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Additionally, patients with inflammatory bowel disease, severe gastroesophageal reflux disease, or other significant gastrointestinal disorders should be monitored closely if treatment is initiated, as the gastrointestinal effects of semaglutide may worsen their underlying condition

27 Its overexpression increases autophagic flux, promotes the formation of autophagosomes even under nutrient-rich conditions, and improves contractile adaptation under stress, partly by modulating Myh7 expression

The oral-contraceptive interaction is a separate study (GPGR), reported in the FDA Mounjaro NDA 215866 summary review: a single 5 mg tirzepatide dose with a combination oral contraceptive (0.035 mg ethinyl estradiol / 0.25 mg norgestimate) reduced the Cmax of norelgestromin and ethinyl estradiol by 55% to 59% a range spanning both analytes, not a separate figure for each with AUC lowered 28.8% (norelgestromin) and 27% (ethinyl estradiol), and tmax delayed 2.5 to 4.5 hours

Biomed Pharmacother 63 (8): 553560