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Brain sections were incubated with AV-45 radiotracer and attached to the phosphor imaging plates for 24 hours
PMID 22006024
One older study on Byetta (exenatide) showed minimal transfer, but there are no studies on semaglutide, tirzepatide, or liraglutide in breast milk, and no data on infant outcomes when exposed via breast milk
My general framework: Start with semaglutide if cost is a significant concern, or if there is no strong reason to expect poor tolerance Start with tirzepatide if the patient has tried semaglutide before and struggled with side effects, if faster initial response matters clinically, or if the patients goals require larger total weight loss Switch to tirzepatide if a patient on semaglutide is experiencing persistent nausea or has plateaued and escalation options are limited One pattern worth noting: men I see a consistent pattern with male patients who struggle to tolerate semaglutide nausea and GI disruption can be particularly disruptive for them, and theyre often less willing to push through it
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