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Enzymatic degradation by proteases is a significant concern, so chemical modifications to the peptide can improve stability and resistance to enzymes like DPP4

Nausea was reported in 42.4% of patients on the 12 mg dose, with diarrhoea and constipation affecting 32% and 26.1% respectively

When the food is swallowed, a substance in saliva called R-protein a protein that protects B12 from being destroyed by stomach acid travels to the stomach along with the food

It states tirzepatide can carry a higher risk of gastrointestinal side effects than semaglutide at equivalent levels, attributing this to the dual-pathway activation

Journal of Women's Health (2002), 28 (6), 769777

122: 5618 Gaster B, Hirsch I