GLP-1 Tirzepatide & B6 40mg (20mg/1mL)

Route: Subcutaneous injection. The higher 20 mg/mL concentration allows delivery of larger doses in a smaller volume. Inject into the abdomen, thigh, or upper arm; rotate sites with each weekly injection. Ensure aseptic technique with each vial access using a new sterile needle.

Dosing is prescriber-determined. This 40 mg vial at 20 mg/mL allows flexible dosing:

• A 0.5 mL draw delivers 10 mg; a 1 mL draw delivers 20 mg — the prescriber specifies the exact volume.
• Higher doses (15–20 mg weekly) are typically reached after a structured titration from lower starting doses over several months.
• All dosing decisions, volumes, and titration schedules are prescribed by and adjusted by the clinician.

• Tirzepatide: Dual co-agonist at GIP and GLP-1 receptors. GIP receptor activation potentiates insulin secretion and modulates adipogenesis; GLP-1 receptor activation enhances glucose-dependent insulin secretion, inhibits glucagon, delays gastric emptying, and activates hypothalamic pathways that reduce food intake and body weight.
• Pyridoxine (B6): Enzymatic cofactor for biosynthesis of serotonin, dopamine, and GABA; may reduce nausea at higher tirzepatide doses by modulating brainstem emetic pathways.

This higher-concentration formulation is intended for patients who have progressed through tirzepatide titration and are at higher maintenance doses (e.g., 15–20 mg weekly), requiring a reduced injection volume. Prescriber-directed for type 2 diabetes management or weight management in appropriate clinical contexts.

Monitoring: HbA1c, fasting glucose, renal function, thyroid screening, pancreatitis assessment, and injection site evaluation. At higher doses, GI side effects may be more pronounced; close monitoring of tolerability is important.

Contraindications:

• Personal or family history of medullary thyroid carcinoma or MEN2.
• Known hypersensitivity to tirzepatide or formulation components.

Warnings & Precautions:

• Thyroid C-cell tumor risk; pancreatitis; hypoglycemia risk with concomitant secretagogues/insulin; acute kidney injury from dehydration; GI motility disorders.
• Higher concentration formulation: careful dose calculation required to prevent dosing errors.

Drug Interactions:

• Delayed gastric emptying may alter oral drug pharmacokinetics; additive hypoglycemia with insulin or sulfonylureas.

Common Side Effects: Nausea, vomiting, diarrhea, constipation, abdominal pain, decreased appetite, injection site reactions. Higher doses associated with greater GI side effect frequency.

Refrigerate at 2°C–8°C. Protect from light. Do not freeze. Use within the beyond-use date assigned by Genesis Compounding. Access with aseptic technique; use a new sterile needle for each draw. Discard unused medication after the beyond-use date.

Why is this formulation at 20 mg/mL rather than 10 mg/mL?

The higher concentration (20 mg/mL) allows higher doses to be delivered in a smaller injection volume, improving patient comfort at advanced titration levels (e.g., 15–20 mg doses).

How many doses are in this vial?

The 40 mg vial at 20 mg/mL contains 2 mL total. Dose volume per injection is prescribed specifically by the clinician (e.g., two 20 mg doses or four 10 mg doses, depending on the prescribed regimen).

Is B6 effective for reducing nausea at higher tirzepatide doses?

Nausea is more common at higher tirzepatide doses. Pyridoxine (B6) supports the synthesis of serotonin and GABA, which modulate emetic pathways. While evidence in GLP-1 therapy specifically is limited, clinical practice supports its inclusion for tolerability.

Is this FDA-approved?

No. This is a patient-specific, prescriber-directed, 503A compounded preparation from Genesis Compounding and is not FDA-approved as a compounded drug.

What monitoring is required while using this medication?

Your prescriber will monitor HbA1c, fasting glucose, kidney function, thyroid history, and signs of pancreatitis. Report any persistent severe abdominal pain, inability to hold fluids, or neck mass to your prescriber immediately.