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[1] [3] Key risk factors for developing hypotension on GLP-1 therapy include: Concurrent use of antihypertensive medications, especially diuretics, ACE inhibitors, or ARBs Concomitant use of SGLT2 inhibitors, which can cause osmotic diuresis and volume depletion Baseline blood pressure in the low-normal range (systolic 90-110 mmHg) Advanced age (65 years and older) Autonomic dysfunction or diabetic neuropathy Rapid or substantial weight loss Inadequate fluid intake or gastrointestinal side effects causing dehydration Concomitant use of other medications that lower blood pressure Patients with type 1 diabetes using off-label GLP-1 therapy or those with longstanding type 2 diabetes and cardiovascular autonomic neuropathy may be at higher risk for orthostatic hypotension

Zhou W, Chen G, Chen D, Ye H, Zeng X

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Trava explicitly uses compounded semaglutide and tirzepatide (each mixed with vitamin B12) rather than branded drugs, and they are clear that these compounded medications are not FDA-approved

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Kapoor I, Sarvepalli SM, DAlessio D, Grewal DS, Hadziahmetovic M