use.
Allergic Reactions: Rare but serious allergic reactions can occur. Symptoms may include rash, itching, swelling, and difficulty breathing. Seek medical help immediately if these occur.

Drug Interactions:

Alcohol: Limit alcohol use while taking metformin, especially binge drinking, as it increases the risk of lactic acidosis.
Iodinated Contrast Media: May need to stop metformin before certain imaging procedures. Always inform your provider beforehand.
Cimetidine: This medication may increase metformin levels in the blood. Your provider may adjust the dose or monitor for side effects.
Diuretics (Water Pills): Can increase the risk of dehydration and kidney issues, which may lead to lactic acidosis.
Corticosteroids, Beta-2 Agonists, and Diuretics: These may raise blood sugar levels and reduce metformin’s effectiveness.
Other Diabetes Medications: If used with insulin or sulfonylureas, there is a risk of low blood sugar (hypoglycemia). Your provider may adjust your dosage accordingly.