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Important considerations before combining these medications include: Absolute contraindications : The combination should be avoided in patients with cardiovascular disease, uncontrolled hypertension, hyperthyroidism, glaucoma, during or within 14 days of MAOI use, personal/family history of MTC or MEN2, pregnancy, breastfeeding, or severe gastrointestinal disease Cardiovascular risk assessment : Phentermine increases heart rate and blood pressure, which requires careful monitoring with baseline and follow-up measurements of vital signs and possibly EKG if cardiac history exists Gastrointestinal tolerability : Tirzepatide commonly causes nausea, vomiting, and diarrhea, which may be compounded by phentermine's effects Medication interactions : Tirzepatide may reduce the effectiveness of oral contraceptives during initiation and dose escalation

However, despite its mild sweetness, inositol isnt used as a sugar substitute like erythritol or xylitol

Additionally, IGF-1 may indirectly influence brain function and development by regulating nutrient and blood supply, as local IGF-1 production governs brain glucose uptake and metabolism (31)

Hydration and fiber to blunt constipation and nausea

If you have had kidney stones and your doctor can determine the type of stones, they can give you more specific diet recommendations